Gynecomastia means enlargement of the male breast tissue. There are a number of options in Male breast reduction and I just wanted to try to clear up a few things here in this blog. The most common reason for men to have enlarged breasts is unknown. While a very few patients will have a hormonal abnormality it is quite rare and does not change the surgical solutions. Rule of thumb: Gynecomastia surgery should be performed after puberty and is best performed at younger ages when the skin is more elastic and likely to shrink up when the tissue underneath is removed. Types: 1) Long nipple: far more common in women than men a long nipple can be easily shortened under a local anesthesia. 2) Puffy areola: some men (and even women) have a normal breast contour but the areola is large or puffy as though it is sitting on top. The tissue under the areola can be removed under a local anesthesia. 3)True Gynecomastia: a firm lump of breast tissue is sitting right under the nipple areola area and is visible. It feels like a small egg. This can be removed from an incision around the bottom edge of the areola and can often be done under local. 4) Pseudogynecomastia (fake Gynecomastia): here the problem is not the glandular breast tissue. It is that the breast is fatty. This is usually treated by liposuction. I tend to use ultrasonic liposuction as I believe it works better in the dense male breast. I usually do this with patients asleep. 5) Combination- Most Gynecomastia treatment is a combination of number 3 and 4 above and will require a combination of liposuction with direct excision. 6) Droopy breasts- In an older male patient or sometimes in a patient that has lost a lot of weight the skin becomes droopy and will not shrink up when the tissue underneath is removed. In this situation I will recommend excising skin as well as long as the patient is ok with the scars. If you are considering this type of surgery and would like to be evaluated I have offices in Annapolis, Rockville, Maryland and Mclean, Baltimore Maryland. Feel Free to contact me.