Gynecomastia can be an embarrassing condition for men and boys. Most gynecomastia cases—30% to 40%—appear in adolescent boys around the age of 12 and last about 2 to 3 years. Another type of gynecomastia—commonly seen in athletes—usually results from using synthetic steroids.

PSP spoke to Mordcai Blau, MDPC, who practices in Westchester, NY, about his technique for treating gynecomastia. Blau treats more than 200 gynecomastia cases per year.

PSP: What are some of the causes of enlarged breasts in men? Please explain.

Blau: When I first started doing gynecomastia, the main people that were coming in to get the procedure done were bodybuilders, for aesthetic reasons. They take testosterone or steroids, which have a side effect of producing estrogen, a female hormone, which results in real breasts. If you translate gynecomastia from Greek, it means “women’s breasts.”

PSP: Please describe the procedure.

With gynecomastia, the decision that the plastic surgeon has to make using this technique is what part of the glandular tissue to remove and how much to remove in order not to cause any deformities.

Blau: The breast glands have three components: under the areola (the body of the gynecomastia), medially toward the chest (the head of the gynecomastia), and laterally toward the armpit (the tail of the gynecomastia). The more you remove, the less chance of recurrence. That is why I remove 90% and 95% of the gland. You do not want to remove the whole gland, because then you might have a depression.

According to the literature, the recurrence rate is 10% with excision and liposuction and 30% with only liposuction; so it’s better to use both techniques.

PSP: Is there such a thing as male breast cancer?

Blau: It’s extremely rare, but I have found breast cancer, such as that in women, in two of my cases. The ones that I found were in men over the age of 50. Women’s risk in having breast cancer is one out of nine; men’s risk is one out of 10,000 or 100,000.

Although men may be at risk, they do not check for this and they find out about it when the cancer is in its late stage. Anytime that I do gynecomastia, I send the tissue to the lab to be checked for cancer. I send the patients to the same doctors that treat women for breast cancer—they need the same treatment as women.

PSP: Please describe your “Natural Blend Technique.”

Because the incisions are under the areola, in the transition zone, the scar is less obvious and it is 1 inch long. When it heals, the scar is even less obvious.
Doing “wide undermining” gives the tissue low elasticity; it shrinks better and it looks better aesthetically.

Blau: The decision that the plastic surgeon has to make using this technique is what part of the glandular tissue to remove and how much to remove in order not to cause any deformities. With this technique, it is very important to avoid penetrating the fascia into the pectoralis muscle; to avoid bleeding; and to avoid hematoma, seroma, and adhesions.

Another benefit with this technique is the avoidance of scars. Because unlike women, men do not wear a bra, we need to avoid scarring as much as we can. Doing “wide undermining,” or going under the skin to free the skin all around the breast, even beyond the breast tissue, gives the tissue low elasticity, shrinks better, and looks better aesthetically.

PSP: What type of risks are involved with the procedure?

Blau: Like any surgery, risks include scarring, infection, and deformity. Other risks include hematoma and seroma, but those are temporary. Sometimes, surgeons need to drain the fluid.

PSP: Are there any postsurgery regimens that patients should follow?

Blau: The first week postsurgery, patients need to be careful not to lift anything or move the shoulder up because if you move the pectoralis muscle, there will be more bleeding and swelling. You can move the elbow and the wrist, but not the shoulder joint. Don’t even shake hands too hard. Patients can begin light exercise, such as aerobic and treadmill, after 2 weeks of surgery. Between 3 and 4 weeks, they can start chest exercises, such as weightlifting.

PSP: What sort of downtime should patients expect?

Blau: Every patient is different. I take the stitches out 5 days after surgery. If there is a drain, I also remove the drain. I place a plastic closure or compression dressing, and leave it no longer than 5 days. However, 5% of my patients have needed compression dressing an additional 5 days.

Because I do the incisions under the areola, in the transition zone, the scar is less obvious and it is 1 inch long. When it heals, the scar is even less obvious. If I do excision and liposuction, I do it from the same scar; that is also part of my Natural Blend Technique. Some surgeons do one scar for the liposuction at the side or middle of the chest and do a different scar to remove the gland.

The scar heals between 3 weeks and 3 months. Good results are those results that other people can’t see.

Rima Bedevian is associate editor of PSP. She can be reached at [email protected].