Monday, March 27, 2017

What Are the Grades or Severity of the Gynecomastia Condition?

Gynecomastia’s Different Grades

At least 60% of all men will have some form of gynecomastia in their lifetime. For many, it will be as they pass through puberty, but fortunately, adolescent gynecomastia usually resolves on its own within 2 months and up to 2 years. If adolescent male breasts persist beyond 2 years, it is probably permanent, and surgery will be the only solution.

adolescent gynecomastia- Sacramento, CA
adolescent gynecomastia
This 21 year old young man has suffered from adolescent gynecomastia. He had glandular excision and liposuction. His goal was to “reduce my puffy nipples.”

Gynecomastia comes in varying degrees of severity. Each case is individual and needs to be evaluated as such and will determine how surgery is to be performed.  Some men with severe gynecomastia may require surgery to be done in 2 stages.

The American Society of Plastic Surgeons (ASPS) has a scale for the different degrees of gynecomastia and is as follows:

·         Grade I: the severity is mild, tissue can be felt just under the areola
·         Grade II: the severity is mild to high with breast enlargement exceeding the boundaries of the areola but without excess skin
·         Grade III: the severity is high and very visible with excess skin and the boundaries exceeding the areola
·         Grade IV: the severity is high, very visible feminine type breasts with excess skin

The degree of severity along with the patient’s goals will determine how the procedure will be done. In some cases, the breasts may be different, and sometimes only one breast is affected. A gynecomastia specialist has the expertise to reshape the chest for symmetry.

The term “gynecomastia” has become widely known since the class action lawsuit against Johnson and Johnson for their drug Risperdal. Risperdal was used for the treatment of bipolar disorders and autism in children, but the development of breasts was an alarming side-effect. Television was inundated with commercials from attorneys looking for victims of Risperdal to join in their class action suit, which ultimately settled with one of the highest payouts in history.

No matter what grade a gynecomastia patient may have, the emotional effect can be devastating. Dr. Miguel Delgado, M.D. states that 40% of his gynecomastia practice is revision surgery of cases that were done by surgeons who do not have specialized training. When choosing your surgeon, be sure he/she is Board Certified in Plastic Surgery! View many before and after pictures of the surgeon’s patients and read online reviews.

Dr. Delgado’s reputation as one of the top gynecomastia specialist stretches beyond the San Francisco Bay Area, with patients coming from all over the United States and beyond. Dr. Delgado offers a generous travel package for out of town patients.

Call (415) 898-4161 today for a consultation with Dr. Delgado for any gynecomastia issues you may have.  Serving the Sacramento area since 1988.

Sunday, February 26, 2017

Gynecomastia Surgery after Weight Loss

Weight Loss and Gynecomastia

Sacramento, CA. - Men with gynecomastia, who have lost a significant amount of weight, may find that they have redundant skin, fat, and tissue remaining on their chest. The reward of losing a great deal of weight has been somewhat diminished by the need for male breast reduction. Gynecomastia surgery after weight loss requires the expertise and skill of a gynecomastia surgeon.

Every male with gynecomastia needs to be evaluated individually; procedures may vary depending on their unique situation. Some men may be a candidate for what is known as the 2 stage procedure. In the first stage, much of the excess skin is removed by a doughnut shaped incision around the areola and closed with purse string sutures. Stage 2 is a minor procedure that can be done in the office under local anesthesia.


severe Gynecomastia 

4 months after stage 1 
6 weeks after stage 2

For men who are not candidates for the 2 stage procedure, a more aggressive type incision may need to be done. The surgeon makes an incision around the areola and then a vertical incision to the breast crease creating what is known as the inverted T or an anchor reduction. This incision will leave visible scars. However, most men understand this is necessary, and are accepting of the trade-off.

Gynecomastia after weight loss

4 weeks after surgery

       For most men the incisions heal nicely, for others, they may develop keloids which are raised thick scars.  Fortunately today there are several treatments available for scar management. Experienced gynecomastia specialists will use deep suturing techniques that reduce the tension on the skin.

Once incisions from gynecomastia surgery have healed, Dr. Miguel Delgado, M.D. has his patient’s start using silicone sheeting, which has been proven to minimize scarring by keeping the skin hydrated. Massaging the incisions is helpful. For more difficult scars, steroid injections may be used. The Palomar Laser is available now for Dr. Delgado’s patients for various skin conditions, including scar treatment, wrinkles and much more! Lastly, revision surgery may be performed for difficult scars.

Call now (415) 898-4161 for a consultation with Dr. Delgado.

Monday, January 23, 2017

Post Surgical Scars after Gynecomastia Surgery

Gynecomastia Surgery and Scar Solutions
gynecomastia in Sacramento


Before and After Gynecomastia Surgery 

After gynecomastia surgery, some men are discouraged by unsightly scars that may form around the areola where the incisions for male breast reduction were made.

If the body produces too much collagen when healing after surgery, a raised scar, known as a keloid, may form. Collagen fibers that are produced will have a different texture than the adjacent skin. A visible raised scar around the areola defeats the purpose for a man who wants to go shirtless after his gynecomastia surgery.

Scarring is a normal consequence during healing. Some people have more scar development than others for reasons that remain unknown. Benign scar tissue does not need to be removed unless it causes emotional distress, especially for the gynecomastia patient who wants to be able to enjoy the beach or other activities where he will want to remove his shirt.

For men seeking scar removal after their gynecomastia surgery, it is strongly advised that they find a Board Certified Plastic Surgeon who specializes in gynecomastia and has a great deal of experience. Dr. Miguel Delgado, M.D. has been performing gynecomastia surgery and revision surgery since 1989; he offers options for scar removal depending on the severity of the scar. Options include; surgical excision, steroid injections, and the Palomar Icon Fractional Laser, a non-invasive treatment showing very promising results.

Men who wish to avoid scar formation need to follow their surgeon’s instructions post-operatively very carefully. It is imperative to avoid direct sunlight for 6 months to a year while the incisions are young and healing. Sunlight is known to cause hypertrophic scarring. Dr. Delgado recommends that his patients start using silicone sheeting once the incisions have healed.

Call Dr. Delgado at (415) 898-4161) today if you are searching for revisions for your gynecomastia surgery. 

Serving Sacramento  and Sacramento County since 1986.

Wednesday, December 14, 2016

Gynecomastia Revision Surgery - Get it Right the First Time.

Puffy Nipples Remain After Gynecomastia Surgery!

                            Puffy Nipples                                           After Puffy Nipple Correction Surgery

Unfortunately, a common complaint from gynecomastia surgery patients is that they still have “puffy nipples” after their recovery. Dr. Miguel Delgado, M.D. says that 40% of his gynecomastia practice consists of revision cases where male breast reduction was done by other surgeons.

Choose a Board Certified Plastic Surgeon Specializing in Gynecomastia!

Gynecomastia surgery needs to be performed by a board certified plastic surgeon that specializes in male breast reduction. Many surgeons attempt to reduce the male breast by liposuction alone and leave the breast tissue behind. In a small percentage of men, liposuction can effectively reduce the breast, if they have pseudo-gynecomastia, meaning the enlarged breast is only fat. However, most men have a combination of fat and breast tissue and removing only fat will leave the breast tissue behind.

Only experienced gynecomastia surgeons have the expertise to remove the correct amount of fat and breast tissue that will leave a sculpted chest. Less experienced surgeons are very conservative when removing breast tissue so that a “crater deformity” is avoided. On the other hand, if too much breast tissue remains it will push the areola outwards forming “puffy nipples.”  

Crater Deformity
After Crater Deformity Correction Surgery

Best to Get it Right the First Time!

Gynecomastia patients that end up with “puffy nipples” or a “crater deformity” are justifiably disappointed with their surgery results. Unfortunately, their only option will be revision surgery. Again, it is imperative to choose a board certified plastic surgeon with extensive training in male breast reduction because corrective surgery is more challenging due to formed scar tissue from the original surgery.

Call today (415) 898-4161 for an evaluation by Dr. Delgado for any gynecomastia issues.

Saturday, November 19, 2016

Recurrence of Gynecomastia after Male Reduction Surgery

Can Male Breasts Return After Gynecomastia Surgery?

Before and After Gynecomastia Surgery


A frequent question Dr. Miguel Delgado, M.D. is asked by his gynecomastia patients is “can male breasts grow back after surgery?” This is a reasonable question, for what man wants to face a recurrence. Fortunately, for most men the results are permanent; however, there are some exceptions. Understanding these exceptions can help prevent regrowth of breast tissue.

If a man has “true gynecomastia,” the surgical procedure for male breast reduction will include removal of most of the breast tissue and fat, but what remains is necessary for sculpting the chest and supporting the areola. It is this remaining tissue and fat that might cause a future problem.

Determining the cause of development of male breasts can help the patient avoid a repeat of growth. Some of the known causes are:

·      Excessive weight gain
·      Testosterone and estrogen levels out of balance
·      Decrease in production of testosterone, usually in older men
·      Some prescription drugs
·      Recreational drugs, including marijuana
·      Psychological stress
·      Scar tissue build up (uncommon but possible)
·      Puberty
·      Use of anabolic steroids

Puberty is one of the most common causes for gynecomastia for the young male. For most youth, the breasts return to normal after puberty. Some young men are so traumatized by their breast growth that they opt to have surgery before the end of puberty. There is a small chance that these boys may have male breasts return because the hormone levels are still fluctuating. However, it never returns to the original state, and Dr. Delgado has never had to re-operate.

Dr. Delgado will try to determine the source of a man’s gynecomastia during the initial consultation. If the cause can be established, Dr. Delgado will make recommendations to the patient to help avoid possible regrowth in the future. Most of the time, the reason for male breasts cannot be verified, this is called idiopathic gynecomastia.

As mentioned, regrowth is rare. Dr. Delgado has done thousands of male breast reduction surgeries through the years and has only seen a handful of cases where there was a recurrence.

Schedule a consultation today with Dr. Delgado (415) 898-4161 to find solutions to your gynecomastia concerns.