Gynecomastia in Charlotte NC

Over-growth of male breast tissue most commonly starts during adolescence or puberty and can persist into adulthood. Gynecomastia is quite common, occurring in 4% of boys ages 10-19yrs. The persistence of male breast tissue by age 17, is unlikely to disappear and will require surgical treatment with a male breast reduction procedure.

Gynecomastia Treatment in Charlotte, NC

Nothing is more embarrassing for a boy or man than having male breasts. The suggestion of a female breast or nipple puffiness on a male chest is more than traumatic. Guys with male breasts hide, socially isolate, avoid normal physical and social activities. Most guys with male breasts feel terribly self-conscious, not understanding what is happening to their bodies. There is a feeling of something abnormal occurring. Then, insensitive locker room taunting can completely rob any self-confidence leaving a young man with no choice but to hide and avoid any possible activity that requires being shirtless. Insecurity persisting into adulthood can mean daily camouflage with careful selection of clothes, insecurity in social settings, even avoidance of intimacy.

Quick Facts About Gynecomastia


Advantages of Dr. Ditesheim’s gynecomastia surgery approach: No general anesthesia, less recovery. You can drive yourself home. Immediate results. Minimal or no chest scar.


Can be as little as 1 to 3 days post operation.


Costs depend on the type of procedure performed. Set up a personal consultation today to learn more about your options.

Gynecomastia Grades

Grades 1

Excess tissue is localized around the areola, causing a “puffy nipple” appearance with soft-to-the-touch sensation.

Grade 2

Tissue growth extends beyond the areola and is hard to differentiate between normal chest tissue and the excess growth.

Grade 3

Chest enlargement is greater than grades I and II, with excess skin leading to sagging of the chest. Tissue feels distinctly different than surrounding chest tissue.

Grade 4

Significant breast enlargement leading to a clear feminization of chest tissue, often with excess skin leading to sagging tissue below the breast fold.

"I am comfortable to be without my shirt, I can feel my muscle, I could not do that before."


What Gynecomastia Surgery is Right For You?

There are different gynecomastia surgery procedures depending on the Gynecomastia Grade.  The goal in every procedure is to restore a normal masculine chest.   

Gynecomastia surgery for most guys with Grade 1 or 2 is either excision of the glandular tissue and or liposuction of the fatty tissue under the nipple.  For grade 3, if skin has good elasticity, excision of breast tissue will be all that is needed.  For Grade 3 with poor skin quality or Grade 4 breast volume and skin are removed and nipple repositioned.

High Definition Liposuction

The technique of High Definition Liposuction selectively removes fat to shape the chest.

  1. The roundness of the chest is replaced with more angular definition reflecting the chest muscle lateral border.
  2. The fatty tissue above the nipple is selectively removed from the more superficial layers.  Under and below the nipple the deeper fatty tissue is removed. This selective shaping  produces the change in chest shape.

AquaShape Water-Jet Liposuction

Liposuction is a technique that removes fatty tissue using a 3-4mm cannula or long tube. There is only a small incision in the axilla or armpit. The skin around the areola shrinks. The areola appears smaller and darker.

This option can be done without general anesthesia and in some patients can remove lbs of fatty tissue. The result is the formation of a masculine chest and restoration of confidence.

Advantages of Gynecomastia treatment with Aquashape: Water-jet  Liposuction:  

  • No visible scar on the chest
  • Awake procedure, no need for general anesthesia
  • Quicker recovery, no drain and early return to activities (1-3 days)

Vaser Or Ultrasonic-Assisted Liposuction

 VASER or ultrasonic-assisted liposuction uses ultrasonic energy to emulsify fat cells.  The energy is limited to a defined area at the tip of the cannula.  Fat cells are specifically targeted; nerves and blood vessels are spared. VASER  is a more controlled method to deliver high intensity energy without mechanical trauma.  For some men, VASER alone is sufficient to remove the breast tissue.

Surgical Excision

In complex gynecomastia patients where there is excess skin to  remove, where nipple placement must be returned to a more natural position, or where the size of the areola must be reduced, excision techniques are used.  Scars are either placed around the areola border or in the chest crease, following the chest muscle border depending on the complexity. (see Complex gynecomastia below)

Advantages of Gynecomastia Treatment With Surgical Excision of Glandular Tissue:

  • Scar is easily hidden around the nipple
  • Awake procedure, ok to drive home
  • Quicker recovery, no drain, return to school or work 1-3days.

State-of-the art, on site surgical suite located in Charlotte, North Carolina

Our suite is certified with the highest level of accreditation by the American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF).

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Jeffrey A. Ditesheim, MD, FACS


Charlotte, NC plastic surgeon Dr. Jeffrey A. Ditesheim is a highly-accomplished, board-certified plastic surgeon with a reputation for excellence. In choosing a plastic surgeon, you want to be completely confident that your procedure will be performed with advanced surgical skills and true artistry. Dr. Ditesheim has an impeccable reputation in Charlotte, North Carolina and beyond, drawing discerning patients to his exclusive clinic in Ballantyne.

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Considerations Before Gynecomastia

When the very small disc of normal breast tissue immediately under the nipple is hormonally stimulated, a breast shape can appear on a normal male chest.  It is difficult to predict before surgery if the “breast tissue” is hard glandular tissue ( white, like scar tissue) or softer glandular tissue that appears more fibrous and looser.

For patients where gynecomastia is mostly glandular tissue, the hard glandular breast tissue is first mobilized from the chest muscle and then removed with a surgical incision inside the pigmented part of the nipple area ( areola).  After removing the breast tissue, the skin around the nipple shrinks and the scar is hidden in the skin creases around the nipple.  For most guys, there is a combination of fatty tissue and glandular tissue.  In these scenarios, the liposuction is used first to numb the chest and remove the fatty tissue then using a very small incision around the nipple, the hard glandular tissue is removed.

New Awake Procedure

Dr. Ditesheim’s neew awake procedure corrects gynecomastia, restores masculine chest with minimal scar, and a quick recovery. Dr. Ditesheim has designed an advanced gynecomastia treatment procedure that removes the male breast tissue with minimal or no scar on the chest, no drains, 1-3 day recovery and no general anesthesia

The goal of every gynecomastia procedure is removal of the “breast tissue” and restoration of a natual, masculine chest shape.   Traditional surgical techniques meant larger incisions, drains,  6-8weeks recovery and sometimes unnatural chest shape.

Gynecomastia Surgery for Bodybuilders

Gynecomastia for any male is dysmorphic, frustrating, and embarrassing. For competitive bodybuilders and men that dedicate themselves to incredibly high standards of muscle aesthetic, this appearance can seem unsightly and unnatural, leading male bodybuilders to commonly seek out treatment for gynecomastia.

Bodybuilder with gynecomastia showing location of scar hidden in lateral chest shadow.

What Causes Gynecomastia in Bodybuilders?

The muscular definition depends on a thin layer of fat to envelop the complex definition of the muscle. Gynecomastia forms between the skin and the muscle producing an unnatural bulge or a blunting of the pectoral border. Despite a rigorous diet and exercise regime, competitive bodybuilders’ bodies are in a high testosterone state, usually with pro-testosterone supplementation, anabolic steroids or a combination of both. When the body sees more testosterone than it can handle,“aromatase” converts excess androstenedione (male hormone) into estrogen and estrone, (very potent estrogens). Estrogen stimulates the usually very small amount of male breast tissue immediately under the nipple grow. Gynecomastia (male breast tissue overgrowth) results in coning of the nipples or roundness of the trapezoid male chest shape.

Bodybuilder with Gynecomastia: Dr. Ditesheim’s Patient

This patient is a 41 yr old personal trainer and bodybuilder had a complex type of gynecomastia (Grade 4). After a large weight loss there is a mismatch between the skin and the muscle. There is excess skin, inferiorly displaced nipples and excess breast tissue. This imbalance creates a distortion that gives the chest an unnatural appearance.

Before surgery, while standing, the correct position of the nipple on the lower lateral portion the pectorals muscle was selected. A skin pattern was drawn to remove the excess skin. The nipple remained attached, but was moved up to the new position on the pectorals muscle. The scars were placed around the areola (darker skin around the nipple), a short vertical scar to the chest crease and a curving scar that followed the underside of the lateral chest muscle definition. With the chest muscle having good anterior projection, the short vertical scar is hidden on the underside of the chest. The longer scar that runs along the side of the chest is hidden in the lateral chest muscle crease. To hide the scar and enhance the lateral chest definition, the ligaments under the skin are actually sewn to deeper structures. This “wraps” the skin around the lateral pectoral border. One year after the procedure, the right nipple has less sensation, but the left has normal sensation.

Gynecomastia Treatment Options for Bodybuilders

The most important first step for bodybuilders with gynecomastia is to stop anabolic steroids with higher levels of aromaticity. Specifically, these include Sustanon®, Dianabol®, Winstrol®, and Anadrol®. Further therapy is designed to reduce the conversion of androgens into estrogens. These include aromatase inhibitors such as anastrozole. Other therapies act to block estrogen receptor binding, such as Tamoxifen; but these drugs, particularly Tamoxifen can have greater side effects like liver toxicity.

For Grade 1, 2 or 3 Gynecomastia where there is excess breast tissue under the nipple but no skin excess, treatment is to remove the glandular tissue. There is usually minimal to no fat to remove. For most bodybuilders with gynecomastia, a surgical procedure under local anesthesia is reasonable and comfortable. The chest is first infiltrated with a dilute numbing solution. You can remain awake, but will not feel the chest while the surgical procedure is taking place. After, there is a small scar within the areolar border, a special dressing is placed. A foam and compression dressing is placed on the chest to control immediate post-op swelling. You can then drive home. Most men return to work within 1-2 days or after the weekend. Pain medicine is rarely needed after day 2. Workouts are resumed the next week progressing to your full exercise within 2-3 weeks.

Procedure and Recovery

  1. Tumescent solution is infiltrated over the chest through a tiny incision in the armpit. This provides a “numb” area over the entire chest area. 
  2. A liposuction cannula, through the same small incision in the armpit is used to remove “fatty breast tissue” and other fatty tissue from the front or side of the chest wall.
  3. If there is a persistent “knot” under the nipple, the size of a marble or as large as a golf ball, this will be glandular or fibrous breast tissue.    This breast tissue is removed with a small surgical incision just below the nipple, easily hidden in the skin creases
  4. The surgical area is injected with a longer acting local anesthetic for post-op pain control.
  5.  A compression shirt or vest is worn for 3 weeks to minimize chest swelling.
  6. The results are immediate, you can drive yourself home after the procedure and return to work the same day or the next day.  Athletic exercise can be resumed in 1-2 weeks.  

 “My goal for every guy with gynecomastia is to restore a natural, masculine chest contour that will renew his feeling of confidence and empowerment”

Dr. Ditesheim

Frequently Asked Questions

What causes gynecomastia in males?

Gynecomastia is usually characterized by excess localized fat, overgrowth of male breast tissue under the nipple, or skin excesss (usually from significant weight loss). One or both sides of the chest can be affected.

Can liposuction be used to treat male breasts?

For patients whose gynecomastia is mostly excess fatty tissue, Aquashape (water-assisted liposuction) or Vaser (ultrasound-assisted liposuction) can be used to remove the excess fat.

Who is a good candidate for gynecomastia surgery with liposuction?

Breast tissue under the nipple can be made of fatty, fibrous (firmer), or glandular (hard) tissue. It is hard to predict who will have which type of breast tissue. Gynecomastia surgery with liposuction is very efficient in removing fatty tissue under the nipple and over the chest wall. If the breast tissue is too tough, glandular tissue can be removed with an intra-areolar incision.

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Not every plastic surgeon in Charlotte is equal in natural talent and ability. To create truly excellent results in plastic surgery requires an eye for beauty and a personal dedication to helping the patient achieve what they envision. Whether you’re interested in liposuction, a facelift, tummy tuck or any other plastic surgery, Dr. Ditesheim offers an artistic approach that his patients love.

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