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Dr. Delgado—The Gynecomastia Specialist

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  • Internationally Respected Gynecomastia Expert
  • Featured on Worldwide Gynecomastia Treatment Documentaries
  • Medical Director of Gynecomastia.org
  • Over 5,000 Gynecomastia Patients Treated
  • Avg. of 150 Male Breast Reductions Annually
  • Approx. 60% Primary Cases & 40% Revision Cases
  • Virtual Consultations for Out-of-Town Patients

Dr. Miguel Delgado is a board-certified plastic surgeon and world-renowned gynecomastia expert. He has treated thousands of men and boys experiencing this condition, including many who have traveled for surgery from outside of the San Francisco Bay Area. In addition to resolving gynecomastia for first-time patients, a large part of his male breast reduction practice comprises revision surgeries for men who are unhappy with their outcome from other practices. Dr. Delgado is also the medical director of Gynecomastia.org—the largest gynecomastia forum in the world. He dedicates most of his time to helping men and boys who are seeking treatment for this condition.

To learn all about gynecomastia and the various treatment options available, we invite you to browse the informative sections provided on this page. If you have any questions or concerns, or if you are interested in scheduling a consultation with Dr. Delgado to discover what can be done to resolve your gynecomastia, please feel free to contact our practice online or by telephone today.

What Is Gynecomastia?

Gynecomastia—which is often called “man boobs” or “moobs” in the media—is a condition characterized by enlarged male breast tissue that creates the appearance of breasts in boys and men. In addition to puffy or swollen breasts, common symptoms of gynecomastia include breast tenderness and protrusion of the nipples. These concerns usually affect both sides of the chest (sometimes to varying degrees), but it is possible for only one breast to present with gynecomastia.

Did You Know? Gynecomastia is also referred to as:

  • Gyno
  • Gyneco
  • Gynaecomastia
  • Ginecomastia
  • Gynecomazia
  • Man Boobs
  • Moobs

Most people are unaware of how prevalent gynecomastia is due to the fact that men and boys who suffer from it are extremely embarrassed and will do their best to hide the condition. Many will try to conceal their chests with loose-fitting shirts or several layers of clothing, and some even go to the point of limiting their activities at swimming pools, the beach, and the gym—as well as their personal relationships.

Fortunately, gynecomastia can be effectively addressed with surgery, quite often via minimally invasive means. Thanks to public education, gynecomastia surgery (male breast reduction) continues to gain popularity, and receptiveness to treatment has become acceptable. In fact, male breast reduction is one of the most popular plastic surgeries performed on men in the United States each year.

What Causes Gynecomastia?

When hormonal levels of testosterone and estrogen surge during puberty, low testosterone or high estrogen (the female hormone) can bring on female-like breast tissue. This is the primary cause of gynecomastia. In over 90 percent of cases, gynecomastia experienced as a result of puberty will resolve on its own. However, scientific studies show that if breast gland development has not resolved within two years, then it is not likely to resolve at all.

Another cause of male breasts can be attributed to the use of some drugs and medications, especially steroids. Hormone-secreting tumors, although rare, can also cause some enlargement. Once men start approaching their sixties, testosterone levels naturally decrease, which can result in breast development. This is commonly known today as “low T” or andropause in men, which is similar to menopause in women.

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Gynecomastia vs. Pseudogynecomastia

Gynecomastia is defined by breast gland development. In contrast, pseudogynecomastia is due to fat accumulation, with no real gland mass present.

Gynecomastia most commonly develops during puberty and resolves within two years in 90 percent of cases. In the remaining 10 percent, the gynecomastia is present for life. As previously mentioned, the next most common cause after puberty is steroid-induced gynecomastia, which occurs in bodybuilders or the novice. Additional, less common causes are other drugs and, rarely, hormone-secreting tumors. Male breast reduction surgery is a cure for gynecomastia.

Pseudogynecomastia is due to fat in the chest and, in general, the entire body is usually overweight. Since the size of the chest will change with weight fluctuation, an enlarged chest caused by pseudogynecomastia can typically be resolved with weight loss.

In some instances, males can have gynecomastia with a variable amount of fat content. Sometimes it is difficult to diagnose this other than by the history of the condition.

Grades of Gynecomastia – How Severe Is My Gynecomastia?

Gynecomastia has four grade conditions, all of which are explained below.

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Grades 1 & 2

Grade 1 is often referred to as “puffy nipples,” and the breast gland development is centered around the nipple area. Grade 2 is the most common type of male breast enlargement—the tissue extends beyond the central nipple-areola complex and fills out the chest region more extensively. Both Grades 1 and 2 generally respond excellently to breast gland excision with liposuction through a small incision in the inferior portion of the areola (Webster incision). In addition, Grade 1 patients may be good candidates for the “pull-through” technique.

Grade 3

Grade 3 gynecomastia is characterized by skin laxity—the skin begins to sag from the fold (inframammary fold or IF). The treatment of this grade could be gland-excision with liposuction through a Webster incision, a superior crescent lift, or a two-stage procedure. There is more variability with this grade, and the treatment depends on the quality of the skin and age of the patient.

Grade 4

Grade 4 is defined by severe skin laxity. This is the most complex of cases because the nipple-areola complex is turned downward. The only options are a two-stage procedure or a double-incision mastectomy with a free-nipple graft.

A Day in the Life of a Male with Gynecomastia

Every day is a struggle for the man that lives with gynecomastia. Each day typically starts with the unwelcome sight of his chest in the shower, often creating a destructive effect on ego and self-esteem. Men have learned to pick their clothing carefully so they are able to conceal their chests as best they can. Usually, they will opt for several layers of clothing, such as: shirts with pockets, bulky sweaters, jackets, and dark colors to help conceal enlarged breasts. Most avoid lightweight fabrics and T-shirts, as they are too revealing.

The locker room at school poses a challenge with sports, swimming, showers, and any other type of shirtless activity, usually causing young men with gynecomastia to try to avoid such situations entirely.

For men working in a climate-controlled environment dictating a shirt, tie, and jacket, going to work is not a problem. However, there are many men who have jobs outdoors doing physical labor, which can be miserable if the weather is hot. Gynecomastia sufferers will subject themselves to extreme physical discomfort in order to avoid the psychological torture caused by teasing and insensitive comments from their peers and co-workers.

Once the day is over, a man will often consider it to be a good day if there were no comments about his chest. After the workweek ends, then the men get to deal with family outings, swimming pools, barbecues, dates, sports, and the beach. The gynecomastia sufferer must make special efforts to conceal his chest from others. Many times, it is easier to avoid the events altogether.

Feelings of shame, embarrassment, guilt, and inadequacy torment men with gynecomastia, and for most, it is an ever-present burden.

Are There Any Gynecomastia Exercises That Work?

The short answer is NO—building up muscle or aerobic fat-burning exercises will not reduce breast gland! However, what will exercise do? Building up the pectoralis muscle may help camouflage the gland and blend in the contour. On the other hand, many patients complain that doing so pushes out the breast gland and can make the condition look worse, especially in a t-shirt. For those who are overweight, fat-burning exercises can reduce the fat content around the breast tissue, which may improve the appearance of the chest. Patients consistently report that when weight is lost, the chest improves, and when gained, it looks worse—but the gland does not disappear.

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Can Liposuction Alone Be Used to Treat Gynecomastia?

Few clinical studies support liposuction as an effective treatment for gynecomastia, and Dr. Delgado can confirm (from his many years of experience) that when liposuction alone is performed, a flat chest is not successfully accomplished. Liposuction by itself can remove the fat around the gland, but will leave an unnatural bulb (the gland) which must be surgically removed. Liposuction—such as laser, ultrasound, Vaser, Power-assisted liposuction, and Smart-Liposuction—for reduction of the male breast will not resolve the gynecomastia condition completely. A successful gynecomastia surgery will always include gland removal.

In short, liposuction alone can be a good treatment for pseudogynecomastia, but not for true gynecomastia. Both liposuction and surgical excision of the glandular tissue must be performed to properly treat the condition.

What Are My Gynecomastia Surgery Options?

The first step to having a successful surgical experience is being diagnosed by a highly skilled gynecomastia specialist. The second step is to determine the best surgical technique(s) to treat your individual condition. Each gynecomastia case differs in complexity and needs to have its own surgical plan. Detailed below are the various male breast reduction surgical techniques Dr. Delgado can employ to treat gynecomastia.

  • Breast Gland Excision with Liposuction – The Standard Gynecomastia Operation in 90% of Men

    Breast gland excision with liposuction is the most common and successful surgical technique for the treatment of gynecomastia. This technique is used for 85–90 percent of gynecomastia patients.

    To begin the procedure, the patient is marked in the pre-op room in a standing position, then taken to the operating room. General anesthesia is administered, and the surgical site is prepared for sterilization. The chest and armpit area is then infused with “tumescent fluid,” which is a special fluid containing epinephrine that causes vaso-constriction and drastically reduces bleeding. This solution also contains an anesthetic agent—lidocaine—that reduces pain during and after surgery. 

    Liposuction is performed in the chest and armpit region. Once complete, a half-moon shaped incision (Webster incision) is made around the lower half of the areola, which is the access point to remove the breast gland tissue. The skin is then undermined to release the breast tissue in a wide fashion. Next, the patient is sat up to 90 degrees, simulating the standing position. A lighted retractor is then placed, and the gynecomastia gland is cut in half and removed so a nice, flat contour is achieved. 

    The pocket is then washed out, bleeding is controlled, a suction drain is placed, and the incision is closed. Lastly, the treatment area is secured with foam padding, as well as a compression garment. Blood pressure is also closely controlled after surgery.

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  • Pull-Through Technique

    For some patients who have minimal gynecomastia breast gland, the “Pull-Through Technique” is an option. This is achieved by a small incision of three to four millimeters at the bottom of the areola. The skin is undermined with narrow, small instruments, and the gland is pulled out of the small incision. The surrounding tissue is then blended-in for smoothness. 

    This is a blind procedure because the incision is too small to insert a normal-sized lighted retractor. Dr. Delgado uses the pull-through technique on a very limited Grade 1–2 gynecomastia case basis. A crater deformity can result if this approach is not done properly, or if the patient is a poor pull-through candidate. Dr. Delgado employs this approach the least often.

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  • Male Breast Reduction with Superior Crescent Lift

    Male breast reduction with a superior crescent lift is a good technique for men who have Grade 3 gynecomastia—the skin is loose and the nipple-areola complex has lost its normal position and is now lower. The gland excision with liposuction is the same procedure as explained above. Instead of the Webster incision at the bottom half of the areola, however, the incision is made at the top half. The lift results from a half-moon section of skin being removed above the incision and then sutured together. This can easily elevate the areola two to three centimeters, and it will also raise the lower skin along the crease. That said, the icision does not heal as nicely as the Webster incision due the tension applied to lift the area.

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  • Two-Stage Procedure for Moderately Severe Gynecomastia

    Two-stage gynecomastia correction is for men who have male breast gland with skin laxity. This technique starts with the “standard” gland excision with liposuction. The chest can then be flattened, but the skin will have laxity. Sometimes, a superior crescent lift is added to this step. The surgery site is allowed to heal, ultimately enabling the degree of extra loose skin to be determined. This takes four to six months before the next operation is performed. 

    The second stage is performed under local anesthesia in the office. The second surgery is a periareolar skin resection. An incision is made around the areola, and a second doughnut-shaped incision is made wider to excise a section of skin. The outer circle is then purse-stringed down to the smaller areola, which tightens the skin but is limited by the outer circle diameter. The second stage is great for achieving tighter skin and avoiding a large incision like the double incision mastectomy (which is described next).

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  • Double Incision Mastectomy with Free Nipple Grafting

    The double incision mastectomy is a standard technique for Grade 4 severe gynecomastia. In many cases, this is the only procedure that will provide a good result. A double incision mastectomy will sculpt a tight chest with good contour and will reposition the nipple-areola complex higher and with a smaller diameter. The incision will often taper along the armpit region and sometimes toward the back, depending on the extent of the loose skin. The goal is to have a smooth transition of the contour from the chest through the axilla, and taper toward the back if necessary.

    The disadvantage to the double incision mastectomy is the incision that runs along the fold of the chest. That said, this incision fades to some degree over a year, and some patients hide the scar with an artistic tattoo! This is a great procedure for the right candidate, and Dr. Delgado has had 100 percent satisfaction from patients with this technique.

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What Is Recovery After Gynecomastia Surgery Like?

After gynecomastia surgery, you will likely be able to drive a car in about two to three days, and return to school or work within five to seven days—unless the work is physically demanding, which will typically require 10-14 days of recovery. Formal exercise needs to be avoided for four to six weeks. Dr. Delgado usually allows lower body exercise at four weeks and full work-outs starting at six weeks. A compression garment is worn for six weeks to reduce swelling and improve the chest contour. The internal healing takes longer for the underlying tissue because the skin has to shrink and adhere down. This occurs by scarring together, which causes firmness to the touch. This takes approximately two to three months to resolve.

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Will I Have Scars After Gynecomastia Surgery?

Yes, you will have incision scars after gynecomastia surgery, which will depend on the technique performed:

Pull-Through Method – The pull-through technique is a 3–4mm incision, and the scar is typically very difficult to see after complete healing.

Gland Excision with Liposuction – This is the most common procedure and generally results in an excellent scar. Dr. Delgado has been asked to revise only a few scars over his many years in practice. It is the same location as breast augmentation in women, which again is a superior scar.

Superior Crescent Lift – The superior lift incision is more challenging and may result in diminished scar quality in comparison to gland excision with liposuction. That said, scar revisions can often be helpful in creating a better appearance.

Two-Stage Procedure – The two-stage periareolar incision is usually a good-quality scar because a permanent GORE-TEX® Suture is used to prevent spreading of the incision.

Double Incision Mastectomy – The double incision mastectomy with a free nipple graft is the longest incision, which is located in the lower breast crease.

What Is the Cost of Gynecomastia Surgery?

As a customizable procedure, the cost of gyneocmastia at our San Francisco and Marin County practice will vary based on the specific needs and goals of the patient. This cost includes surgeon’s fees, anesthesia, operating facility, compression garments, and all follow-up care. Exact pricing for male breast reduction surgery can be determined with a virtual consultation or a personal consultation.

Gynecomastia surgery usually requires general anesthesia, which is performed by a board-certified anesthesiologist at Marin Cosmetic Surgery Center. When comparing costs, be sure your plastic surgeon and anesthesiologist are both board-certified. Some practices perform gynecomastia surgery under local anesthesia, or sometimes IV sedation. This type of anesthesia is less expensive but can be significantly more painful and result in less control over the operation—for example, controlling bleeding and achieving an excellent outcome. Dr. Delgado operates at the Marin Cosmetic Surgery Center, which is Federally- and State-accredited. In addition, the staff are hand-picked and trained by Dr. Delgado to ensure the highest quality.

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Why Choose Dr. Delgado for Gynecomastia Surgery?

Dr. Delgado has focused on gynecomastia surgery since 1990. Indisputably an authority in the surgical resolution of gynecomastia, he has performed thousands of male breast reduction surgeries and has been featured treating patients from all over the world on international and local television documentaries and programs. Dr. Delgado is contacted frequently by other physicians for expert advice, and the most difficult cases are often referred to him. To enable men to consult with him from around the globe, he conducts virtual consultations daily—for both patients near and afar. His practice has evolved to providing gynecomastia revision surgery for nearly 40-plus percent of all procedures.

Dr. Delgado is the medical director of Gynecomastia.org. This is the largest gynecomastia forum website in the world. He has spent countless hours making this the best website on gynecomastia in the world!

Dr. Delgado established his own outpatient surgical facility, the Marin Cosmetic Surgery Center, in 2001. It is located on the campus of Sutter Hospital Campus in Novato, California. Having his own private surgery center allows Dr. Delgado to present to his patients the ultimate level of care in an intimate environment, while in a location adjacent to a full-service hospital. Each staff member and surgical team member has been personally chosen and trained to the highest of professional standards by Dr. Delgado, with many of his team members having been with him for over ten years. Thus evolved “The Gynecomastia Center of Excellence.”

It is Dr. Delgado’s personal mission and passion to help men who suffer from gynecomastia; he has even developed a website dedicated to focus on the concerns of men with this condition: gynecomastia-specialist.com. There, you can read more about his surgical approach for adult and teen patients, body builders, revision cases, and pseudogynecomastia.

Additional Frequently Asked Gynecomastia Questions

Is there a way to treat gynecomastia without surgery?

Advertised easy, non-surgical cures that are in the news have not been proven to be effective. There is considerable ongoing research to find ways to reverse gynecomastia without surgery, but there is not an effective consistent medical treatment at this time. Unlike true gynecomastia, however, pseudogynecomastia can be treated with diet and exercise.

During surgery, will the entire gland be removed?

In certain cases, the entire gland is removed, and sometimes only 80 to 90 percent will be removed. This is not like a cancer procedure where everything is removed without a concern for the appearance. This is a cosmetic operation—the goal is to achieve a flat and masculine chest. Therefore, Dr. Delgado is very aggressive with the removal of the gland but not at the expense of creating a crater deformity or other unwanted appearance. A pathology report is required by the State of California for any significant breast tissue. At the time of surgery, the tissue is sent to pathology and will be made available to you.

Can the breast tissue come back after surgery?

In most cases, it will not. However, the tissue can still be stimulated to grow by steroids or other medication usage. If the patient gains weight after surgery, the amount of fat content will show  on the chest and body. Due to continued hormone stimulation, Dr. Delgado has noted that for a very small number of adolescent gynecomastia patients who have surgery at a young age, recurrence of their gynecomastia can occur—but to a much smaller extent.

Is the surgery painful?

Most patients state that the surgery is not particularly painful. Usually, men find they may need pain medication for only two to three days. When the drains are removed, it can be a little uncomfortable; however, now it is less so with recent, improved techniques.

Will nipple sensation be affected?

There is always a possibility to have a change in nipple sensation with surgery. This also depends on which gynecomastia surgery is performed. Most patients do not mention any difference, but there have been some that noted a change. The previous owner of gynecomastia.org, Merle Yost, surveyed many men who had gynecomastia surgery with nipple sensation changes as one of the subjects he addresses. You can sign onto the site, gynecomastia.org, and read the comments left by post-surgical patients about the changes they have experienced with sensation changes of the nipples.

Dr. Delgado has noted that, over the past 28 years, there has been an insignificant amount of concern over nipple sensitivity. The most common issue is the normal temporary loss of sensation after surgery with the swelling in the area. This gradually returns over two to three months.

Are there risks with gynecomastia surgery?

All surgeries come with risks, and this cannot be overstated. One of the most common complications is bleeding under the skin. In the past, Dr. Delgado’s rate was about eight to nine percent of patients, but techniques have improved, and over the past three years there has been a lower hematoma rate of approximately three to four percent. If patients live more than an hour away, Dr. Delgado advises them to stay at a local hotel in the event that this may occur.

Another complication is over- or under-resection of tissue. Under-resection is treated with re-excision, but over-resection will require or fat flaps or fat injections. These are the most common procedures that Dr. Delgado performs for revision gynecomastia surgery for patients who are not satisfied from other practices.

Complications are a fact in the practice of medicine. How they are managed is what determines the outcome. With Dr. Delgado’s vast experience with gynecomastia surgery, he is very comfortable in treating complications, and the complication rate at his practice is very, very low.

What happens if I am not happy after surgery?

Having patients be extremely satisfied with their results is Dr. Delgado’s goal. If you are not happy with your results after treatment with Dr. Delgado, he will not charge you if it can be addressed with an in-office procedure. Likewise, he will not charge a fee for his services if a procedure needs to be done in the surgery center, but there may be fees for the anesthesiologist and the surgical facility. This revision policy is in effect for one year.

Contact Dr. Delgado

For more information about gynecomastia, or if you are ready to book a personal consultation or a virtual one, please contact Dr. Delgado today.

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