It's Time

2015 06-07

Before and After Pictures of Gynecomastia Patient’s Show a Surgeon’s Skill

Gynecomastia before and after photos |San Jose, CA

gynecomastia B&A
San Jose, California: This is a 21-year-old male who presents with gynecomastia to the San Francisco, California office and presents for gland excision and suction assisted lipectomy as well as a superior areola crescent lift due to the laxity of his skin. His gynecomastia surgical treatment was performed in Marin County California at Marin Cosmetic Surgery Center in Novato, California. His post op photographs are seen approximately 3 months after surgery.

San Jose, California-Most surgeons take before and after pictures of their patients. Board Certified Plastic Surgeons receive special training in photography due to the importance of this documentation which assists them in surgical planning. Beyond surgical planning, the photographs are a useful tool for surgeons to show prospective patients the quality of their work. Many patients appreciate being able to see their before pictures to compare them to their surgical result.

For a man with gynecomastia, also known as man boobs, searching for a gynecomastia specialist can be daunting. There are many aspects for the man to consider. First, he needs to be sure the surgeon is Board Certified in Plastic Surgery. Second check out where the surgery is to be performed, hospital or surgical center and find out if it is accredited. If it is an accredited surgery center, he should ask for a tour and note if it is organized and clean.

A Gynecomastia Surgeon Photos are worth a thousand words.

During the consultation, the gynecomastia patient needs to ask lots of questions. Find out how many male breast reduction surgeries are performed per year. Ask the surgeon what method of surgery he or she plans. Unless the man has “pseudo-gynecomastia” (only fat and no excess breast tissue), the combination of liposuction and surgical excision is necessary. Liposuction alone will leave breast tissue behind, necessitating a secondary surgery to remove the breast tissue. In order to remember all your questions, it is advised to bring a list. Dr. Delgado encourages men to call or email with questions at any time.

Possibly one of the most important aspects to help a man determine the expertise of the gynecomastia surgeon is in the viewing of the surgeons before and after surgery pictures of actual patients. It is important to note that patients pictures that are posted on Dr. Delgado’s website or shown in albums at the time of consultation have all given their written consent. Patient’s privacy is highly respected, and those who are willing to share their photos with prospective patients are greatly appreciated, but definitely not required.

photographerIn viewing the before and after pictures, there are a few things to note that will help determine the accuracy of what you are looking at. There should be different angles taken of each patient; front view, oblique and side view. Almost anything can be made to look good from just one angle. The background should be consistent, a blank wall or a black drape works well. The person needs to be placed in the frame in the same position, with arms down at their sides, or in the same position, for both before and after surgery. In addition, color saturation and lighting needs to be the same or as close as possible, for easier comparison.

Bearing all these things in mind, it is understandable how difficult it can be for a man to choose the best top plastic cosmetic gynecomastia surgeon he can find. The effort will be well worth it, to be able to avoid revision surgery. The single most common cause for the need of a secondary surgery is where the initial surgeon mistakenly thinks that liposuction alone will remove the male breasts of a man with “true gynecomastia”. As mentioned earlier, liposuction will work for the man that has “pseudo-gynecomastia” which is caused by fat alone.

Dr. Delgado is pleased to offer men who have “pseudo-gynecomastia” an alternative to liposuction surgery, and that is CoolSculpting. CoolSculpting is a non-invasive treatment that reduces fat over a 2 to 4 month period. Fat cells are intensely chilled, at little to no discomfort for the patient, causing the fat cells to die and to be shed by the body. Patients love this new treatment for removal of fat from the male chest, abdomen and love handles. Since it is not a surgical treatment, there are no scalpels, incisions, sutures, or scars, allowing patients to return to their normal activities with no downtime. Men who are candidates for CoolSculpting will find that their gynecomastia costs are greatly reduced.

Men who suffer with moobs or male breasts are invited to schedule a consultation with Dr. Delgado to determine what surgical or non-surgical options are available to them by calling (415) 898-4161 or sending an email.

2013 12-01

CoolSculpting Treats Pseudo-Gynecomastia

Pseudo-Gynecomastia can be treated with CoolSculpting

San Jose, California-True gynecomastia is man boobs that are caused by excess breast tissue and excess fat. 60% of men will have some form of gynecomastia at some point in their life. Men with moobs may have what is termed pseudo-gynecomastia, which is not caused by breast tissue, but fat alone. Usually this is due to weight gain or aging.

CoolSculpting Machine
CoolSculpting Treatment Available for San Jose Patients

Pseudo-gynecomastia is treated differently than true gynecomastia since breast tissue is not involved, liposuction alone can reduce the male chest. Unfortunately, many surgeons treat true gynecomastia as if it were pseudo-gynecomastia with very disappointing results. What happens is the fat is removed leaving behind the breast tissue that is too dense to go through the cannula of the liposuction machine. Without the fat to “pad” the breast tissue, it becomes more pronounced than before. Dr. Delgado’s gynecomastia practice is now at 40% of “redo” surgeries of this type. Besides the additional cost of gynecomastia surgery “redo”, a man will have to take time out of his schedule for surgery and recovery again. In addition, “redo” surgery is more difficult than the first time as now there is scar tissue for the surgeon to deal with and the skin will have lost some of its elasticity. It is highly advised for a man to do his research prior to surgery to find a Board Certified Plastic Surgeon that specializes in gynecomastia surgery.

As previously mentioned, for the man that has only pseudo-gynecomastia, liposuction has proven to be a great technique for a less invasive surgical procedure. In Dr. Delgado’s quest to stay on top of all the latest innovations in the treatment of his patients, he is pleased to announce that he now has CoolSculpting available for his patients. CoolSculpting can be an ideal treatment for the man with pseudo-gynecomastia.

CoolSculpting is a non-invasive procedure that uses a cooling device that kills fat cells, which are then naturally eliminated from the body.

This procedure can be used on the male chest to get rid of unwanted fat without surgery, allowing the man to return to normal activities without any downtime. Patients are pleased that there are not any resulting scars, scalpels or needles. The patient arrives in comfortable clothing, and most will read a book, work on a laptop or take a nap during their treatment. The area to be treated is placed between two cooling plates which patients claim is not painful, but they feel pressure and coldness from the plates. The treatment usually lasts about an hour.

As the body sheds the fat cells that have been destroyed, clothes will begin to feel loose. The results are not immediate, but noticeable results will start to become evident after 2 to 3 weeks and continue for up to 2 to 4 months. Most patients get the desired result after one treatment, but it is possible to have an area treated again if more fat removal is desired. The only risks associated with CoolSculpting have been some temporary bruising, redness or numbness. CoolSculpting is not to be considered fat reduction for large amounts of fat, but more for sculpting the areas of the body that has stubborn pockets of fat, such as; the love handles, the abdomen and chest of a man that has pseudo-gynecomastia. For larger amounts of fat removal, liposuction remains the best treatment.

CoolSculpting is an exciting treatment for patients that previously wanted to avoid surgery due to; the cost, fear of surgery, or the time taken out of busy schedules. If you have areas of stubborn body fat that you would like to melt away, schedule a consultation with Dr. Delgado to find out what your options are.

As always, Dr. Delgado has the most innovative procedures available to his patients, in addition to CoolSculpting, Ultherapy is a non-surgical treatment to tighten the skin of the neck and face.  Call Today 415-898-4161 or email.

2013 10-21

Gynecomastia and Breast Cancer

Breast Cancer and Gynecomastia


San Jose, CA-Breast cancer is less common in men (1 in 1,000) than women (1 in 8) because men have lower levels of female hormones and less breast tissue. Men with gynecomastia, also known as moob’s have more breast tissue than normal, and many feel a button or disk like growth under the areola. This can be benign, or a possible cancerous tumor, and they need to have their breasts checked by the best top plastic cosmetic surgeon.

There can be many causes for the male breast to develop as discussed in the blog dated May 15, 2013. In many cases, the cause remains unknown. Even though the incidence of breast cancer in men remains low, at 1% of all breasts cancers, it needs to be ruled out.

Breast cancer in adolescent boys is extremely low; it is more likely found in men over 60 years of age.

There are several risk factors related to breast cancer for men. Men at risk might not develop breast cancer and others who have no apparent risk may, there is no way to prove the actual cause.

It is wise to be informed of possible risks so that one can take measures to protect themselves. Some of the risks are; obesity, fat cells in men converts the male hormones into female hormones, this means the estrogen level is higher in the obese male body.

Some men with prostate cancer have been treated with estrogen related drugs, it is believed this treatment many increase the risk of breast cancer.

Heavy alcohol consumption affects the liver, and the liver carries hormones in the blood, the man with cirrhosis of the liver will have estrogen levels and lower levels of androgen resulting in a higher rate of developing man boobs and a higher risk of developing breast cancer.

Before and After gynecomastia surgery
This 29-year-old San Francisco Bay Area man is 6’4” and 275 lbs. He has never been able to expose his chest without feeling uncomfortable. He underwent glandular excision and suction-assisted lipectomy of the chest and axillae.

There are many more factors that can influence the threat of breast cancer in men; some occupations such as working in a hot climate may affect hormone levels, radiation exposure, and family history of breast cancer, aging, inherited gene mutations, and congenital conditions such as Klinefelter’s Syndrome.

The main thing men can do to protect themselves is maintain a healthy body weight through a wholesome diet and regular exercise, and limiting alcohol consumption.

Early detection can be lifesaving, although men are notorious for being negligent in seeking medical advice even when they may present with symptoms. Some symptoms to watch for are; skin changing around the areola or puckering or dimpling, bloody or opaque discharge from the nipple, a firm non-painful mass below the nipple. Usually it is the woman in a man’s life that is responsible for the man seeking an evaluation. It is routine that breast tissue samples are sent to pathology for all breast reduction surgeries to rule out breast cancer. The cost for pathology many times is covered with insurance, but even if it is not, it is a small price to pay for peace of mind.

Breast Cancer in men are rare.

Dr. Delgado in all his years of performing breast reduction treatment on men and women has only had two women that he had to inform that breast cancer was found through the pathology test and as unfortunate as this is for those women; he may have saved their lives through the discovery. So far, there have not been any reported cases of discovery of breast cancer in any of his male patients that have undergone male breast reduction surgery.

Patients who are contemplating gynecomastia surgery are invited to call for a consultation with Dr. Delgado who is a gynecomastia specialist. Newly added to the office is “CoolSculpting”, a non-invasive fat reduction treatment for the love handles and abdomen that has proved to be a very popular treatment for men and women alike.

2013 09-25

Gynecomastia Costs Reduced for Out Of Town Patient’s With Free Travel Package

San Francisco
San Francisco

San Jose,CA-There are many gynecomastia surgery cases reported that have very disappointing results, just check out the forums on to see multiple posts by men that wish they had researched further before picking their surgeon to treat their man boobs also known as moobs. Many plastic surgeons will offer to do male breast reduction surgery, but you need to know if they specialize in it and are they Board Certified in Plastic Surgery? Do they show you numerous before and after pictures of their patients? Do they go into detail of how they would perform the procedure specifically for you? If you have true gynecomastia and your surgeon talks about removing your male breasts by liposuction alone, get another opinion. The male breast is made up of fat and breast tissue, liposuction will only remove the fat.

Finding the right surgeon the first time is of great importance so that there does not need to be a “second” time. Dr. Delgado’s gynecomastia surgeries at this time are at about 40% for redo surgeries for patients that had their original surgery done elsewhere. The biggest reason for a secondary surgery is when the original surgeon has tried to remove the male breast with liposuction alone, leaving the breast tissue behind. Another reason for a secondary surgery is when the original surgeon has removed too much fat, and tissue, leaving behind what is called a crater deformity, it can be fixed but needs the expert skills of  the best top plastic cosmetic surgeon who is also a gynecomastia specialist.

See the blog dated December 1, 2012 on how to find the best gynecomastia specialist. Due to the fact that there is not an abundance of gynecomastia specialists, many men travel great distances in order to have the surgery done correctly. Dr. Delgado realizes that this is a great expense for men, and therefore, offers a free travel package to the San Francisco Bay Area for his services. Many men opt to have additional cosmetic surgery such as liposuction or “CoolSculpting” for additional body contouring at the same time as their gynecomastia surgery, to save money and time. If this is of interest, Dr. Delgado would be happy to discuss the options during your consultation.

Men can have a virtual consultation with Dr. Delgado via Skype or over the phone. If the patient emails or mails photos, Dr. Delgado is able to give a personal evaluation followed by a written surgical quote outlining the costs of gynecomastia surgery. This way the patient is able to make one trip having the pre-operative appointment a day or two before the scheduled surgery.

Novato Oaks Inn
Novato Oaks Inn

The travel package offers:  4 Days at Novato Oaks Inn, travel vouchers round trip for San Francisco International Airport to Novato. The hotel offers spacious guest rooms, complimentary continental breakfast and room service, free shuttle to local shops, restaurants and theaters, free wireless internet access, special wedge pillows for support.

A complimentary shuttle will take you to Dr. Delgado’s; 165 Rowland Way, Suite 300 Novato, California office or 415 Sutter Street, Suite 2433 San Francisco, California office as needed during your stay.  In-Room Post-Operative Visit by Dr. Delgado is also included.

Wine Country
Wine Country

Novato is only 30 minutes away from San Francisco or in the other direction 30 minutes to the wine country of Sonoma and Napa. Many men come several days early bringing a family member or a friend to make a mini-vacation out of their stay, enjoying the many sites that the city of San Francisco has to offer and also many include a visit to the nearby wine country. For more details on what the San Francisco Bay Area has to offer click here.

Due to the high demand by out of town patients for gynecomastia treatment, Dr. Delgado finds that his travel package makes having surgery away from home much more affordable for most men. The surgery takes place at Dr. Delgado’s own private facility, “The Gynecomastia Surgery Center of Excellence” giving his male breast reduction patients the utmost in concierge care. For a complimentary consultation by Skype or phone call the office at (415) 898-4161.

2013 09-02

Emotional Consequences Gynecomastia Can Have on Men

Before and After Gynecomastia
24-year-old resident of San Jose, California who presents for evaluation of his gynecomastia. His male breast enlargement has been present for ten years. He does have pain and tenderness in the chest area. He underwent gland excision and chest liposuction. He had 200 cc of fat aspirated from each side. His surgery was performed at Marin Cosmetic Surgery Center in Marin County, California. His photographs were taken 2 ½ months after surgery.

San Jose, CA-Gynecomastia or male breasts can appear at different stages in a man’s life. For many the onset is at puberty, but 90% of those will resolve on their own with no action needed as a young man passes through puberty. For the remaining 10% the development of breasts will carry on into adulthood becoming a permanent condition, requiring men who are looking for male breast reduction treatment to seek out the best top plastic cosmetic surgeon who specializes in gynecomastia surgery.

For some young adult men that did not have moobs develop during puberty may find them starting to develop if they are taking steroids, smoking pot, or taking some prescription drugs. It is believed that use of lavender oil and tea tree oil in shampoos, soaps or lotions may cause the male breast to grow.

Hormone changes are part of the natural aging process as men age, their estradiol levels gradually rise and progesterone and testosterone levels gradually fall giving way to estrogen dominance. Usually this occurs between the ages of 50 and 80 resulting in 1 in 4 men developing gynecomastia and more so in men who are also gaining weight.

Sometimes medications and/or health conditions can cause the imbalance such as; medication for ulcers, heart conditions, benign prostate problems and prostate cancer. Gynecomastia can also be the result of testicular tumors, pituitary gland disorders, and cirrhosis of the liver. In addition, herbal supplements that contain phytoestrogen which is an estrogen-like chemical found in plant foods like; beans, seeds, grains, soy and soy products, may change hormone levels.

Gynecomastia may slightly increase the risk of male breast cancer due to the change in the ratio of testosterone to estrogen. Breast cancer in men is very rare with only about 2,000 cases diagnosed each year in the United States, with about 400 who will die from it.

Gaining excess weight will give many men pseudo-gynecomastia, which is caused by fat alone and not the growth of breast tissue. Pseudo-gynecomastia usually can be resolved by losing weight or liposuction, however the result may be loose skin that has been stretched to the point it will not retract and excision of the hanging skin is the only option.

The development of man boobs in the older man usually has different repercussions than for the adolescent who is struggling with body image and self-esteem issues. The older man is usually more secure and no longer has the need to prove his masculinity, he also doesn’t have to worry about his friends teasing, ridiculing him and calling him hurtful names.  That is not to say that the development of male breasts in the older men is not a disturbing condition, it is, it is just not as devastating as it is for young boys.

The older man in most cases has more options. With age comes knowledge and an older man is probably more educated and understands gynecomastia better than the younger man. One choice may be a compression vest or shirt, but if the man lives in a warm climate or wants to go the beach or is in a situation where they need to remove their shirt it may not be the best option. Support from others who suffer with gynecomastia, such as online with, has proven to be a great benefit for many.

Some men may realize that it is psychologically disturbing and will seek counseling. Older men are more likely to find ways to cope instead of harboring excessive amounts of shame and embarrassment.  Older men will probably notice that many of their male friends have the same development of the male breast and don’t feel as concerned.

Many older men choose to have surgery and are in a position to afford gynecomastia surgery costs. They don’t need anyone’s permission and most likely are able to pay for it themselves. With all the other issues that an aging man has to face, being able to have male breast reduction surgery or other cosmetic procedures such as a facelift, brow lift, eyelid lift, or liposuction gives them a sense of some control over their body and the changes aging makes.

With all that being said, it is still a wise decision for a man to have regular checkups including breast exams.

2013 07-31

Male Breast Reduction and the “Light Pull-Through Procedure”

Light Pull Through Procedure
This 29-year-old San Francisco Bay Area man suffers from adolescent gynecomastia, and prior to surgery had never exposed his chest in public. He underwent glandular excision and suction-assisted lipectomy of the chest, from which I excised 23 grams of glandular tissue from the right and 21 grams from the left.

Popular search terms on Google that are related to gynecomastia are:

• Gynecomastia cures

• Gynecomastia surgery costs

• Non-surgical gynecomastia treatment

• Gynecomastia surgeons

• Surgery for gynecomastia

• How to get rid of man boobs…to name just a few.

It is evident that, with the plethora of information available on the internet, men are searching for solutions to their man breasts. As men get educated as to what is involved with gynecomastia surgery, they learn what the procedure for “true gynecomastia” entails. True gynecomastia is where the man has a combination of fat and breast tissue that makes up the male breast, and the only way for removal is by a combination of liposuction and surgical excision.

True gynecomastia is in contrast to “pseudo-gynecomastia” which is caused only by fat and can be removed by liposuction alone. However, very few men have pseudo gynecomastia, but there are many surgeons who treat true gynecomastia as if it were pseudo-gynecomastia. It is amazing that liposuction as a stand alone treatment for gynecomastia, continues when the results are so disappointing. The breast tissue is too dense to come through the cannula of the liposuction machine and, therefore, is not removed. Breast tissue may actually be more prominent on the chest after the fat has been removed by liposuction.

As I have mentioned in a previous blog (June 16, 2013), 40% of my gynecomastia practice is now revision surgery where I am correcting male breast reduction that was done by liposuction alone by another surgeon. It is understandable that men would opt for a lesser involved surgery if offered to them, but not at the expense of having an unsatisfactory result. The only surgical option for men with true gynecomastia is excision with liposuction, which is generally a three to four hour procedure. This procedure would include the placing of drains for about four days to remove accumulated fluids that collect in the “dead space” left after fat and tissue removal.

Gland Removal
The Light Pull-Through Procedure
Gland removal

However, for men that have puffy nipples or minor to moderate gynecomastia, which would be equivalent to an A or a B cup size breast, there is a less invasive procedure available. I refer to this procedure as the “light pull-through procedure”. This is an excellent procedure that is done with an endoscope. An endoscope is an instrument that is inserted through a small incision, and in this case would be on the lateral sides of the areola and about only 2 to 3 millimeters in length. The endoscope allows the surgeon to see inside the chest by special optical fibers that send a picture to a monitor screen. After fat is removed by liposuction through the same incision, breast gland is then freed up with a special instrument and gently pulled through the opening, thus the term “light pull-through procedure”. This is not a new procedure it has been for about 20 years, but it has been improved through the years with exceptional results.

For the man that is a candidate for the “light pull-through procedure”, the additional benefits besides being less invasive are; drains are not needed, the surgical time is less, recovery time is less, and the resulting scar is smaller due to the smaller incision. In either case the scar, once healed is barely detectable.

Gynecomastia comes in varying degrees; each case has to be evaluated individually. The gynecomastia specialist will be able to determine which procedure will give the best results; taking short cuts are not in the patient’s best interest. While some patients will be candidates for the less invasive procedure, some will not, in fact, there are some patients with more severe gynecomastia that may even require a secondary surgery to excise loose skin.

There are many factors the surgeon needs to consider, to get the best outcome for the patient. The type of gynecomastia is only one factor, the age of the patient can make a difference, and the elasticity of the skin needs to be considered. For the man that is older or has had some type of male breast reduction surgery in the past, the skin may not retract as well as it once did.

Men are encouraged to make an appointment for a consultation so that they can have a personalized evaluation and understand what options are available to them.

2013 07-15

The Purpose of Drains and the Compression Vest After Gynecomastia Surgery

Custom Compression Vest Designed by Dr, Miguel Delgado
Custom Compression Vest Designed by Miguel Delgado, M.D.

San Jose, CA-For true gynecomastia, the removal of fat and breast tissue from the male chest will leave a large area of open or “dead space”. The resulting pocket of space is an area that fluids can collect. The fluids that collect are referred to as a seroma and are yellow body fluids. If the collection of fluids is blood, then it would be referred to as a hematoma.

If drains are not put into place after surgery and fluid started to collect, it would need to be removed by needle aspiration. Removing fluid by needle aspiration is not difficult to do, but it is very inconvenient for the patient as it may need to be done every 4 or 5 days until the cavity has collapsed and it may prolong the healing time. To avoid this issue I always use drains unless the gynecomastia patient has had the “light pull-through procedure”.

With the drains in place, any fluid that tends to collect will be removed by squeezing a bulb that is connected by a tube from the cavity and is attached to the outside of the vest. In addition to removing fluid, the suction of the bulb will create a negative pressure that encourages the cavity to close down. After surgery, the patient is placed in a compression vest which fits snugly but not too tight. With both drains and vest, my seroma rate is almost zero. However, there is a small scar from the drain incision that has caused concern for some patients. It can be more obvious than the resulting scar from the gynecomastia surgery that is from the glandular excision around the areola. In listening to my patients, I now have an instrument I use to make the small incision high up in the armpit and towards the back. This has worked out very well and patients have a hard time finding the drain incision.

The drains will remain in place until I determine it is safe to remove them, this is usually at

Surgical Drain
Surgical Drain

the first post-operative visit 3 to 4 days after surgery. The fluid that is collecting into the bulb gives me a lot of information and allows me to know what is going on inside, by the speed it is coming out, the consistency, and color. Once the drains are removed, showering is allowed; in the meantime the patient may only have sponge baths.

Due to many comments from patients that the compression vests were bulky and somewhat uncomfortable, I designed my own custom vests. My vests have special pockets for the drain bulbs which can be removed after the drains are taken out. Then there is a thinner vest #2 that men graduate to, it is a cotton T-shirt base layer with a thin layer of compression over only the chest region. Much more comfortable than previous styles and thin enough that even men who wear dress shirts daily do not complain about them showing.

My male breast reduction patients are to wear the compression vest 24/7 for six weeks. It is only to be removed when showering. It is a good idea to have 2 vests so that while laundering one the other can be worn. The vest should be washed on the gentle cycle and line dried. If time is an issue, the vest can be put in the dryer with a couple of towels on the cool air setting.

I treat many patients from out of town, and having no complications post-operatively is a priority for me.

2013 07-01

Risperdal May Cause Gynecomastia

risperdal-tabletsSan Jose, CA- There is an anti-psychotic drug “Risperdal” that is manufactured by Johnson and Johnson (J & J). The Food and Drug Administration (FDA) approved the drug for adults in 1993 for the treatment of schizophrenia. Then the drug was approved in 2003 to include treatment of Bipolar I disorder in adults. Later in 2006 Risperdal was approved for treatment of irritability associated with autism in children from ages 5 to 16. Then approval was obtained in 2007 for children age 10 and up for treatment of schizophrenia and Bipolar I disorder, as it is used for adults.

Prolactin is the hormone that is released in the pituitary gland and is responsible for breast development and milk production in women. High levels of prolactin decrease the level of estrogen in women, and testosterone in men. It has been noted that Risperdal elevates prolactin which can cause breast growth, breast budding, gynecomastia also known as male breasts or moobs, and even production of milk in young girls, boys and adult men. Some studies showed the elevation of prolactin as soon as eight weeks of being on Risperdal.

Only approved uses for drugs are allowed to be promoted by the manufacturer under federal law. The term “off label” means using a drug for other than approved uses.  Allegations have been made that the manufacturer of Risperdal had encouraged  “off label” use to treat such conditions as attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), oppositional-defiant disorder (ODD), conduct disorder (CD), disruptive behavior disorder (DBD), Tourette’s syndrome, post-traumatic stress disorder (PTSD), and pervasive development disorder (PDD).

Before and After Gynecomastia
HISTORY: This is a 29-year-old resident of Santa Rosa, California who presents for evaluation of gynecomastia. He underwent breast gland excision and chest breast liposuction.

J & J is facing several lawsuits due to the fact that the FDA only gave limited approval for use of Risperdal in children. Some cases are still pending, and others have settled such as; Texas in January 2012 was awarded $158 million for fraudulent marketing and $181 million awarded to 36 US states for promoting non-approved uses including dementia, anger management and anxiety. The largest settlement made last year of 2.2 billion is on hold as J & J is negotiating to avoid wording in the agreement that may leave them vulnerable to private lawsuits.

An attorney that represents many of the harmed patients also filed a petition with the FDA on July 27, 2012 on behalf of his clients; he is hoping to get the drug banned for use in children until long term safety can be determined. He also wants J & J to immediately put a “black box” warning on the label to alert patients, parents and their prescribing physicians to the possible development of gynecomastia.

The petition also addresses the fact that many times health care professionals prescribe medications without performing regular physical examinations for young boys and young men with attention to abnormal breast growth, testicular development and sexual maturation. Most parents do not know what gynecomastia is and would not know to be on the lookout for abnormal breast growth in their son without specific warning.

Besides the possible development of male breasts, Risperdal may cause significant weight gain, thus affecting the adolescent’s endocrine system. With the label warning greatly understating the risk of weight gain, the treating physician may attribute the development of gynecomastia breasts to over nutrition or puberty. Sadly with the continuation of Risperdal, gynecomastia may become a permanent condition that will only be resolved by gynecomastia surgery.

Gynecomastia may be the result of many different drugs, but there is not a known drug that will reverse the condition. For all males suffering with the effects of gynecomastia, a consultation with a Board Certified Plastic Surgeon that specializes in male breast reduction is highly advised.

2013 06-16

Redo Surgery for Gynecomastia Now at 40%

Liposuction only
This 43-year-old San Francisco Bay Area man previously underwent liposuction to correct his gynecomastia in 1992 with another surgeon, but was dissatisfied with the results. I performed a revision procedure on him, consisting of glandular excision and suction-assisted lipectomy of the chest. Total fat extraction was 350cc from the right side and 375cc from the left.

San Jose, CA-In the last two years, I have seen an increase from 25% to 40% in the amount of  gynecomastia “redo surgeries” that I do.

There are several different issues that bring patients back for revisional surgery. Probably the most common complication is where liposuction alone was used to remove fat leaving behind the dense breast tissue. The only exception to this would be the patient that has “pseudo-gynecomastia” which means the enlarged male chest is caused by fat alone.

True gynecomastia has both fat and breast gland. Liposuction is very effective for removal of fat, but the surgeon needs to be careful not to remove too much as it works as a buffer so that the skin can move over the muscle.  Breast gland needs to be removed by surgical excision as it is too dense to go through the cannula; the cannula is the narrow tube that removes the fat from the chest by liposuction. Gynecomastia specialists routinely perform this combination to get a masculine shape for the chest.  However, there are many surgeons that believe they can reduce the male breast by liposuction alone. This is a common error leaving men with less than desirable results, necessitating “redo surgery” to remove breast tissue. Redo surgery is more difficult than the initial surgery as now there is scar tissue to contend with as well as the probability the skin has lost some of its elasticity.

Another cause for redo surgery is where the surgeon has removed too much breast tissue and/or fat leaving what is known as a “crater deformity”. When this happens, it needs to be corrected with a fat transfer using the patient’s own fat from another part of the body or preferably a fat flap which has its own blood supply and can be rotated into the crater.

Crater Deformity
Crater Deformity
After Surgery for Crater Deformity
After Crater Deformity Correction

Another reason men seek revision surgery is when they are unhappy with the resulting scar from their original surgery. Depending on how the surgery was done and where the incision was made can make the revision a bit trickier. Having an obvious scar is unacceptable as a tradeoff for the gynecomastia itself.

 Each patient is unique and needs to be evaluated by a gynecomastia specialist; fortunately most cases can be revised. It is regrettable but the patient will need to wait until he has healed from the first surgery, and then allow time off for a secondary procedure and recovery and of course incurring additional costs.

Hopefully men will do their research and choose their surgeon carefully so that they can avoid possible “redo surgery”. At the time of the consultation, be sure to see many pictures of actual patients of the surgeon taken before and after surgery. Ask a lot of questions such as; how will the procedure be done, and how many gynecomastia procedures are done each year, is the surgical center or hospital accredited? Ascertain that your surgeon is Board Certified in Plastic Surgery and specializes in gynecomastia so that a revision will not be required.

2013 05-31

The Puffy Nipple Syndrome

puffy nipples2
This is an 18 year old male who presents with adolescent gynecomastia. He complained about having “fluffy nipples”. His goal was to flatten the nipples to look more natural in his clothing. He had suction assisted liposuction with glandular excision. His post surgical recovery displays his newly flattened nipples.


San Jose, California-Some men believe “puffy nipples” are not true gynecomastia since it is only the areola/nipple complex involved. However, this is not the case; the puffy nipple is caused by breast tissue just under the areola/nipple giving fullness to the nipple as in a dome effect. This condition is more common in young men, and it develops during puberty. The breast bud can grow to different sizes, but much of the time it will resolve on its own after puberty.

For those men that continue to have puffy nipples long after puberty, the only resolution is male breast reduction surgery by excision of the gland. In the same manner as for true gynecomastia, an incision is made around the areola, and the gland is dissected from the areola and deeper tissue. This removes the fullness allowing the areola and nipple to shrink and flatten.