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

Male Breast Reduction and the Light Pull-Through Procedure photo
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

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• 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.

The Light Pull-Through Procedure Gland removal photo
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.