Male Breast Liposuction Today: Hypertumescent Power Liposculpting—A 700-Case Retrospective Study

Abstract

Introduction: Many men (∼36–40%) have some form of breast enlargement or swelling, called gynecomastia. The condition may make these men self-conscious about the feminine appearance of their chests in public. Classic removal, with direct excision of the glandular tissue and fat, has been the treatment for gynecomastia in the past. The purpose of this retrospective surgical review and discussion is to compare various treatment modalities for gynecomastia that have been used in our practice over time, and then to present a protocol for the procedure that is the most successful in terms of highest patient satisfaction and lowest revision rate. Materials and Methods: A retrospective surgical review of 700 gynecomastia liposuction treatment regimes, including open and closed techniques employing liposuction with manual, ultrasonic, power, and rotary cannulas is presented. Results: Comparisons of various treatment modalities used by the authors in over 700 cases demonstrate the advantage of hypertumescent infiltration of the dense tissue of the male breast before liposculpture. The aesthetic result is more satisfactory for several reasons: (1) scarring is minimal, (2) neurovascular damage to the delicate areola or surrounding tissue is avoided, (3) the surgeon is allowed to sculpt the tissue rather than just remove it, and (4) a more “normal” looking chest without the periareolar scar is created. Discussion: Many men with gynecomastia need diet, exercise, and counseling. We have found that many of these men have high levels of free estrogen accompanied by total testosterone under 300 ng/dL. This endocrine pathological scenario is exacerbated by obesity. If the patients continue to be overweight after treatment, their upper torsos will gradually become feminized again. Thus, our patients are encouraged to follow a high-protein and low-fat diet with caloric restriction and to vigorously exercise so that their results will last. Conclusions: Surgical treatment can successfully treat gynecomastia in male patients and leave very little scarring. Postoperative diet and exercise will also dramatically improve patients' appearance and self-esteem.