Posted on: July 31st, 2013
By: Miguel A. Delgado Jr., MD
Miguel A. Delgado, Jr., M.D.
San Francisco, CA-Most patients are nervous when they have an appointment to see the doctor. This is especially true for patients seeking elective procedures as they have additional concerns about vanity and may feel guilty for indulging in something that is not necessary but will make them feel better about themselves.
It is the exceptional office that has a staff that understands the feelings of the new patient and has the ability to make them comfortable from the moment they arrive for their first consultation visit.
When arriving for a gynecomastia initial consultation, the patient will be escorted to an exam room and will be joined by Dr. Delgado. Dr. Delgado’s warm and friendly manner puts patients immediately at ease. Many patients have made the comment that they do not feel that Dr. Delgado talks down to them as many doctors are known to do, but more on an equal basis that builds trust and allows the patient to feel comfortable asking any questions that they may have.
To begin the consultation, Dr. Delgado has several questions he will ask. Usually he will want to know how long the patient has had male breasts, and when did they develop. He will want to know if there has been any noticeable change with weight gain or loss. Does he take his shirt off in public? Do other men in the family have gynecomastia? And what are his goals?
At this point, Dr. Delgado explains his surgical technique of excision combined with liposuction, pointing out that liposuction alone is only for the patient that has what is known as “pseudo-gynecomastia”, meaning fat alone is causing the male breasts. He points out that 40% of his gynecomastia cases are now revision surgeries, due to the original surgeon using liposuction alone and leaving breast tissue behind.
He goes into great detail to explain how the incisions are placed around the areola so that after healing they are almost invisible.
Drains are placed at the end of surgery Dr. Delgado explains, in order to remove fluid that normally collects when there is a “dead space” left after removal of fat and tissue. He shows how a compression vest will be worn to assist in the healing of the chest, and that he has them custom made to include pockets for the drains. Further, he says that the vest will be worn for 6 weeks and after that all normal activities including exercise can be resumed.
Now Dr. Delgado will do an exam of the patient’s chest and will be able to give a personalized evaluation of what he recommends. After the examination, the patient then will meet with Dr. Delgado in the office of the patient care coordinator. Dr. Delgado has several albums of before and after pictures of his male breast reduction patients that he presents. He will show where the incisions are and how they healed; he shows the small scar from the drain and how he now has it hidden in the armpit. These photographs will give the patient a good idea of Dr. Delgado’s work, and the results that can be anticipated.
Many patients choose to have additional surgery done at the same time to save money and recovery time. For patients that are interested, Dr. Delgado will show pictures of patients that have had a combination of surgeries. Popular add on surgery, for example, would be, liposuction of the love handles and/or abdomen, some may want facial surgery such as a rhinoplasty (nose job) or eyelid surgery or possibly a chin implant. Dr. Delgado will be happy to discuss additional surgery at the initial consultation if requested.
At the end of the consultation with Dr. Delgado, the patient then meets with the patient coordinator who will present the fees outlining gynecomastia costs and answer any additional questions the patient may have such as pre-operative and post-operative instructions, financing, and scheduling surgery. The patient is encouraged to call the office at any time with additional questions for the patient coordinator or Dr. Delgado.
In his quest to educate his patients and make them as comfortable as possible prior to the consultation, Dr. Delgado produced a 6 part video that is posted on his website and You Tube showing the whole process from the initial consultation to post-operative visits and the patients final impressions.
Posted on: July 15th, 2013
By: Miguel A. Delgado Jr., MD
This 26-year-old San Francisco patient is 5’6” and 172lbs. He underwent glandular excision and suction-assisted lipectomy of the chest and axillae. From the axillae, I removed 400cc of fat from the left and 450cc from the right. From his chest, I extracted a total of 250cc of fat from the right and 202cc from the left. I also excised 35 grams of glandular tissue from the right side of his chest and 29 grams from the left side.
San Francisco, CA-What is gynecomastia? Gynecomastia, also known as moobs, man breasts, and man boobs are the description of the development of male breasts, it will affect 60% or more of all men at some point in their lifetime.
The question of possible non-surgical options for getting rid of gynecomastia comes up frequently for all gynecomastia surgeons from adolescents and men hoping to find a resolution to get rid of the male breasts without cosmetic surgery.
The cause for some types of gynecomastia needs to be ruled out before attempting surgery or non-surgical methods. For example, 90% of adolescents will find their gynecomastia will go away on its own after puberty with no treatment at all. If a patient is suffering from “pseudo-gynecomastia” which is caused by fat alone, weight loss or liposuction may get rid of the man boobs, but liposuction is a surgical procedure. Some men will find that losing weight or removal by liposuction will leave them with loose skin, and then may opt for surgical skin tightening.
For all others, it is important to try to determine the cause of the development of male breasts so that it will not reoccur if surgical intervention is the choice. For example, many men develop breasts while taking certain prescriptions drugs, or steroids, or smoke marijuana or other illicit drugs. Consulting with a gynecomastia specialist is recommended to help determine the cause and to stop the offending drug or find an alternative.
There are men suffering with moobs that do not have surgery as an option. There are some measures that can be taken, but unfortunately, none will actually get rid of their gynecomastia.
One option that some men choose is to wear a gynecomastia compression type shirt; there are many styles and manufacturers to choose from and can usually be worn undetected under clothing. However, the compression vests can be binding and/or hot, and a trip to the beach or swimming or any activity that involves removing ones shirt, still presents a problem.
Exercise and lifting weights can build pectoralis muscles and will enhance definition, but the male breasts will remain, and the additional muscle mass may make them even more noticeable.
If any research is done on the internet about gynecomastia, it is almost impossible not to see advertisements for herbal based supplements that allege they can reduce fat cells in size and quantity. The main ingredient is Chromium Picolinate, which is found in many over the counter diet products, and their fat reducing claims remain unsubstantiated. Even if they did work, they are only claiming a reduction of fat and not breast tissue which is present in all cases of true gynecomastia. There have been many reports on www.gynecomastia.org from men who have tried these products and they report very disappointing results. If you are tempted to try these products, before plunking down money, check Google reviews for the product, make sure that they are not posted by the company themselves as they have multiple websites and they do a very high volume of advertising.
The Mayo Clinic recommends that men who do not have surgery as an option seek psychological counseling and/or find support groups with other men suffering with gynecomastia, such as www.gynecomastia.org. There is comfort to be gained by learning how others deal with their condition, and many stories are shared on this popular site. For some men learning to live with gynecomastia without self-loathing is definitely an option.
Men who are able to have male breast reduction surgery and choose this option have an extremely high patient satisfaction rate. For several years in a row male breast reduction surgery has been on the increase, The American Society of Plastic Surgeons (ASPS) reports that for 2012, there was an increase of 5% over 2011.
Posted on: July 1st, 2013
By: Miguel A. Delgado Jr., MD
This is a 17-year-old resident San Francisco Bay Area, California who presents with gynecomastia. He underwent gland excision and suction assisted lipectomy with 150 cc of fat aspirated from each side.He had 46 grams of tissue removed from his right chest and 400 grams of tissue removed from his left. His postoperative photographs are taken 3 months after surgery.
San Francisco, CA-Gynecomastia, often misspelled, mispronounced, and misunderstood. Most people are not aware that having male breasts is a condition that can be caused by many different factors including, heredity, prescription drugs, illegal drugs, steroids, Klinefelter’s syndrome, puberty, aging, weight gain, and cancer of the male breast. For some, the cause remains unknown. If a pediatrician tells parents that their son has gynecomastia, many ask “what is gynecomastia?”If parents haven’t heard of the condition, how can they help their sons?
In 1995, there was an episode on Seinfeld where Kramer one of the main characters, invented “the Bro” also to be known as “the Manssiere”, a bra for men. This episode brought humorous attention to the condition except for those that suffer with male breasts. Negative attention has been in the media off and on ever since with cruel descriptive words like; man boobs, moobs, bitch tits, he-hooters, dude rack, man cans and more.
As boys enter puberty, it is not uncommon for them to develop female type breasts or what is termed as “puffy nipples”. At an average age of 13, this phenomenon is usually brought about by hormones being out of balance, but usually when the hormones even out the breasts will disappear. When the hormones are raging, for both boys and girls, they can become extremely emotional and sensitive and for good reason, their bodies are going through a lot of changes. This can be a very confusing time for young people and having supportive parents can make all the difference in the world.
As much as 40% to 50% or more young men going through puberty will develop some degree of gynecomastia on one or both sides. A visit to the pediatrician is in order to monitor any breast growth. For 90% of young men, the gynecomastia will resolve on its own within a few months to a couple of years. For the small percentage of boys that the gynecomastia remains, parents ask, “what is the treatment for gynecomastia?” There are no known treatments that can reverse the formation of breast tissue once it has remained past puberty except male breast reduction surgery. The good news is that the male breast reduction procedure is very successful with almost no evidence of surgery having been performed.
Gynecomastia can be demoralizing for any man, but for young boys who do not understand what is happening to their body, it can be devastating. Most feel it is their fault and experience incredible shame. They are not comfortable telling anyone what they are going through and do their best to hide their chest with loose fitting shirts. They avoid situations where they might have to bare their chest, such as going to a pool or the beach. It is amazing how many young boys are able to hide their breasts from their parents and hide the agony they are experiencing. Classmates can be especially cruel with teasing and name calling for the boy with breasts.
It is hopeful that parents will notice any unusual breast development in their son so that they can be good support for them. If it is before puberty starts or before 9 years of age it could be a more serious complication, and he needs to be seen by a physician. Search engines on the internet make information readily available. Family members or friends who have some knowledge of gynecomastia may take parents aside and guide them to seek help for their son. Pediatricians are in a position to alert parents and educate them and their son.
The World’s best resource for information on gynecomastia is www.gynecomastia.org. There is a directory of Board Certified Plastic Surgeons throughout the United States. The site offers many before and after pictures of male breast reduction patients, a blog page with interesting articles posted by member surgeons.
The most popular and active section of the site is the forums. One of the most popular forums is called “gynecomastia talk” where boys and men can share questions and experiences, and then there is a forum called “your stories”, one called “ask a doctor” whereby guys can post questions to the surgeons who are members of the site.
Another forum is called “surgery success stories”, this section has several stories written by boys and/or their parents. One in particular tells of a boy who had been silently suffering with his gynecomastia breasts for a long time and finally in an attempt to hide them better ordered a compression shirt that was supposed to help flatten his chest. His package arrived when he wasn’t home, and his Mom saw it first. When he came home and saw her with it he was beyond embarrassed, but it turns out his parents were very supportive and even willing to down-size their house in order to have enough money for him to have male breast reduction surgery. He didn’t allow that to happen, but the door was now open for them to have good communication and find a way to resolve his problem. This incident helped him to have a closer relationship with his parents.
There are many similar stories posted on gynecomastia.org. Unfortunately, not all young men are so lucky to have such supportive parents, but many of the forum members encourage young men to try talking to their parents. For those that do not have a good support system, gynecomastia.org is even more valuable. Many boys and men have found the support they need from other forum members, with ways to deal with all the different issues gynecomastia presents.
Posted on: June 18th, 2013
By: Miguel A. Delgado Jr., MD
Paulus of Aegina
Physician and Surgeon
San Francisco, CA-Men suffering with moobs, or male breasts have asked “What is the history of gynecomastia?” First introduced in the second century A.D., the term “gynecomastia” means; woman “gyne” and breasts “mastos”.
The first known record of a physician to address the issue of male breasts was Claudius Galenus also known as Galen, a famous physician and philosopher of that time. Galen was a physician to five Roman emperors. He produced over 500 books on medical science and philosophical subjects. He became a very famous physician and had his own pharmacy stocked with medicines he made from extracts of vegetables and animals.
Galen’s influence remains today; the word “galenic” describes medicines and drugs from animals and vegetable ingredients. While he was the physician to the emperors of Rome, he treated wounded gladiators giving him a wonderful opportunity to study the anatomy of man and perform surgery. It is not recorded that he actually attempted male breast reduction surgery, but he has the earliest record of describing the condition as an abnormal amount of fat in the male breast. History does not report any attempts at surgical correction of gynecomastia until five centuries later.
During the later years of the Roman Empire, it is believed that the seventh century Byzantine physician Paulus of Aegina (625-690AD) was the first to attempt a surgical treatment of gynecomastia, believing it to be caused by the formation of fat and advocating excision through a single sub mammary lunar incision or in more severe cases through two lunar incisions extending well beyond the areola. This procedure had been used extensively, but the resulting scars were broad and conspicuous causing almost as much embarrassment as the original condition itself. Paulus is best known for writing a collection of books known as “Medical Compendium in Seven Books”, containing the sum of all Western medical knowledge. It was unrivaled in its accuracy and completeness. As a competent and skilled surgeon, the sixth book was devoted mainly to surgery, and he may be known as one of the originators of plastic surgery as we know it today. In the book, he describes the different surgical processes and techniques including his personal experiences and observations. He conveyed plastic surgery experience and knowledge for such procedures as, nasal and jaw fractures, and gynecomastia, etc. that has been passed down through the ages. He was the first to describe physical characteristic that are still significant today such as the prevalence of gynecomastia in the adolescent, and the presence of fat deposits in many but not all patients, and that some patients will need secondary surgery.
Advances in the procedure continued through the eighteenth and nineteenth centuries, but the most notable progress was by Jerome P. Webster, M.D. There was an article published in the Annals of Surgery by Dr. Webster in September 1946 called “Mastectomy for Gynecomastia Through a Semicircular Intra-Areolar Incision” whereby he describes an operation he devised with a semicircular intra-areolar incision and he first performed it in 1934. It was done under general anesthesia by two surgical teams, one on each side, in order to keep the surgical time as short as possible, and then hope the surgeons had a similar technique. Webster’s procedure made the greatest impact on gynecomastia surgical treatment.
With the exceptional advances in surgical technique and anesthesia that we have today, men have more surgical options that include minimally invasive procedures, for outstanding results with little or no visible evidence of surgery performed.
Posted on: May 31st, 2013
By: Miguel A. Delgado Jr., MD
This 49-year-old man had gynecomastia surgery twice with other physicians. He sought my help wanting to undergo a third procedure as he was still unhappy with his result. He underwent glandular excision and suction-assisted lipectomy of the chest.
San Francisco, California-On August 17, 2010, I published a blog “Liposuction for Gynecomastia”. At that time, I stated the percentage of redo surgeries that were originally done by other surgeons was at 25% to 30%.
Today, the percentage of redo male breast reduction surgeries in my practice has increased to 40%! This is due to the same reason as before. There are many surgeons that believe the desired results of a well sculpted male chest can be attained by liposuction alone. When liposuction alone is used, breast tissue remains and it can actually look more prominent than before the fat was removed.
True gynecomastia is a combination of fat and breast tissue. The fat can be removed very well by liposuction; however, the breast tissue is too dense to come through the cannula. Breast tissue needs to be removed by excision, and it needs to be done by a gynecomastia specialist who has the expertise to give a masculine contour to the chest.
If the breast tissue is removed too aggressively, the result can be a crater deformity, another cause for redo. This is an extremely frustrating situation for the man who has finally had surgery to correct his moobs. The good news is that almost all of these cases can be corrected, but just emphasizes the fact that men need to do their homework in picking a Board Certified Plastic Surgeon for gynecomastia reduction surgery. Ask a lot of questions, request to see before and after pictures, ask how many male breast reduction surgeries are performed each year, you want to be sure to pick a gynecomastia specialist so that a gynecomastia redo surgery will not be necessary. A good source for Board Certified Plastic Surgeons is www.gynecomastia.org.
After Surgery for Crater Deformity Correction
Posted on: May 15th, 2013
By: Miguel A. Delgado Jr., MD
San Francisco, California-Men with gynecomastia, also referred to as moobs, are relieved to know that there are support groups available to help them get current information and to help them cope. Our society makes it difficult for men to reach out for support for a very embarrassing and sometimes devastating condition. It is not considered masculine to be sharing personal issues especially over symptoms of enlarged male breasts which gives them a feminine appearance.
Fortunately in 1999 Merle Yost, a psychologist who suffered with the condition himself, created the website Gynecomastia.org. He collaborated with gynecomastia specialist Dr. Delgado from the onset in what became the world’s best resource for information on gynecomastia. Besides offering valuable information through blogs, press releases and articles posted by member doctors, there is a vast amount of before and after pictures, and a directory of gynecomastia surgeons listed by state.
However, the most popular aspect of the site are the forums. The forums allow members who join (at no cost) to address issues, ask questions of each other and member doctors. Many share stories of how gynecomastia has affected their life and their journey to resolution, in most cases by male breast reduction surgery. They share pros and cons of their experience from beginning to end and many times their opinion of their surgeon. The support men receive from each other is invaluable. They finally have found a place they feel safe in sharing a nightmare they thought they had to face alone.
Having treated men for years with gynecomastia, Dr. Delgado referred many patients to the site for additional support, the positive feedback he got encouraged him to take over the maintenance and ownership of the site in 2010 when Merle Yost stepped down. Knowing the value the site has had through the years, Dr. Delgado wanted to maintain its integrity, and keep the membership at no cost to the forum members. There is a membership fee to the participating surgeons listed in the directory which covers the maintenance of the site and ensures only Board Certified Plastic Surgeons who have a true interest in gynecomastia are members.
Posted on: April 30th, 2013
By: Miguel A. Delgado Jr., MD
6 months After Stage One Surgery
San Francisco, California-
Gynecomastia breasts (also known as moobs) comes in many different forms, from minor to severe. Each case is unique and needs to be evaluated as such.
For the fortunate men that have what is known as “pseudo-gynecomastia”, liposuction alone may be possible, for that condition is caused by fat alone and does not include breast tissue.
Then for the man that has only a mild to moderate case, it is possible for them to have a less invasive procedure known as the “Light Pull-through Procedure”, see details in the blog dated October 27, 2010.
For the moderate to severe cases, it is sometimes recommended that the surgery be done in two separate stages, allowing the patient to heal from the first surgery for approximately 4 to 6 months so that the blood flow can reestablish itself underneath the nipple-areolar complex. At the time of the initial consultation, it will be possible for Dr. Delgado to advise the patient if a second stage, also known as the peri-areolar lift, may be necessary to get optimal results. The second stage is usually done as an office procedure under local anesthesia with a fee of about $2500 to $2800, but as mentioned before each case is individual and the secondary surgery will depend on how much skin and laxity is present.
2 Weeks After Stage Two Surgery
Posted on: April 15th, 2013
By: Miguel A. Delgado Jr., MD
This 55-year-old man suffers from adolescent gynecomastia. He underwent glandular excision and suction-assisted lipectomy of his chest, flanks and abdomen. From the right flank, I removed 1325cc of total fat, 1175cc from the left flank, 2650cc from the abdomen, 475cc from the right side of the chest and 450cc from the left side, bringing the total amount of fat removed to 6075cc.
San Jose patients ask if they can combine more elective surgical procedures to their gynecomastia surgery. Combining procedures is very common, most popular is the addition of more liposuction to the abdomen, love handles or lower armpit area and/or back. Having a secondary surgical procedure saves money and the recovery time will be the same. Adding areas of liposuction to the upper torso gives Dr. Delgado the ability to get a more sculpted result.
Due to busy work schedules, it is not unusual for some San Francisco Bay Area men to ask if unrelated cosmetic plastic surgeries can be done at the same time as their male breast reduction surgery, and the answer is “absolutely!” Today longer procedures are quite common and considered extremely safe due to advances in anesthesia and surgical technique. Marin Cosmetic Surgery Center has all state of the art equipment and a highly trained staff allowing patients to combine such surgeries as eyelid surgery to their moob reduction surgery. Each patient is different, and a personal consultation is necessary to determine how much surgery can be done at one time. In addition to getting an outstanding surgical result, safety is the main concern for each patient. At the time of the initial consultation, Dr. Delgado is happy to discuss all surgical desires of his male breast reduction patients.
Posted on: March 30th, 2013
By: Miguel A. Delgado Jr., MD
Before and After Gynecomastia Surgery
This question is asked frequently by San Francisco Bay Area men, and the answer is; rarely will liposuction alone get rid of man boobs. True gynecomastia is a combination of fat and breast tissue. Liposuction will only effectively remove fat. Breast tissue is too dense to go through a cannula. There are many surgeons who attempt to remove moobs by liposuction alone, they leave behind the breast tissue which now without the surrounding fat may be even more apparent.
I would say that 35% to 40% of my male breast reduction cases are “redo” surgeries where the original surgeon used liposuction alone. This presents a more difficult “redo” surgery because now there is scar tissue making dissection more difficult and the skin may have lost much of its elasticity. This is especially frustrating for the patient who will have to go through another surgery involving more expense and recovery time and maybe not the result that could have been obtained if breast tissue had been excised in the original surgery.
There are instances when liposuction is a great tool, but mostly it should be used for touch up procedures, to extract and/or inject fat. In the rare case where the male breast is caused by fat alone, liposuction may be very effective. This is not considered “true gynecomastia” however; it is referred to as “pseudo-gynecomastia”. In many cases, pseudo-gynecomastia can be reversed with weight loss if the skin has not been overly stretched.
In order to avoid needing a “redo” surgery, be sure to find a Board Certified Plastic Surgeon that specializes in gynecomastia surgery. Look at the surgeons before and after photos, and ask questions as to the method of surgery to be used.
Posted on: March 15th, 2013
By: Miguel A. Delgado Jr., MD
Gynecomastia Surgery Continues to Rise
Each year the American Society of Plastic Surgeons (ASPS) reports statistics on the amount of plastic surgeries performed for the previous year. They look at the overall cosmetic and reconstructive surgeries and report which procedures have had an increase or decrease. For the year of 2012, it has been reported that things are quite stable.
Cosmetic procedures were up 5%, but there was a 2% drop in cosmetic surgical procedures. A rise of 6% in minimally invasive procedures such as Botox and injectable fillers accounts for the overall increase.
The treatment of male breast development, gynecomastia, also known as moobs, is one of the largest increases in body contouring surgeries for Northern California men as well as across the nation. Gynecomastia surgery had a 5% increase in 2012 over the previous year. Awareness and acceptance of male breast reduction surgery is attributed to this increase.