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Male Breast Surgery

Gynecomastia and Augmentation

 

1.) Gynecomastia

Derivation Greek Gyne-Woman

Mastos-Breast

Incidence 36-40%

History Palus Aegenta

(625-690BC)

2.) Described 1st Surgical Intervention

Gynecomastia

Types-not important clinically

Pseudogynecomastia-excess amount of adipose tissue w/ normal amount of glandular breast tissue

Idiopathic condition

Most common

3.) Gynecomastia

Types

True Gynecomastia-excess glandular w/ subareolar bud

Causes

Hypogonadism

Alcoholism

Drugs

Thyroid hormone, anabolic steroids, marijuana, estrogens, spironolactone, digitalis, diazapam, phenytoin, clomiphene

Paraneoplastic syndromes

Unilateral-requires a primary tumor be ruled out-mammogram, FNA

4.) Gross Anatomy

Examine-flex pectoralis, muscle to palpate breast tissue-muscle interface-PINCH TEST

Normal male breast tissue-very fibrous-one of the most challenging areas for liposuction

True breast tissue located beneath nipple areolar complex

May extend into axilla-treat BOTH areas

Draw intended surgery on polaroid photos

Promise 50% cosmetic improvement

Occasionally 30%

Consent-possible open glandular excision

5.) Technique

Anesthesia-I.V. sedation with Versed/Demerol

1 entry port: Lateral inframammary crease-axilla

KLEIN TUMESCENT FORMULA-double strength. Over-tumesce to expand fibrous tissue

PHOTOGRAPHIC STUDIES:

Photo 1: Pre-operative markings discussed with the patient regarding amount of tissue

removal, location, areas to remain, and nipple area. Used as a "game plan".

Photo 2: Instruments on Mayo Stand - Gowns and gloves, suction tubing, Klein infiltration tubing,

curved Iris scissors, #11 blade with handle, towel clamp, infiltration handle and cannula, suction

cannulas, 0.5% Xylocaine solution (with epinephrine) in 20cc syringe using 23 gauge needle,

4x4 gauzes and towels.

Photo 3: Klein Pump with double-strength Klein's Tumescent Solution.

Photo 4: #11 blade is used to make a 2mm incision in the anterior axillary line.

Photo 5: Infiltration with tumescent solution - "Schafer Technique" utilizes the "HYPER-TUMESCENT"

method to spread thick glandular tissue - up to one liter per side.

Photos 6 & 7: Aggressive suctioning of "HYPER-TUMESCED" male breast tissue

with round 14 and 16 gauge spatulas on Starr Power Cannula.

Photo 8: Reston Foam with Compression Vest used after surgery.

Photos 9, 10 &11: Before and After Photos of Gynecomastia patients

Before and After Photos of Male Breast Augmentation (Pectoral Implants):

Candidates: Thin muscle definition or s/p gynecomastia surgery

Sizers: Similar to sizers used on female patients, e.g. Hanson

Placement: Transaxillary and subpectoral

 

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Program 2013  l Program 2014  Program 2015 | Program 2016 | Program 2017 | Program 2018

The American Society of Cosmetic Breast Surgery 2017    Last modified: June 23, 2017