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Gynecomastia is a very important part of our practice that I enjoy doing. Gyneco means woman-like, and mastia means breast or chest. So it’s a woman-like breast. On a man that means not just necessarily obesity but also the glandular tissue that comes along with it which is the hard fibrous area that you can actually feel under the nipple and the aerola. We see many young men who get it with the onset of puberty, and then we see many men in their 20s, 30s, and 40s who have no antecedent cause for this.

Gynecomastia surgery traditionally has not been a very satisfying operation for either the surgeon or the patient. The reason why is 99% of surgeons are still doing the same technique that’s been done for the last 80 years. They put the patient to sleep. They make a 3:00 to 9:00 incision around the aerola. They start cutting out the tissue under direct vision. Then it starts bleeding. They can’t see very well. They may get a contour problem or a depression, and then ultimately they put drainage tubes from the side to drain out the fluid.

So about nine years ago I came up with a new idea, no scar at all on the chest, no drainage tube. We’re able to remove the two components of gynecomastia, the fatty tissue and the glandular tissue through an incision this long under each arm. And there are two instruments that allow us to do it, the use of ultrasonic liposuction and we have a multi-jointed cutting device where we’re able to cut out the rest of the glandular tissue with an instrument that goes through this incision all the way down to the nipple.

After we’ve cut all that out and it’s perfectly flat, the last thing we do before closing the incisions is to re-inject the entire field with a long acting anesthetic. So when the patient gets up, we’ve already got the compression garment on, they are pain free. They’re typically only in the recovery room 45 minutes to an hour, and that stays numb until the next day.

They wear the compressive garment under their street clothes for three weeks, and they’re done. We see them at eight to 10 days post-op. We see them six weeks after that, three months after that, and they’re delighted.