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The Anatomy of Gynecomastia

January 18, 2022

One of the biggest misconceptions about gynecomastia or “man boobs” is that the condition is caused by excess fat alone. Many patients schedule consultations with the assumption that liposuction alone will resolve their gynecomastia, and may have even been told this by other doctors. In fact, breast tissue alone is the primary cause of gynecomastia with excess fat being a secondary component, followed by skin laxity. Liposuction alone is rarely sufficient in creating the results patients are looking for. Dr. Cruise developed the Cruise Classification System to explain varying presentations of gynecomastia in detail, but the following are the basics of gynecomastia anatomy.

Excess Glandular Tissue

Gynecomastia is primarily categorized by excess glandular tissue or, more simply, breast tissue. This tissue develops for a variety of reasons, ranging from hormonal imbalance to genetics to drug side effects. Consider, for example, type 1 gynecomastia. These patients have “puffy nipples” due to excess glandular tissue just below the areola, but do not have excess fat.

To resolve this puffy nipple gynecomastia, Dr. Cruise manually excises the excess glandular tissue. This involves making a small semi-circle incision at the bottom margin of each areola. Through this opening, the excessive tissue is manually removed. During recovery, patients wear a compression garment for a few weeks to promote skin contraction. 

Excess Fat Surrounding the Chest

It is true that excess fat often plays a role in gynecomastia. Typically, this fatty tissue is located in areas such as the lower breast pole, breast roll, pre-axilla, or upper abdomen. This results in rolls, folds, or bulging in the chest or underarm areas. To treat this excess fat, liposuction is used alongside manual excision of the glandular tissue. This helps sculpt the area to achieve a masculine chest contour. The degree of liposuction will vary depending on the type of gynecomastia each patient is facing, and some may not require liposuction at all. For example, a Type 2 patient may need no liposuction, while a type 4 patient would almost definitely require liposuction to achieve the ideal result.

Skin Laxity in the Chest

Skin laxity is the final type of tissue that will contribute to the appearance of gynecomastia. This is particularly true for types 4, 5, and 6. In these cases, patients will see drooping or sagging skin in the chest that results in a noticeable breast roll, folds in the armpit area, and even folds that extend to the back. The areolas are also in a lower than ideal position on the chest. Skin laxity may be caused by age-related collagen loss over time or weight fluctuation. If excess skin is present, it should be removed through excision. Dr. Cruise takes care to strategically remove skin so the intended new contour is created.

Gynecomastia Surgery: More than Removing Tissue

In addition to the presence of tissue types beyond excess fat, another key reason why liposuction alone is usually insufficient in treating gynecomastia is the necessity to manually sculpt the chest to restore a masculine shape. During a consultation, Dr. Cruise will discuss your ideal results and create a customized treatment plan that will free you of your gynecomastia permanently.  

Schedule a Consultation

To learn more about your gynecomastia surgery options, schedule a consultation with Dr. Cruise. Call (323) 488-4419 to schedule your consultation in our Newport Beach, CA office or complete our online form for a virtual consultation

Plastic Surgeon | Website | + posts

Dr. Joseph Cruise is a board-certified plastic surgeon with over 20 years of experience. Regarded as one of the top gynecomastia surgeons in the world, Dr. Cruise has gynecomastia-specific content that can be found at Dr. Cruise has dedicated his career to cosmetic surgery but has also had extensive training in General Surgery, Hand Surgery, and Microvascular Surgery. Dr. Joseph Cruise is also a member of the Rhinoplasty Society as well as the American Society of Plastic Surgeons.

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