Chest Wall Contouring for Gynecomastia

Male patients for the treatment of breast growth [gynecomastia] often request chest wall contouring. Enlarged breasts – usually hormonally related, can afflict both teen-age boys and mature men. However, gynecomastia may also be a side effect of prescribed medications or, infrequently, a primary breast tumor. Surgical techniques are designed to reduce the breast size and contour the breast – no attempt is made to remove all of the breast tissue.

In contrast to female breast augmentation, the goal of chest wall contouring is to distract attention from the chest’s pre-operative appearance and attendant post-operative scars. The ideal goal of successful chest wall contouring is a patient who is comfortable enough to expose himself publicly and not be restricted to exposing his chest in his doctor’s exam room.

There are four goals in considering chest wall contouring. First, the solution to contouring is to establish what the normal male chest dimensions are. Interestingly, although men are, on average, 4 inches taller and 30 pounds heavier than women are, the supra-sternal notch-to-nipple length is the same in both sexes [Fig1]. Second, male hormones increase muscle development, fibro-fatty thickness, body hair growth, and weight gain. Third, surgical scars on the chest wall are unpredictable and therefore located judiciously. Even then, chest scars are a leap of faith. Fourth, the surgeon must have a selection of surgical options to address the wide range gynecomastia presentations. As surgeons, we have very little control over the first three factors. However, we do have some control over the surgical technique and location of the incision sites.

For the past 10 years, I have employed three different surgical options for chest wall contouring based on pre-operative size, shape, asymmetry and underlying muscle development.

For small chest wall gynecomastia, elderly patients, and men with overriding comorbid problems [diabetes, bleeding problems, high blood pressure, liver problems], liposuction alone is often effective.