Gynecomastia is a medical term that comes from the Greek words for "women-like breasts." Though this oddly named condition is rarely talked about, it's actually quite common. Gynecomastia affects an estimated 40 to 60 percent of men. It may affect only one breast or both. Though certain drugs and medical problems have been linked with male breast over development, there is no known cause in the vast majority of cases.

For men who feel self-conscious about their appearance, breast-reduction surgery can help. The procedure removes fat and or glandular tissue from the breasts, and in extreme cases removes excess skin, resulting in a chest that is flatter, firmer, and better contoured.

If you're considering surgery to correct gynecomastia, this brochure will give you a basic understanding of the procedure - when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please ask Dr. Freedland if there is anything about the procedure you do not understand.

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Surgery to correct gynecomastia can be performed on healthy, emotionally stable men of any age. The best candidates for surgery have firm, elastic skin that will reshape to the body's new contours.

Surgery may be discouraged for obese men, or for overweight men who have not first attempted to correct the problem with exercise or weight loss. Also, individuals who drink alcohol beverages in excess or smoke marijuana are usually not considered good candidates for surgery. These drugs, along with anabolic steroids, may cause gynecomastia. Therefore, patients are first directed to stop the use of these drugs to see if the breast fullness will diminish before surgery is considered an option.

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Thousands of these procedures are performed successfully each year. When done by a qualified plastic surgeon, the results are generally quite positive. Nevertheless, there are always risks associated with surgery and specific complications associated with this procedure.

Post-operative complications such as infection and blood clots are rare, but can occur. Infection can be treated with drainage and antibiotics, but will prolong your hospital stay. You can minimize the risk of blood clots by moving around as soon after the surgery as possible.

Poor healing, which results in conspicuous scars, may necessitate a second operation. Smokers should be advised to stop, as smoking may increase the risk of complications and delay healing. Often there is temporary loss of sensation, which may last up to a year after surgery.

You can reduce your risk of complications by closely following Dr. Freedland's instructions before and after the surgery, especially with regard to when and how you should resume physical activity.

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The initial consultation with Dr. Freedland is very important. Dr. Freedland will need a complete medical history, so check your own records ahead of time and be ready to provide this information. First, Dr. Freedland will examine your breasts and check for causes of the gynecomastia, such as impaired liver function, use of estrogen-containing medications, or anabolic steroids. If a medical problem is the suspected cause, you'll be referred to an appropriate specialist.

Your plastic surgeon may, in extreme cases, also recommend a mammogram, or breast x-ray. This will not only rule out the very small possibility of breast cancer, but will reveal the breast's composition. Once Dr. Freedland knows how much fat and glandular tissue is contained within the breasts, he or she can choose a surgical approach to best suit your needs.

Treatment of gynecomastia may be covered by medical insurance - but policies vary greatly. Check your policy or call your carrier to be sure. If you are covered, make certain you get written pre-authorization for the treatment recommended by Dr. Freedland. Don't hesitate to ask Dr. Freedland any questions you may have during the initial consultation - including your concerns about the recommended treatment or the costs involved. He invites you to view Before and After photos of his patients.

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Individuals considering gynecomastia reduction often feel a bit overwhelmed by the number of options and techniques being promoted today. However, Dr. Freedland can help. In deciding which is the right treatment approach for you, Dr. Freedland will consider effectiveness, safety, cost and appropriateness for your needs. This is called surgical judgment, a skill that is developed through surgical training and experience. Dr. Freedland also uses this judgment to prevent complications; to handle unexpected occurrences during surgery; and to treat complications when they occur.

Dr. Freedland's education and training, which he received at the University of Michigan, has helped to form his surgical judgment. Patients are encouraged to consider a doctor certified by the American Board of Plastic Surgery ("ABPS"). By choosing a plastic surgeon who is certified by the ABPS, a patient can be assured that the doctor has graduated from an accredited medical school and completed at least five years of additional residency - usually three years of general surgery (or its equivalent) and two years of plastic surgery. To be certified by the ABPS, a doctor must also practice surgery for two years and pass comprehensive written and oral exams.

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Dr. Freedland will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding vitamins, iron tablets and certain medications. If you develop a cold or an infection of any kind, especially a skin infection, Dr. Freedland may have to postpone your surgery.

If you smoke, plan to quit at least two weeks before your surgery and not to resume for at least two weeks after your surgery. Avoid overexposure to the sun before surgery and do not go on a stringent diet, as both can inhibit your ability to heal. Though it is rarely necessary, Dr. Freedland may recommend that you have blood drawn ahead of time in case it is needed during surgery.

Whether your surgery is done on an outpatient or inpatient basis, you should arrange for someone to drive you home after your surgery, and to help you out for a day or two after you leave the hospital, if needed.

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Surgery for gynecomastia is most often performed as an outpatient procedure, but in extreme cases, or those where other medical conditions present cause for concern, an overnight hospital stay may be recommended. Dr. Freedland feels a hospital provides the safest environment for your surgery and therefore performs almost all of his procedures at a JCAHO accredited hospital. The surgery itself usually takes about an hour and a half to complete. However, more extensive procedures may take longer.

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While some surgeons use local anesthesia, combined with a sedative to make you drowsy. You'll be awake throughout the surgical procedure. Thus, your chest region will be insensitive to pain, but you may feel some tugging or occasional discomfort. Dr. Freedland typically selects general anesthesia, so you'll sleep through the operation and be extremely comfortable throughout the entire process.

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If excess glandular tissue is the primary cause of the breast enlargement, it will be excised, or cut out, with a scalpel. The excision may be performed alone or in conjunction with liposuction. In a typical procedure, an incision is made in an inconspicuous location - either on the edge of the areola or in the under arm area. Working through the incision, the surgeon cuts away the excess glandular tissue, fat and skin from around the areola and from the sides and bottom of the breast. Major reductions that involve the removal of a significant amount of tissue and skin may require larger incisions that result in more conspicuous scars. If liposuction is used to remove excess fat, the cannula is usually inserted through the existing incisions.

If your gynecomastia consists primarily of excessive fatty tissue, Dr. Freedland will likely use liposuction to remove the excess fat. A small incision, less than a half-inch in length, is made around the edge of the areola - the dark skin that surrounds the nipple. Or, the incision may be placed in the underarm area. A slim hollow tube called a cannula, which is attached to a vacuum pump, is then inserted into the incision.

The newest liposuction technique is called power-assisted liposculpture (PAL). It utilizes the sonication of UAL without the complications of burning the skin. Thus the final results are better. The recovery time, amount of swelling and pain is typically less with this technique than with UAL. Many surgeons do not yet have access to this new technology. Be sure to ask your surgeon about this technique.

In extreme cases where large amounts of fat or glandular tissue have been removed, skin may not adjust well to the new smaller breast contour. In these cases, excess skin may have to be removed to allow the removing skin to firmly re-adjust to the new breast contour.

Occasionally, a small drain is inserted through a separate incision to draw off excess fluids. Once closed, the incisions are usually covered with a dressing. The chest may be wrapped to keep the skin firmly in place.

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Whether you've had excision with a scalpel or liposuction, you will feel some discomfort for a few days after surgery. However, discomfort can be controlled with medications prescribed by Dr. Freedland. In any case, you should arrange to have someone drive you home after surgery and to help you out for a day or two if needed.

You'll be swollen and bruised for a while - in fact, you may wonder if there's been any improvement at all. To help reduce swelling, you'll probably be instructed to wear an elastic pressure garment continuously for a week or two, and for a few weeks longer at night. Although the worst of your swelling will dissipate in the first few weeks, it may be three months or more before the final results of your surgery are apparent.

In the meantime, it is important to begin getting back to normal. You'll be encouraged to begin walking around on the day of surgery, and can return to work when you feel well enough - which could be as early as a day or two after surgery. Any stitches will generally be removed about 1 to 2 weeks following the procedure.

Dr. Freedland may advise you to avoid sexual activity for a week or two, and heavy exercise for about three weeks. You'll be told to stay away from any sport or job that risks a blow to the chest area for at least four weeks. In general, it will take about a month before you're back to all of your normal activities.

You should also avoid exposing the resulting scars to the sun for at least six months. Sunlight can permanently affect the skin's pigmentation, causing the scar to turn dark. If sun exposure is unavoidable, use a strong sun block. Dr. Freedland can instruct you on skin care products that can help make your scars less visible.

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Gynecomastia surgery can enhance your appearance and self-confidence, but it won't necessarily change your looks to match your ideal. Before you decide to have surgery, think carefully about your expectations and discuss them frankly with your plastic surgeon.

The results of the procedure are significant and permanent. If your expectations are realistic, chances are good that you'll be very satisfied with your new look.

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