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Category: Gynecomastia consultation

Gynecomastia Surgery After Weight Loss


After significant weight loss, gynecomastia sufferers have an additional issue to deal with. Besides reducing male breasts, there is now redundant, tissue, fat, and skin requiring more contouring and skilled techniques.

2 Stage Gynecomastia Surgery

Some men are candidates for the 2 stage procedure. The first stage removes breast tissue and fat under the skin. The second stage is a minor procedure that can be done in the office under local anesthesia. Excess skin is removed around the areola in a doughnut shape and is closed with a purse-string type sutures.

Before and After Stage One Gynecomastia Surgery

Before and After Stage One Gynecomastia Surgery


He is seen two weeks after Stage Two Surgery

Massive Weight Loss and Gynecomastia

For men who have had massive weight loss, most will likely not get desired results with the more traditional procedure of removal of fat and tissue with a hidden incision around the areola. Instead, for the more severe cases, the patient may need an incision going around the areola and a vertical incision to the breast crease creating an anchor reduction.

The anchor incision, also known as an inverted T, will leave visible scars. Most patients understand the trade-off and are accepting of the procedure in order to obtain the best breast shape.Male chest After weight Loss

Male Chest After Weight Loss

After gynecomastia surgery

After Gynecomastia Surgery


Many patients find their incisions heal nicely and are comfortable with their results. For others, it is possible they may develop keloid scars which are raised and can be quite noticeable.

Scar Care After Gynecomastia Surgery

Today there are several different treatments available to help with scar management. The experienced board certified gynecomastia specialist will use deep suturing techniques to reduce tension on the skin that helps avoid keloids. Once the incision has healed silicone sheeting is applied, it will help keep the skin hydrated, which helps in scar control.

Additional preventive measures include; steroid injections, scar massage, and laser treatment such as the Palomar Laser. As a last option, scar revision may be done, but that will involve another incision.

Call Today!

Gynecomastia patients are encouraged to call Dr. Miguel Delgado at (415) 898-4161 for a consultation.

Gynecomastia Consultation Questions

Gynecomastia questions

For men who have hidden the embarrassing condition of female type breasts, making an appointment to see a gynecomastia specialist is a big first step. It is understandable for gynecomastia patients to be anxious and therefore, Miguel Delgado, M.D. recommends writing down all questions as it is easy to forget what you want to ask. However, Dr. Delgado wants his patients to know that he is easily accessible and encourages his patients to call (415) 898-4161 anytime they have a question.

The following questions are some you may want to consider:

1. Is your gynecomastia specialist board certified?
2. Is the anesthesiologist board certified?
3. What type of anesthesia is used?
4. If surgery is to be done at a surgery center, is it accredited?
5. How many years has your specialist been performing male breast reduction, and how many each year?
6. What caused my gynecomastia?
7. How long will my male breast reduction last, and will it come back?
8. How would my surgery be done?
9. Will liposuction alone work for me?
10. Where will the incisions be? Will the scars show?
11. What prescriptions will I need? What are they for?
12. How long after surgery before I can go home?
13. Will I have drains?
14. How long will I need to wear a compression vest?
15. How much time do I need to take off work?
16. When can I start lifting weights?
17. What risks does the surgery have?
18. How are complications handled?
19. Can I see before and after pictures of gynecomastia patients?
20. What is the cost?

Getting the answers to all of your questions will ease your anxiety about the gynecomastia procedure and ensure a positive experience. Dr. Delgado states that the only complaint he has received from his male breast reduction patients is that they wish they had their surgery a long time ago! Start today by calling (415) 898-4161 for your initial consultation!

Gynecomastia Pinch Test a Self Diagnosis

Medical Author: Miguel Delgado, M.D.

Gynecomastia Pinch Test

In addition to being known as “man boobs” or “moobs,” gynecomastia results in the development of male breast tissue that resemble those of women. There are, however, some cases of gynecomastia that are not caused by breast disorders. Man boobs can sometimes be caused by overweight individuals. It is possible to determine whether the gynecomastia is true gynecomastia or pseudo gynecomastia by performing the gynecomastia pinch test. In order to reduce enlarged male breasts, it is important to get the correct diagnosis.

Gynecomastia: What Is It?

Generally, gynecomastia occurs when breast tissue grows larger because of hormonal imbalances. A decrease in testosterone levels and an increase in estrogen levels can result in this imbalance. In addition to hormonal imbalance, there are several factors that can cause it:

  • A number of medical conditions
  • Prescription drugs
  • A person’s age
  • The genetic component
  • A significant reduction in body weight
  • Use of drugs
  • Abuse of anabolic steroids.

Males who are affected by gynecomastia may experience one-sided breast growth or it may affect both sides. A gynecomastia pinch test will not always identify the specific cause of man boobs but can determine whether it is fat or breast glands.

Gynecomastia Before And After

Diagnosing Gynecomastia with the Gynecomastia Pinch Test

It is recommended that you consult a gynecomastia specialist, such as Dr. Delgado if you are experiencing male breast enlargement.   A comprehensive physical examination and a review of your medical history will be required for the diagnosis of gynecomastia. During the consultation, the doctor will determine whether gynecomastia symptoms are caused by hormonal factors or if they are caused by drug-induced gynecomastia symptoms. Drugs such as anabolic steroids and prescription drugs are commonly used.

To determine whether the condition is true gynecomastia or pseudogynecomastia, a physical examination and gynecomastia pinch test is conducted. The procedure will require you to lie on your back. Using his forefinger and thumb, the doctor will examine the breast tissue. True gynecomastia is characterized by a rubbery or firm mass of disk-shaped tissue under the nipple. When no such tissue is present except for spongy soft fat tissue, the gynecomastia pinch test can determine whether the diagnosis is pseudogynecomastia.

A number of additional tests may be performed to assist with the diagnosis of gynecomastia and determine the cause if there is one:

  • The purpose of a mammogram is to obtain a radiologic image of the breast tissue
  • Measurement of hormone levels by endocrine hormone tests.
  • Evaluation of kidney, liver, and thyroid function by blood tests.

Symptoms and Diagnosis of Gynecomastia

The American Society of Plastic Surgeons categorizes gynecomastia into four grades based on the severity in adolescents and adults.

Gynecomastia is characterized by the following symptoms:

  • Breast pain or swelling
  • Tenderness of the breast tissue
  • Under the nipple, movable tissue can be observed
  • Nipple discharge that is bloody
  • Fluid is secreted in a manner similar to breast milk
  • Underarms and nipples are itchy
  • Having a sudden feeling of unwellness
  • Sex drive changes and mood swings.

The gynecomastia pinch test can determine pseudogynecomastia or excess fat build up.

Gynecomastia: Four Grades

Grade 1 – The breast tissue enlargement is minor and not very noticeable. Slight swelling is present, but excess skin is not present.

Grade 2 – Moderate breast enlargement that is unnoticeable when clothing is worn loosely. Excess skin is not present.

Grade 3 – There is a moderate to severe degree of breast enlargement that is noticeable. As the swelling increases, excess skin may develop, resulting in a crease in the breast.

Grade 4.  There is a significant and severe enlargement of the breast tissue. A significant amount of excess skin gives the breasts a feminine appearance, with a noticeable sag and crease.

Gynecomastia Before And After Photo

What is the treatment for gynecomastia?

Gynecomastia surgery is the only recognized permanent solution and the best treatment for gynecomastia. The breast tissue will not return after male breast reduction surgery. A male breast reduction surgery can be performed in a variety of ways, depending on the severity of the condition:

  • The standard treatment for gynecomastia consists of the excision of the breast tissue along with liposuction that remove excess fat. It is widely recognized that this technique is the most effective method for the reduction of male breast enlargement. It is performed by making an incision around the lower edge of the areola known as a Webster incision.  The breast glandular tissue is surgically excised and the fat is removed by liposuction.  As a result, the chest will appear masculine and sculpted.
  • The two stages technique is used in the treatment of patients with moderate skin laxity or grade 3 gynecomastia. The first stage is described above, and the second stage is the periareolar lift, which is typically done four to six months after the first procedure. This allows the blood supply to re-establish on the nipple-areola, reducing the risk of complications. In this stage, skin reduction is performed by making an incision around the edge of the areola. This is followed by a second larger incision, which makes the tissue between the incisions doughnut-shaped. The excess skin and tissue are removed, and the incisions are sutured closed.

Gynecomastia Before And After, Free Nipple Double Incision Mastectomy for grade 4 gynecomastia

  • For all grade 4 and some grade 3 gynecomastia symptoms, a double incision mastectomy is recommended. Nipples and areola complexes are removed as a skin graft. Depending on the amount of redundant tissue and excess skin, the next stage involves making an incision from the breast fold to the armpit.

    The back of the table is raised to put the patient into a sitting position to see the effects of gravity on the excess skin. The result is a tight and contoured chest that can be created by removing the precise amount of skin. The new nipple-areola complex position is calculated and attached, as a skin graft to ensure a well-balanced and aesthetically correct position.

How to Choose a Plastic Surgeon

Miguel Delgado, M.D - Cosmetic and Plastic Surgeon and Gynecomastia Expert

Gynecomastia surgery is performed by a variety of surgeons. If you are considering gynecomastia surgery, make sure your surgeon has board certification in plastic surgery, like Dr. Delgado, who specializes in gynecomastia.

Complete Dr. Delgado’s inquiry form to learn more about gynecomastia plastic surgery procedures.

A member of the American Society of Plastic Surgery and Aesthetic Society, Miguel Delgado, M.D., F.A.C.S, is a highly regarded San Francisco Board-Certified Plastic Surgeon. Dedicated solely to cosmetic surgery, Dr. Delgado has a surgical practice exclusively in this field. In addition to specializing in gynecomastia surgery, he also manages, the largest and oldest gynecomastia forum dedicated to supporting, educating, and providing solutions to men suffering from breast enlargement. Practicing medicine in San Francisco for 30 years, Dr. Delgado celebrates his 30th year in practice. He was voted the Best Plastic Surgeon in San Francisco Magazine and Castle Connely’s “Top Surgeons” from 2018 to 2022.

 Frequently Asked Questions

1. How do you do a pinch test for gynecomastia?

A gynecomastia pinch test is performed by pinching the deep tissue under the nipple in the male breasts. Gynecomastia breast tissue feels like firm tissue but the excess fat is soft and spongy. However, a more accurate gynecomastia diagnosis is performed by a board-certified plastic surgeon to evaluate the breast size and its contents.

2. How do I know if it’s gyno or fat?

The gynecomastia pinch test is a gynecomastia physical exam to diagnose gynecomastia from excess fat or psudogynecomastia.

3. How does gynecomastia feel?

Enlarged breast tissue feels firm to very firm. It can also feel like thick fibrous network of tissue. This thick fibrous tissue is still considered gynecomastia tissue and be must surgically removed since liposuction will not work.

4.Does gynecomastia hurt when you touch it?

Men who experience gynecomastia can have breast pain and discomfort. This true for ment who have glandular gynecomasia and not pseudogynecomastia. Gynecomastia or manboobs caused by fat build up is not painful.

Read Reviews When Choosing Your Gynecomastia Surgeon


Miguel A. Delgado, M.D.

Miguel A. Delgado, M.D.
Gynecomastia Specialist
★★★★★ Ratings: 4.74 -118 Reviews

Gynecomastia Surgeons are Rated

Trying to find the right gynecomastia surgeon can be a daunting experience. All surgeons claim they are experts on their websites,  and, of course, that is to be expected. So how do men find the right gynecomastia surgeon for their male breast reduction procedure?

Men are understandably embarrassed by their man boobs and don’t usually share their condition with others, in fact, most have spent many years trying to hide their chests. So asking for a referral most likely is not going to happen!

Read the Reviews

Miguel Delgado, M.D. suggests that men look for reviews on the internet written by men who have gone through the surgery. There are many sites that offer unbiased opinions directly from the patients.

Some of these sites are:


There are many more out there, so do your homework and see what other patients have to say about the surgeons you are considering. Remember though, no one is perfect, and most Vitals logodoctors may have one or two bad reviews, do not let that be your deciding factor. Look at the overall reviews for a good indication of the qualifications of the surgeon. Some patients have unrealistic expectations and are never satisfied.




Reviews can give you a plethora amount of information before you even set foot in the doctor’s office. Patients give ratings such as:

1. Ease of making appointments

2. Friendliness of the staff

3. Average wait time

4.Does the doctor answer all your questions?

5. Do you feel rushed?

6. Satisfaction of surgery results

7. Good follow up care

All of these points are very important and a big advantage in helping you choose your surgeon.

Do Your Homework!

In addition to reading reviews, an excellent website is has forums where men share stories of their surgery experiences and what they thought of their surgeon.

When doing your homework, be sure that the surgeon of your choice is Board Certified in Plastic Surgery and specializes in gynecomastia.

Miguel Delgado, M.D. is a Board Certified Plastic Surgeon and has specialized in gynecomastia surgery since 1988, and is up to date with all of the latest techniques for male breast reduction surgery. View before and after pictures of many of his patients here.

Miguel Delgado, M.D. has produced multiple videos on gynecomastia surgery and they can be viewed here.

Call Today!

If you are ready to discuss your surgery options or just have questions, call (415 898-4161) or email ([email protected])today for a consultation with Miguel Delgado, M.D.

The Gynecomastia Consultation, What to Expect

Miguel A. Delgado, Jr., M.D. - Gynecomastia Specialist

Miguel A. Delgado, Jr., M.D.
Gynecomastia Specialist

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.

How to Lose Man Boobs


Before and After Gynecomastia

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. Bodybuilders

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 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 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.

What Procedures Can be Combined With Gynecomastia Surgery?

gynecomastia patient with liposuction

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 gynecomastia 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 male breast 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.

What You Need to Know Before Gynecomastia Surgery


Miguel A. Delgado, Jr., M.D.

Male breast reduction surgery is now the 4th most popular cosmetic surgical procedure for men according to the American Society of Plastic Surgeons. The percentage of cases has been increasing each year as more men become aware that surgery is an option to get rid of their man boobs.

Once the decision is made to pursue surgery, the gynecomastia patient needs to find a cosmetic plastic surgeon that is Board Certified in Plastic Surgery. Look for one that specializes in gynecomastia surgery. The surgeon should be able to present you with many before and after pictures of their patients. Ask how the procedure will be done. Most gynecomastia procedures need to have liposuction and excision of breast tissue in order to get the best result. In some cases liposuction alone can give a good result, but this is for the patient who has what is known as “pseudo-gynecomastia” which means the gynecomastia is caused by fat alone. I would say at least 30% of my gynecomastia surgery cases are “redo” cases where liposuction alone was done leaving behind breast tissue.  Having to redo the surgery is much more difficult for now there is scar tissue to deal with and the skin may have lost some of its elasticity.

Lastly in looking for a surgeon  in San Jose or any San Francisco Bay Area, ask where the procedure will be performed, check to see  if the facility is accredited and if the anesthesiologist is Board Certified.

How Will I Look After Gynecomastia Surgery?


male breast reduction surgery before and after

Before and After Gynecomastia Surgery

A big concern of San Francisco Bay Area men contemplating male breast reduction surgery is what they will look like after surgery. There isn’t a “one size fits all” answer. Each patient is different, depending on the degree of the gynecomastia breast. Age can be a factor, younger men usually have better skin contraction. Men with moderate to severe gynecomastia, may need to have a two stage procedure for the best result.

During the consultation, it is not unusual to hear a man request that his chest be made as flat as possible. This is understandable for the man that has been suffering with man boobs for many years. A totally flat chest does not look normal, it is important that it is sculpted and has somewhat a natural contour. Dr. Delgado shows his patients many before and after pictures; he does his best to accurately describe what the outcome will be for each individual patient.

What are the Surgical Risks for Gynecomastia Surgery?

Many San Francisco Bay Area men have asked what the risks for gynecomastia surgery are. One way of reducing risks is having surgery in a private surgery center such as Marin Cosmetic Surgery Center where quality control and less ongoing surgeries means less chance of infection. Risks for all surgeries  include:

• Bleeding (hematoma)

• Infection

• Blood clots

• Adverse events related to anesthesia

Pre op gynecomastia - photo

Pre operative gynecomastia


Post operative hematoma - photo

Post operative hematoma


Postoperative gynecomastia - photo

2 months after evacuation

Specifically for male breast reduction surgery, the most common complication would be a hematoma, the additional risks would be:

• Breast asymmetry

• Nipple inversion

• Loss of sensation

• Scarring

• Seroma

• Loose skin

It is imperative to keep your gynecomastia surgeon informed of any noticeable changes such as excessive swelling, bleeding or bruising. It is how complications are managed that determines the outcome. When treated immediately there are almost no permanent negative results.

SHIRTLESS IS A GOOD THING line-border - pic See how Gynecomastia Surgery Has Changed The Lives Of Men

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Dr. Delgado has offices in Marin and San Francisco for your convenience


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450 Sutter Street Suite 2433
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(650) 405-0154




165 Rowland Way Suite 300
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(650) 484-5416


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