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Boynton Plastic Surgery Gynecomastia Specialist

the art is in
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Gynecomastia Specialist
James F. Boynton MD, FACS
Board Certified Plastic Surgeon
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Meet Gynecomastia Surgeon

James F. Boynton, MD, FACS

Dr. James F. Boynton has devoted a large part of his career in plastic surgery to performing advanced procedures designed to treat gynecomastia and enlarged breast tissue in men. Certified by the American Board of Plastic Surgery and a Fellow of the American College of Surgeons, Dr. Boynton has been trained by some of the foremost gynecomastia surgeons in the world and has successfully performed male breast reduction surgery for hundreds of patients. Our board-certified plastic surgeon has also been recognized as one of America’s Top Doctors® by the Castle Connolly organization, as well as a Top Doctor in Houston in H-Texas magazine and a Leading Physician of the World / Top Plastic Surgeon in Texas by the International Association of Plastic Surgeons.

Dr. Boynton fully understands the effects that gynecomastia can have on one’s self-esteem and way of life, and is committed to providing state-of-the-art techniques that can meet each patient’s unique goals with exceptional results. Dr. Boynton’s surgical abilities combined with his careful, discreet, and compassionate approach to patient care has made him one of the preeminent plastic surgeons in Houston—one who many men fully trust to renew the appearance of their chest with outcomes that look natural and align with their ultimate goals.

If you are ready to schedule a consultation with Dr. Boynton to discuss your options, or if you would like additional information about gynecomastia treatment, please don’t hesitate to contact our office today.

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Your Guide to Gynecomastia

What Is Gynecomastia?

Gynecomastia is a very common condition among men that produces an excessive amount of fatty tissue and/or glandular tissue in the breasts. Characterized by enlargement of the breasts, gynecomastia can have a significant effect on chest contours, even among individuals who are healthy and physically fit, and it can result in extreme self-consciousness in men who experience it. While gynecomastia often first develops during adolescence (“pubertal gynecomastia”), it can also appear well into adulthood. In some cases, the effects of gynecomastia go away on their own during or just after an individual’s teenage years; however, in many others, gynecomastia symptoms do not fade, and standard diet and exercise routines have no significant effect. Fortunately, male breast reduction surgery can often be a very successful remedy to the physical and emotional toll this condition can create.

What Are the Symptoms of Gynecomastia?

The most prominent gynecomastia symptom is noticeable enlargement of the breasts due to an abundance of fat cells and/or glandular tissue. With that in mind, gynecomastia can also produce symptoms such as breast asymmetry, tenderness or pain in the breast areas, nipple chafing and sensitivity, nipple discharge, swelling in the breasts and/or nipples, and a protrusion or growth under the nipple.

Grades of Gynecomastia

Gynecomastia is categorized in several different grades on a scale ranging from mild to severe. During the initial consultation with Dr. Boynton, our plastic surgeon will evaluate the degree of gynecomastia for which you are experiencing, which can help determine the treatment plan that is best for your needs. The grades of gynecomastia are:

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What Are the Causes of Gynecomastia?

Gynecomastia can be caused by a number of different factors. In some cases, the specific cause of the condition may be undetermined. Here are a few of the more common potential causes of gynecomastia, as well as some of the rarer conditions known to possibly contribute to the development of gynecomastia:

Hormonal Fluctuations/Imbalances

Low testosterone and hormonal imbalances are often attributed to the development of gynecomastia. This can be the case in both puberty and in older age ranges since hormone levels can be in flux during these periods.

Obesity and Significant Weight Fluctuations

Obesity and continuous weight fluctuations can result in collections of excess fat cells that settle in the breasts. When an individual’s gynecomastia is primarily characterized by excess fat in the breasts rather than glandular tissue, this is typically referred to as “pseudogynecomastia” (described in the section below).

Heredity

Genetic factors and a family history of gynecomastia may also play a part in its development.

Certain Health Conditions

Individuals with certain health conditions may be more susceptible to gynecomastia. These conditions include liver disease, kidney failure, Klinefelter syndrome, malnutrition, tumors that are hormonally active, hyperthyroidism, and others.

Use of Certain Medications

While rare, some types of medication may have side effects that could potentially produce or exacerbate gynecomastia symptoms. These can include certain kinds of anabolic steroids, antidepressants/anti-anxiety medications, heart medicine, anti-ulcer medications, and others.

Drug/Alcohol Use

Alcohol and the use of some kinds of drugs—such as marijuana, amphetamines, and opioids—may be possible contributors to the symptoms of gynecomastia.

Gynecomastia vs. Pseudogynecomastia

The word “gynecomastia” is often the term generally utilized to reference the condition responsible for enlarged breast tissue in men. In actuality, there are two types of gynecomastia—and the distinctions between them are very important:

True Gynecomastia

When gynecomastia is found to be characterized by excessive glandular tissue that has developed in the breasts, this is what’s known as “true gynecomastia.” The condition is frequently caused by an imbalance of the hormones testosterone and estrogen. Higher amounts of estrogen vs. lower amounts of testosterone may ultimately lead to a greater abundance of glandular tissue being produced in the breasts. This is one reason why true gynecomastia can manifest in puberty or in older ages, as the hormones are often undergoing significant changes during these times. With that in mind, these hormonal changes can result from other issues, as well, such as certain kinds of medications, health conditions, or other factors. One of the most important differences between true gynecomastia and pseudogynecomastia is that true gynecomastia is typically not able to be sufficiently remedied by means other than surgery. In many cases, the most reliable way to renew chest contours and effectively address a collection of excess glandular tissue in the breasts is through male breast reduction.

Pseudogynecomastia

Pseudogynecomastia is a type of the condition which is characterized by a buildup of excess fat in the breasts. This abundance of fatty tissue (often due to weight fluctuations) is the predominant cause of the enlarged breast appearance. Even after weight loss, the excess fat cells may have isolated themselves in the breast areas, which can lead to a fuller or “swollen” appearance, and the breasts may even be noticeably sagging. Unlike true gynecomastia, milder cases of pseudogynecomastia may eventually fade on their own or be improved with diet regimens and exercises that focus on chest strengthening. However, more severe grades of pseudogynecomastia may need liposuction (also known as “lipo-contouring”) surgery to effectively address the concern.

In many cases, patients experience both true gynecomastia and pseudogynecomastia in combination. The good news is that both of these conditions can be successfully treated.

What Is Male Breast Reduction?

Male breast reduction is an umbrella term that encompasses a number of various techniques designed to treat the effects of gynecomastia and provide men with enhanced chest contours and a “flatter” breast appearance. There are several male breast reduction options for gynecomastia (described below). Techniques include lipo-contouring for patients primarily affected by excess fat deposits in the breasts, glandular tissue extraction for individuals with gynecomastia symptoms mainly produced by excess glandular tissue, and the combination of both techniques for those who have severe gynecomastia resulting from excess fatty tissue and glandular tissue. Dr. James F. Boynton also performs treatments such as pedicled gynecomastia surgery (also known as the “pedicled chest lift”), nipple reduction, and free nipple grafting. 

Ultimately, male breast reduction can be an ideal option for many men who suffer from gynecomastia, offering them a genuinely effective way to address their concerns and begin feeling more confident and comfortable. It is important to remember that gynecomastia is very, very common and there should be no stigmas attached to male breast reduction procedures. Dr. Boynton can meet with you in a confidential consultation to evaluate your needs and talk with you about the most suitable treatment options. 

Are There Exercises That Help Gynecomastia?

For some individuals, certain types of chest exercises may actually help improve signs of gynecomastia. It is very important to note that exercises can only potentially benefit those who are experiencing pseudogynecomastia (excess breast fat) rather than true gynecomastia (excess glandular tissue in the breasts). In milder cases of pseudogynecomastia, it may be possible for men who engage in exercises such as butterfly curls, bench presses, pushups, and other kinds of weight or fitness training for the chest to diminish the excess fat and build pectoral muscle tissue. These exercises in combination with a healthy diet and an aerobics routine may serve to enhance tone in the chest and reduce signs of gynecomastia.

Men who have true gynecomastia will likely not find significant improvement through exercises. Since excess glandular tissue is what characterizes true gynecomastia, even the most rigorous chest exercises will probably not make a major difference. In these cases, male breast reduction surgery may be recommended to successfully achieve individual goals.

What Are the Gynecomastia Surgery Options?

Dr. Boynton is extensively trained and experienced with numerous state-of-the-art procedures for the treatment of gynecomastia. During the consultation, Dr. Boynton will determine whether you are suffering from pseudogynecomastia (excess fat), true gynecomastia (excess glandular tissue), or both of these conditions in combination. He will then explain the most ideal treatment options for your needs and explore all aspects of those procedures with you.

Here are some of the most frequently performed gynecomastia treatments at Dr. Boynton’s practice:

Liposuction with Minimally-Invasive Excision of Glandular Gynecomastia

Our board-certified plastic surgeon offers an advanced gynecomastia surgery technique that can be an exceptional treatment option for the right candidate. Liposuction/lipo-contouring with minimally-invasive tissue excision requires just two incisions approximately 2mm in length. Dr. Boynton will insert thin cannulas through these “puncture incisions” and lipo-sculpt the chest wall and armpit areas using microaire power-assisted liposuction, which he believes contours the chest the best. That is performed in conjunction with glandular excision using a minimal incision approach. This technique allows Dr. Boynton to remove excess fat and more “fibrous” tissue from the breast areas. With this approach for tissue excision, the fibrous tissue is extracted from beneath the nipple and areola complex with the goal of producing enhanced contours and a “flattening” of the breasts.

Glandular Breast Tissue Extraction

Glandular tissue extraction may be recommended for patients who have true gynecomastia. This treatment can be performed in a number of ways, depending on the severity of the condition and other concerns unique to each patient. In many cases, an incision in the lower part of the areola can be made to allow Dr. Boynton to remove excess glandular tissue that is causing the appearance of enlarged breasts. The scars that result from this technique are typically almost unnoticeable because the incisions are made in the areola, allowing them to blend in with the naturally darker pigment of the skin.

Pedicled Chest Lift – Pedicled Gynecomastia Surgery for Pseudogynecomastia After Weight Loss

Pedicled gynecomastia surgery, sometimes referred to as a “pedicled chest lift,” can be advantageous for candidates who suffer from pseudogynecomastia after massive weight loss has produced an abundance of excess, loose skin in the breasts. The advantage to the pedicle is that the circulation to the nipple is maintained; however, this can leave a slight bulge in the chest that may require further procedures to flatten. This “full male breast reduction” technique is designed to utilize an inframammary (IMF) incision under the breasts and a periareolar incision around the nipple while preserving the blood supply flowing to the nipple. Excess fat is then removed. While the pedicled chest lift is often an ideal option for patients who have lost a lot of weight and are experiencing loose skin in the breast areas, it is more invasive than other techniques. Dr. Boynton can determine whether this treatment is best or an alternative procedure that can still provide good results is more suitable.

Chest Lift With Free Nipple Grafting

Some patients with pseudogynecomastia may be good candidates for free nipple grafting. This is another option commonly performed for individuals who are experiencing pseudogynecomastia after losing a significant amount of weight. This technique often gets the flattest chest and it also has the “freedom” of positioning the nipple exactly where we want it by utilizing the FNG (free nipple grafting) technique. The downside to this is that 60 percent of the time there is obligatory areolar tattooing / pigment tattooing required to get the pigment color. Sometimes it isn’t necessary for all patients, but the pigment can be more splotchy without the pigment areolar tattooing. During the free nipple grafting procedure, Dr. Boynton can create incision lines surrounding the areolas and in other minimally noticeable areas, which helps produce scarring that is less conspicuous following fat removal. Free nipple grafting can be an effective technique for many individuals who have lost a large amount of weight and subsequently develop severe gynecomastia, offering them the benefit of dramatic aesthetic improvement without excessive scarring.

Nipple Reduction

Nipple reduction can not only be advantageous for men suffering from gynecomastia, but also for individuals who are simply concerned about over-projecting nipples that are prominently visible even through clothing. In many cases, nipple reduction can be performed simultaneously with gynecomastia treatment, or it can be a staged procedure. If it is an isolated condition, a nipple reduction procedure can often be performed as an in-office treatment using local-based anesthesia and completed in about 20 minutes. Ultimately, nipple reduction surgery can be performed to create a more proportionate aesthetic.

What Is Recovery from Gynecomastia Surgery Like?

Gynecomastia surgery does not often require a lengthy period of at-home rest and recovery. While precise recovery information will be based on each patient’s unique needs, the gynecomastia surgery technique utilized, and other factors, most patients usually only need to take a day or two off from work, depending on the type of job for which they are employed. Many individuals are even ready to go back to their full exercise and workout routines after about two weeks. Discomfort following the procedure is generally of a mild to moderate degree, and over-the-counter medication may be all that’s needed to relieve pain as the treatment area heals. Bruising, swelling, and tenderness can be expected in the breast areas, but these effects should gradually dissipate. For most patients, Dr. Boynton will prescribe a compression vest to be worn for a temporary period that can aid the healing process, and he may also recommend post-lymphatic massage therapy to relieve swelling. Dr. Boynton will provide a detailed list of instructions and post-operative guidelines to help you achieve a safe and efficient recovery.

It is important to note that it can take some time for the final results of gynecomastia surgery to appear. A significant majority of the results will be noticeable after the first month following surgery, and most of the final results will be visible after about three months. In most cases, the final outcome of gynecomastia surgery is apparent by the sixth month.

Does Gynecomastia Surgery Result in Scars?

Gynecomastia surgery will result in some degree of scarring; however, the techniques Dr. Boynton utilizes for these procedures allow him to create small incisions in rather discreet areas. This makes it possible for the scars to be relatively light and inconspicuous. In cases where minimally-invasive liposuction/lipo-contouring with tissue excision is utilized, the incisions necessary are only about 2mm in length and are sometimes referred to as “puncture incisions.” Individuals who have a pedicled chest lift will have incisions around the nipple and the inframammary fold (the crease under the breast), which should lead to noticeable but still fairly inconspicuous scarring. For patients who require glandular tissue extraction, the incisions for this procedure can often be made in the lower areolar areas, allowing the residual scars to blend with the areola’s pigmented color and appear less noticeable.

Rest assured that Dr. Boynton fully understands patients’ concerns about the appearance of scars and works diligently to minimize their aesthetic effects. Fortunately, male breast reduction procedures typically utilize incision techniques that do not require excessively lengthy incisions, and scars often fade over time, as well.

Are There Any Non-Surgical Gynecomastia Treatments?

While there are currently no non-surgical treatments capable of reducing/extracting glandular tissue in cases of true gynecomastia, there may be non-surgical solutions (such as certain types of exercise) that can be effective to some extent for individuals who have pseudogynecomastia. In those cases, the condition is caused by excess fat, which may respond to weight loss or exercises that concentrate on enhancing the pectoral muscles. However, depending on the amount of excess fat in the breasts, there may be limits to what diet and exercise routines can achieve, and lipocontouring may be necessary to more fully accomplish individual goals.

In cases of true gynecomastia, the condition is mainly caused by excess glandular tissue in the breasts, which cannot be improved with exercise or dieting. In fact, some chest exercises may actually make true gynecomastia more noticeable due to expanding pectoral muscles pushing the glandular breast tissue out even further. Male breast reduction surgery will likely be the only effective solution to achieve significant reduction for true gynecomastia.

How Much Does Gynecomastia Surgery Cost?

The cost of gynecomastia surgery typically starts in the $8,000 to $9,000 range at Boynton Plastic Surgery. The precise estimate will be different among patients due to the highly customized nature of male breast reduction procedures. Factors such as the surgical techniques utilized, the overall complexity of the treatment, fees associated with anesthesia and the operating facility, and others will be calculated all together to determine the total cost estimate. During the initial consultation with Dr. Boynton, he can create a personalized treatment plan and have a member of our staff produce a full estimate of the cost for your review. We are happy to answer any and all questions you may have about the convenient payment options available at our practice, which include financing through the reputable healthcare financing agency known as CareCredit®. This organization provides a selection of affordable financing plans for qualified applicants who wish to pay for their gynecomastia procedure in a series of installments.

Additional Frequently Asked Questions About Gynecomastia

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Patient Reviews

“I have suffered from gynecomastia all my life, and after losing ~200 pounds I needed a reduction in my chest. After a year of research, I chose Dr. Boynton due to his focus on results and his thoughtful approach to each patient’s particular goals. Dr. Boynton and his amazing staff exceeded my expectations at every turn. I knew I was in good hands through the entire process and never felt pressured or rushed. The doctor’s bedside manner is extraordinary and I truly feel that he is gifted at his vocation. I have highly recommended him to close friends, and will continue to do so.”
“[Single best thing is…] I can wear shirts that aren’t black and I don’t feel insecure when taking my shirt off. Dr. Boynton and his staff changed my quality of life. I was very insecure about myself and only able to feel comfortable on certain clothes. That is no longer the case. Dr. Boynton and his staff were very helpful after my surgery, and the nicest staff you could ask for.”
“Dr. Boynton is unbelievably personal, attentive and precise about the desired results. He truly cares about the outcome, rather than just completing the procedure and moving to the next patient. Follow up is frequent but the clinic take time very seriously. Visits are very quick and to the point, they are incredible. And the staff is unreal. So kind and professional. I honestly feel like a king whenever I have a follow up office visit. Definitely recommend Dr. Boynton to those considering.”