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Michael Law MD Aesthetic Plastic Surgery

Gynecomastia in Men Surgery FAQ

Gynecomastia Specialist for Cosmetic Plastic Surgery in Raleigh, NC Serving Patients from RTP, Durham, Chapel Hill, Alexandria, Fayetteville, Atlanta, Greensboro and the whole East Coast.

Gynecomastia surgery removes excessive breast tissue from behind the nipple that can be removed with a small incision. Dr. Michael Law has been performing gynecomastia correction surgery for over two decades. Gynecomastia correction surgery is a life-changing procedure adding confidence for years to come.

Frequently Asked Questions for Gynecomastia Surgery

Dr. Law, I am considering gynecomastia surgery at your location in Raleigh. Will I have a drain?

Drains are absolutely unnecessary for most routine gynecomastia surgeries. The most commonly performed surgeries are excision of pure glandular gynecomastia, which is a concentration of breast tissue only behind the nipple-areola complex, and treatment of mixed gynecomastia which generally involves both liposuction and direct excision of the fibrous breast tissue. The surgical technique I developed, combined with the use of a low-profile compression dressing for one week post-op, means that drains aren’t necessary for these procedures.

For patients with significant chest area skin laxity who require removal of excess skin, an operation sometimes referred to as simple mastectomy, I do place drains for those surgeries and they tend to remain in place for one week post-op.

Is men’s gynecomastia surgery a simple procedure?

I think that to some surgeons it appears simple abstractly. However, if the goal is to create a masculine chest appearance in which the patient never appears to have had gynecomastia, and in addition to that does not appear as if they have ever had a surgery either, then it requires a great deal of finesse and experience to produce that kind of result. Patients come to see me because they are too self-conscious to remove their shirt in public and sometimes in private as well. I take that aspect of my patient’s motivation for surgery very seriously, and it is important that patients not be left with a contour deformity, skin irregularity, or obvious scar which leaves them persistently self-conscious about their chest appearance. My goal is for my patients to beable to remove their shirts in public and private feeling confident about their masculine chest appearance.

Can you describe what the compression dressing is, and will I need to change it myself after my gynecomastia surgery?

The compression dressing consists of folded 4×4 gauze pads held in place with a clear plastic Tegaderm dressing. This dressing is low profile and is not really visible under any shirt aside from a form fitting T-shirt. The dressing is held in place with a topical adhesive so patients can shower the night of surgery and the drain will remain in place. The dressing does not have to be changed by the patient. It is removed by the surgeon or a nurse practitioner at the one-week post-op appointment and does not have to be reapplied.

After my gynecomastia surgery, will I be wearing a compression vest?

We do provide our patients with a gynecomastia post operative compression garment. It is a form fitting, Lycra-containing, tank top-style garment that can be worn under any clothing. I ask patients to wear it almost around the clock for two weeks, and then for half the day, either daytime or nighttime, for another two weeks. It is a comfortable garment and patients are very compliant with its use, often feeling comfortable wearing it for longer than the recommended period of time.

Is there a difference between a binder and a compression garment, and will I be wearing both of those after surgery?

A binder is an elastic wrap-type garment that is held in place with a Velcro closure. It is not necessary for gynecomastia surgery. However, I will often have patients use a Velcro abdominal binder over their compression shirt if I am performing liposuction of the abdomen and/or flanks at the same time as the gynecomastia correction surgery.

Will you remove 100 percent of the gland causing gynecomastia puffy nipples?

I tell patients that I will be removing 98 to 99 percent of their fibrous breast tissue. Essentially, the entire gland is removed. However, it is important to leave a very thin “cuff” of breast tissue on the posterior surface of the nipple-areola complex, so that the patient does not develop what is sometimes referred to as a “crater deformity” post-op. This is not enough tissue to permit regeneration of the gland; however, it is enough to help maintain the shape of the nipple-areola complex so it looks flat and aesthetically ideal.

Do you use specialized sutures for gynecomastia surgery to help prevent “crater deformity”?

Prevention of crater deformity requires finesse and experience during removal of the gland. It is important to preserve not only a very thin cuff of breast tissue on the posterior surface of the nipple-areola complex, but also a modest amount of subcutaneous fatty tissue immediately behind the nipple-areola complex to support that structure postoperatively. If the nipple-areola complex becomes adherent to the pectoralis major muscle fascia, then a crater deformity may develop and the nipple-areola complex may even animate (and by that, I mean move visibly) when the pectoralis major muscle contracts. In many patients, I will create pedicle grafts and free grafts of fatty tissue to suture in place behind the nipple-areola complex to ensure that it is well-supported postoperatively and that an indentation or “crater deformity” does not develop.

I have seen in some immediately post-op before and after gynecomastia photos areolas that seem to fold over. Is that part of the normal healing process, or does that mean that too much tissue was removed?

That is an excellent observation, and it is something that I have treated numerous times for patients who have come to see me for correction of post-surgical deformities. The skin of the nipple-areola complex generally has a much thinner dermis compared to the surrounding chest skin. The surrounding chest skin often has a fairly robust capacity to shrink following removal of excess fat and breast tissue, and thereby assume a very favorable contour. Because the nipple-areola complex dermis is much thinner, once the distending breast tissue is removed it may tend to appear flaccid and even fold on itself horizontally. This is another finesse aspect of men’s gynecomastia surgery. In most patients, I perform a crescentic excision of either nipple-areola complex skin or the surrounding chest skin so that when the superior and inferior areolar border incisions are closed, the nipple-areola complex is taut and lays flat and appears aesthetically ideal postoperatively.

View Photos of Gynecomastia Scars.

In some patients the nipple-areola complex does not fold horizontally, but over time ends up looking flattened vertically with an exaggerated, horizontally oval shape. This can be corrected by performing the procedure I just described, which removes adjacent skin immediately above and below the nipple-areola complex thereby increasing the vertical diameter of that structure. The scars from the skin excision tend to be minimally noticeable to invisible within a few weeks of surgery.

Do all men have glands behind their nipples?

Yes, all men have fibrous breast tissue behind the nipple whether it is outwardly visible or not.

Why do some glands become large and others don’t?

While there are some known factors that can trigger the development of gynecomastia, including hormonal issues, some prescription medications, the use of anabolic steroids and similar agents, etc., most cases of gynecomastia are considered “idiopathic” which means we don’t really know why it happened. Clearly, gynecomastia has become endemic in industrialized nations, and therefore there must be some substances that are pro-estrogenic which are stimulating the development of gynecomastia. This may be a variety of industrial chemicals that are now ubiquitous in commercial products, it may be antibiotics and hormones used in the meat, dairy, and poultry industries currently, or other factors that have not yet been identified. Interestingly, I have seen many patients who have unilateral gynecomastia with a profound and obvious development of breast tissue on one side while having a completely normal appearance on the other. We currently don’t have an understanding or explanation why a patient would have that response on one side and no similar response on the other.

View all Gynecomastia Videos Here.

If I have successful gynecomastia surgery, is there anything that could make the gland grow back (for instance, if I were to use steroids)?

The procedure that I perform removes almost all of a patient’s fibrous breast tissue, except for a thin rim of breast tissue left on the posterior surface of the nipple-areola complex to help support it and maintain an ideal contour postoperatively. This is not enough tissue to regenerate the full breast gland. However, if a patient was exposed to a pro estrogenic agent postoperatively, it is certainly possible that a modest amount of fibrous breast tissue could regenerate. This would not produce a feminized breast appearance, but it may create a slightly “puffy” nipple appearance over time. That situation can be easily corrected by means of a fairly minor procedure under local anesthesia, in which the modest regrowth of tissue is reduced to make the nipple-areola complex appear flat again.

What kind of gynecomastia liposuction do you use, or does that even matter?

It matters a lot, and over the last 20 years there has been an explosion in liposuction technologies with new means of treatment becoming available including laser liposuction and ultrasonic liposuction. Interestingly, in my opinion, the most significant advance in liposuction technique over the last ten years has not been so much technology related as technique related. I am a huge proponent of power-assisted liposuction using what is often referred to as the SAFE lipo technique. This employs a power-assisted liposuction system which serves to piston the end of the cannula a few millimeters several hundred cycles per minute. This enhances the efficiency of fat mobilization and removal, and allows the surgeon to perform thesurgery using less force while focusing on a more sculptural liposuction technique. Flared liposuction cannulas, which are fairly aggressive, are used to mobilize fat and to separate fat from breast tissue. No suctioning is performed while the flared cannulas are in use. Once the fat is fully mobilized, a non flared cannula of a fairly small diameter is used to remove excess fat. Once the excess fat has been removed, the flared liposuction cannulas are used, once again with the aspirator turned off, to equalize the subcutaneous fat distribution to ensure that the contours created are perfectly smooth. This technique essentially performs a form of internal fat grafting, in which fat is moved around subcutaneously to create the smoothest possible and most aesthetically ideal chest contour. Additionally, the flared cannulas are used to mobilize fat well beyond the area where the gynecomastia issue is present. This generates a contraction phenomenon in the entire skin envelope of the chest, which also helps to create the best possible chest contour.

What should a patient look for if they want a gynecomastia specialist as their surgeon?

The first thing you should look for is a surgeon who clearly has significant experience with men’s men’s gynecomastia surgery, as evidenced by numerous, aesthetically appealing “before and after” images on their website. It is important that the photographs are taken from a perspective that allows you to zoom in and see the area where the surgical scars are present, to confirm that the scarring is minimal and not likely to be noticeable by a casual observer. Additionally, when you contact a surgeon’s office, ask the staff what that surgeon’s favorite procedures are to perform. If gynecomastia isn’t in the top three, and especially if it isn’t mentioned at all, that surgeon probably does not have a particular interest in the procedure and may not be performing it on a regular basis. Also, look for a surgeon who does a high volume of post-gynecomastia surgery contour correction, more specifically a gynecomastia specialist. Any surgeon who has experience in treating chest contour deformities created by other surgeons clearly has an understanding of how to produce an excellent gynecomastia surgery outcome themselves, with smooth and aesthetically ideal chest contour and minimally noticeable to functionally invisible surgical scars.

Read why so many patients choose Dr. Michael Law for Gynecomastia Correction Surgery here.

What are the most common reasons that a man might require gynecomastia revision surgery?

The most common issue that I see is a major contour deformity. These can arise from both over-removal and under-removal of fat by means of liposuction, and from under-removal or too aggressive removal of fibrous breast tissue by direct excision. I have seen many patients with areolar deformity from both unfavorable scars and from tethering to underlying tissue followingan overly aggressive surgery. I have also seen quite a number of patients with animation deformity where contraction of the pectoralis major muscle creates odd and sometimes even bizarre chest contour due to over-resection of tissue and significant subcutaneous scarring following an ill-advised surgery.

Treatment of these deformities is an order of magnitude more challenging than a primary gynecomastia surgery. In some patients, more than one procedure is required to produce a chest contour that is more favorable or at least acceptable to the patient. It is absolutely critical that you do your homework and find a competent and experienced gynecomastia surgeon who has a large number of “before and after” photographs of gynecomastia patients which can provide you with confidence in that surgeon’s capabilities. With gynecomastia surgery it is so critically important to get it right the first time.

So I have puffy nipples, but when it’s cold or my nipples are erect, it goes away. Do I have gynecomastia?

I see many patients for gynecomastia surgery who tell me that when a room is cool that their gynecomastia almost completely goes away or may not even be apparent at all. However, when room temperature or outdoor temperature rises, the involuntary muscle around the nipple-areola complex relaxes, the peri-areolar and surrounding chest skin relaxes, and the gynecomastia problem again becomes apparent.

This is quite relevant to preoperative patient assessment as well as preoperative and postoperative patient photography. When I evaluate a gynecomastia patient in consultation, we will often warm the room to 73 to 74 degrees so that the patient’s gynecomastia issue is easily apparent. At a room temperature of 68 to 70 degrees, some patients’ gynecomastia may not be detectable, particularly with pure glandular gynecomastia. Make sure that the surgeon you are seeing is evaluating you in a warm examination room, and is photographing you preoperatively and postoperatively in that same kind of environment. This will be a routine procedure for an experienced gynecomastia surgeon.

Can gynecomastia be performed under local anesthesia?

Absolutely; however, treatment under local anesthesia is generally limited to patients with mild to moderate cases of pure glandular gynecomastia. Patients with extensive pure glandular gynecomastia in which the gland is large enough to create a feminized breast appearance are best treated under general anesthesia as the dissection is fairly extensive and would be difficult to tolerate under local anesthesia only.For patients with mixed gynecomastia, I treat all of these patients under general anesthesia as the thorough liposuction and fat equalization procedure using the power-assisted liposuction device is not well-tolerated under oral or IV sedation only.

How soon can I go back to work after surgery for gynecomastia?

Patients who work in an office environment may return to work a day or two post op. We are very proactive and preemptive about pain control, and most of my patients report that their pain is a 0 to 1 on a 10-scale in the post-anesthesia care unit. We administer long-acting local anesthetic both at the beginning and at the end of the surgery, so patients are generally smiling when they leave our Surgery Center. Patients have some additional mild discomfort as the local anesthesia wears off. However, in most cases it is not enough to require narcotic pain medication.

Given this level of postoperative comfort, patients with an office-type work environment will often be back at work within two to three days of surgery. Our patients with more physically demanding jobs generally take two weeks off from their work activities. Patients are allowed unlimited walking at a casual pace for the first two weeks postop, but are not allowed to actively exercise. Increasing levels of aerobic exercise are permitted in weeks three and four, and increasing levels of isometric exercise in weeks five and six. So patients are essentially back to full-effort physical activity at the end of six weeks.

What is pseudo-gynecomastia?

Pseudo-gynecomastia refers to male breast enlargement that is due to proliferation of fat rather than proliferation of breast tissue. It is typically seen in overweight to obese males. Interestingly, many patients who are thought to have “pseudo-gynecomastia” often have some breast tissue that is apparent once the fatty tissue is reduced by liposuction. One only knows for certain what is creating the unfavorable breast profile until the day of surgery. So some patients who are thought to have pseudo-gynecomastia actually end up having some breast tissue that needs to be removed to produce an aesthetically ideal chest contour postoperatively.

Gynecomastia in Puberty. Can teenagers have gynecomastia surgery?

Absolutely. While parents often hear from pediatricians that their male child’s gynecomastia may “gradually go away,” that actually rarely happens. Gynecomastia unfortunately is a problem where once a patient develops it, they are essentially stuck with it until it is corrected surgically.

I have treated a large number of teens for gynecomastia, and their very supportive parents have repeatedly expressed to me how utterly life changing the improvement has been for them.

I am traveling from out-of-town for gynecomastia surgery. Do you offer virtual consultations?

Yes. We do offer virtual consultations for patients that are traveling to Raleigh. Most patients communicate this to their Patient Care Coordinator, so that they can help with booking hotels, and providing the best information to our patients for a comfortable stay and recovery. Dr. Law does like to examine patients one day prior to surgery and one day after, for their first post operative appointment. Most patients are free to go home after that post operative appointment. For future follow up appointments, we are able to schedule virtual appointments and obtain photos to track your progress. We have been performing surgical procedures for patients from all over the world for many years and all patients receive the same standard of care whether they are traveling or live in The Research Triangle Park area. For patients who wish to travel for their post operative appointments they are welcome to do so as well.

How much does gynecomastia surgery cost?

The price of gynecomastia surgery will vary significantly from patient to patient and from surgeon to surgeon. The most expensive gynecomastia surgeon is not necessarily the best, but the least expensive surgeon is likely cutting corners in some way. The most expensive gynecomastia surgery is revision surgery. Selecting the right surgeon the first time around will mean a revision surgery is less likely to be needed. Be sure that prices for gynecomastia surgery are presented as all-inclusive. Gynecomastia surgery prices should include cost for anesthesia, facility fees, surgeon fees and all pre-op and post-op visits. In my practice, appointments are scheduled in advance of surgery for a full year. There is never any additional cost for additional visits if a patient has a question or concern after surgery.

Is Gynecomastia Surgery Painful?

Most patients tell me that the recovery from gynecomastia surgery is very tolerable without much pain. I work hard to be sure that all patients are comfortable during their recovery period. Many men describe the feeling after surgery as being similar to an intense workout. I do not routinely prescribe narcotics for gynecomastia patients and my patients do not need them.

How bad is scarring after gynecomastia surgery?

Often there are no visible scars after surgery. If you look at my photo gallery, you will see that I have a feature that allows you to zoom in closely. I want prospective patients to see dozens of examples of what scars will look like. The incisions are made in such a way that they are typically barely perceptible. The incisions are made on the border of the areola. Class I, Class II gyno patients will not have incisions on the chest wall. In patients with Class III gynecomastia, I can often provide a desired result using incision around the areolas only. The quality of the skin, based on the age of my patient will determine whether or not incisions on the chest wall are needed. In Class III and sometimes even Class IV cases of gynecomastia, a staged procedure can allow me to avoid incisions on the chest wall. After a single procedure, I will remove the gland and some unwanted fat, but not all. This will make the skin contract. A second procedure can be performed a few months later to eliminate all unwanted fat. Some men with class IV just want it all gone in one surgery, and are less concerned about an incision on the chest wall. In those men, I take every measure possible to create a scar that is fine, thin, and not noticeable. Following surgery we do offer laser services and scar creams to help accelerate healing. But really, scarring has to do with surgical technique and the unique anatomy of each patient.

How soon can I workout after gynecomastia surgery?

Most of my patients are very fit and gynecomastia patients often want to get back in the surgery right away. In our fully integrated medical spa, we offer Emsculpt, so that my gynecomastia patients can safely build muscle and also get the benefit of some endorphins. Emsculpt can never be used on the chest. The arms cannot be treated with Emsculpt early in the healing phase. But, thighs, calves and abs can be treated with Emsculpt before patients can get back into their fitness routine.

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