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
