The goal in every gynecomastia surgery is to restore a natural masculine chest. Since the goal is to be comfortable without a shirt, it Is very important to place scars where they will be less noticed or hidden.
If the breast tissue is more fatty than glandular, liposuction is used to remove the breast fatty tissue. The scar for liposuction is placed under the arm in the hair-bearing armpit. This 4mm scar is easy to hide. If the shape of the chest normalizes with removal of the breast tissue, no additional treatment is needed. No skin is excised. This is an excellent approach for men of all ages, but particularly for pseudo-gynecomastia.
For most young men, there will be glandular tissue. This is a white, tough scar-like tissue that needs to be removed surgically. When there is fatty and glandular breast tissue, liposuction is used first to remove any fatty breast tissue. The glandular tissue is isolated. A small 1-2cm incision is made within the areola skin and the glandular tissue removed. The scar is easily hidden.
In a minority of men with complex gynecomastia, there is excess skin. Gynecomastia after a large weight loss or in higher weight men can cause hanging breasts (Gynecomastia Grade 4). There is excess chest skin that has usually stretched significantly and needs surgical removal. In boys and young men without a large weight loss, the skin will retract to its normal shape and position. Different skin patterns result in scars in different locations. There can be a circumareolar scar (yellow), a lateral chest crease scar (yellow or white on image at right), or a lateral pectoral border scar (red on image at right). For examples of these scars see chart below.
A new technology combines radio-frequency heat energy with helium plasma to deliver controlled heat pulses to the collagen under the skin. (light green in image). The Reunion energy is diffused across the entire chest in the subcutaneous and deeper tissue layers to “tighten” the skin. Early results suggest results appear 2 weeks to 2 months after treatment with peak tightening at 6-12 months. At this point Renuvion is being used in combination with skin excision to limit scar.