Recurrence of Gynecomastia
Although recurrence of gynecomastia is not common after excision by an experienced Board Certified Plastic Surgeon, it is possible.
In our practice, recurrence is exceedingly rare (fewer than 1% of our patients experience recurrence). For this reason, our policy is to not charge a surgeon’s fee for recurrence. True gynecomastia is caused mainly by excess glandular tissue, which causes a protrusion of the nipple-areola complex (puffy nipples). In our practice our goal is to remove over 90% of the mammary gland, which leaves enough glandular tissue to support the nipple-areola complex and prevent concavity of the areola, which itself may be aesthetically objectionable.
The inexperienced surgeon may leave more glandular tissue than is necessary. This excess glandular tissue may become noticeable once the person becomes leaner or when the initial post-surgical edema (swelling) demises over the first few weeks.
Conditions that may imitate gynecomastia recurrences but are not related to glandular tissue may include the following:
A. Initial edema swelling for the first few months after surgery
B. Weight gain
C. Scar tissue
Because young people naturally undergo very intense healing processes, they may experience excess production of fibrous tissue (scar). It sounds paradoxical but it is the realty.
Post-surgical use of anabolic steroids following partial removal of the glandular tissue may produce a recurrence of true gynecomastia. To minimize the chances of recurrence in bodybuilders it is essential to excise most of the sub-areola glandular tissue and the entire medial “head” and “lateral” tail of the hypertrophied glandular tissues.
In the rare instance that endocrine disease produces hormonal changes that cause enlarged male breasts, the plastic surgeon should be especially aggressive in trying to prevent recurrence. In these instances excision of most of the gland is of paramount importance.
In conclusion the most important factor for prevention of recurrence is complete excision of the glandular tissue. In many instances liposuction alone, regardless of the method employed (ultrasound, laser, etc.), is insufficient in completely eradicating this condition.