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Gynecomastia Surgery, Sometimes a Two-Stage Procedure

Posted on: April 20th, 2018
Posted by Dr. Miguel Delgado

 

For men with moderate to severe gynecomastia, a different approach for male breast reduction surgery is required. Older men who have lost elasticity of their skin or have had a massive weight loss of 100 to 200 pounds may have a tremendous amount of loose skin. Some surgeons will opt for a mastectomy type surgery where removal is done in one procedure. However, Dr. Miguel Delgado, M.D. tries to avoid this as he feels the resulting scar that goes across the chest is almost as disturbing as the large breasts

Gynecomastia Specialist, Dr. Miguel Delgado

A gynecomastia specialist, Dr. Delgado has been performing gynecomastia surgery since 1988. Dr. Delgado believes the way to get the best surgical result for a man with severe gynecomastia is to do male breast reduction surgery in two stages.

Stage One

The first stage is done with aggressive excision of the breast tissue along with liposuction. If the patient doesn’t have a lot of loose skin, a crescent lift may be done. A crescent lift is where a half donut shaped piece of skin is excised above the areola that reduces sagging and the lower fold. For some patients, the result is such that they may choose not to have a secondary procedure, but the scar will be  more visible at the top of the areola.

gynecomastia first stage

Extreme Gynecomastia

For more severe cases such as the one pictured here, a secondary procedure is scheduled after four to six months after the first stage.

Stage Two

Gynecomastia, First Stage After 6 months

Six Months After First Stage

The secondary procedure is the periareolar lift. The periareolar lift removes a donut of skin completely around the areola. After healing, the incision will blend into the areola extremely well.

Post Op at Two Weeks

gynecomastia two weeks after second stage

Two weeks after second stage

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


Scar Tissue After Gynecomastia Surgery

Posted on: April 9th, 2018
Posted by Dr. Miguel Delgado

Scar tissue After Gynecomastia surgery in San Francisco

Before and After Gynecomastia Surgery

Two really excellent sources in getting feedback from gynecomastia patients are the websites; Gynecomastia.org and RealSelf.com. One concern, which comes up from time to time on both sites, is men who state that after a few weeks their gynecomastia has come back.

Scar Tissue Feels Like Breast Tissue

Recurrence of breast tissue is an alarming situation for men who have invested in their male breast reduction, only to have it come back. As long as the patient has not resumed in taking medications, steroids, or other known causes of gynecomastia, it most likely is not regrowth of breast tissue. If the original outcome of surgery was a nice sculpted chest, the recurrence of puffy nipples or the feel of breast tissue under the skin is most likely the formation of scar tissue. Scar tissue can form any time after surgery, usually within 4 to 12 weeks.

Puffiness May Be Swelling

If there is puffiness right after surgery it could be swelling or possibly not enough breast tissue was removed, but it would not be caused by scar tissue.

Men are encouraged not to panic but to talk to their surgeon about their concerns. The formation of scar tissue most likely will not require surgical intervention. Most of the time, the scar tissue will resolve on its own. However, after recovery, the surgeon can give injections of steroids such as Kenalog. Over time the steroid may dissolve the scar tissue.

Choose Your Surgeon Carefully

It is imperative to choose your gynecomastia surgeon carefully. Many surgeons are concerned about removing too much tissue and creating a “crater deformity,” or they are over cautious and do not remove enough. In either case, gynecomastia revision surgery will be necessary. With the addition of scar tissue from the original surgery, you will need the expertise of a gynecomastia specialist.

Call Now!

Dr. Miguel Delgado, M.D. states that more than 40% of his gynecomastia practice is revision surgery.  Under resection or over resection is the primary cause for revision surgery. If you are having any issues with gynecomastia, call today (415) 898-4161 for a consultation with Dr. Delgado.

 


Dr. Delgado Talks About Drains and Compression Vests

Posted on: March 23rd, 2018
Posted by Dr. Miguel Delgado

 

Dr. Delgado, a specialist in gynecomastia has been performing male breast reduction since 1989. Considered one of the top gynecomastia surgeons in all of the United States he has patients who travel from all parts of the United States and other countries to be treated by him.

Dr. Delgado is a Leader in Gynecomastia

Dr. Delgado provides the latest in technology and technique to his patients, many of which he designs himself. The result is a high satisfaction rate he receives from his patients. In the before and after pictures below is a delighted patient who wanted to share his own photos.

Dr. Delgado has a happy patient

In listening to his patients, Dr. Miguel Delgado,M.D. learned that the tiny scar left by the incision made for the drain was quite bothersome to many patients. Dr. Delgado explains in detail the need for drains; you can read more about that in the blog dated September 2017. Note in the after picture below where you can see the small scar right below the armpit.

Scar from drain before new technique

 

By moving the incision high up into the armpit, once it has healed patients have a hard time locating it!

Patient Comfort is Key

Another innovation by Dr. Delgado is the design of his unique compression vests. Previously commercial vests were bulky and did not have a provision for the awkward drain bulbs. Before, the bulbs were attached to the vest with a safety pin as shown in the picture.

Dr. Delgado vest

Dr. Delgado designed his vest with removable pockets that hold the bulbs. Once the drains were removed, the pockets came off making the vest less bulky. Also, the shoulder straps are adjustable allowing for more comfort. Then there is a second stage vest that is used when healing has progressed. The second vest is made of thinner material and has compression over the chest only. Lined with a soft T-shirt fabric, the vest is even more comfortable and undetectable under most shirts.

Call Today!

Are you ready to address your gynecomastia concerns? Call now(415) 898-4161 for an appointment with Dr. Delgado; you will be glad you did!

 


Castle Connolly Selects Dr. Miguel Delgado Top Doctor Again!

Posted on: March 14th, 2018
Posted by Dr. Miguel Delgado

Castle Connolly Top Doctors

Castle Connolly Medical Ltd. Publishes a variety of books and guides to help consumers find the best in healthcare. This is invaluable information especially for people who are new to an area. The most popular book they put out is “America’s Top Doctors.” In addition to the books, Castle Connolly has a website directory.

Castle Connolly Selects Top Doctors

Thousands of American physicians are surveyed. The doctors are carefully reviewed by Castle Connolly research team. Some things the team considers are; education, residency, fellowships, board certifications, professional reputation, and much more. The selected doctors are considered the best in their specialty. Doctors cannot pay to be included in the directory, nor can they nominate themselves.

Castle Connolly Medical, Ltd. was launched in 1992 by two professional leaders in healthcare. John K. Castle was a member of the Board of New York Medical College for 22 years, and Chairman of the Board for 11 years. Dr. John Connolly was President of New York Medical College for over 10 years.

Media Recognizes “America’s Top Doctors”

Many major media outlets have recognized “America’s Top Doctors,” to name a few:

  • Good Morning America
  • 20/20
  • Morning News
  • Fox Cable
  • 48 Hours
  • Weekend Today in New York

Multiple newspapers include:

  • Chicago Tribune
  • Boston Herald
  • Daily News
  • New York Times

Popular magazines include:

  • Town & Country
  • Redbook
  • Fortune
  • Money
  • Atlanta Magazine
  • And many more

It is possible for physicians to be removed from the list. They may be removed if; they retire, are unavailable to patients, take a full-time administrative post, have any mal-practice or disciplinary issues, negative feedback from patients or physicians.

Finding Your Gynecomastia Specialist

For patients searching for a gynecomastia surgeon, “America’s Top Doctors” is a good start. In addition to confirming your surgeon is Board Certified in Plastic Surgery, be sure the surgeon is a gynecomastia specialist. Ask to view before and after pictures of the surgeon’s male breast reduction patients.

Castle Connolly Selects Gynecomastia Specialists

                                          Before and After Gynecomastia Surgery

Dr. Miguel Delgado, M.D. has been performing gynecomastia surgery since 1989, and is considered one of the very top gynecomastia specialists in the United States and the world. Patients travel great distances to be treated by Dr. Delgado.

Dr. Delgado offers assistance to out of town patients to make their travels worry-free. He arranged a discount at a nearby hotel that includes free shuttle service to the office.

Make an Appointment Today!

Call now (415) 898-4161 to schedule a consultation with Dr. Delgado to discuss any gynecomastia concerns you may have.

 


Gynecomastia Surgery and the “Light Pull-Through Procedure”

Posted on: February 23rd, 2018
Posted by Dr. Miguel Delgado

light pull-through surgery in San Francisco

This 29 year old man suffered from adolescent gynecomastia. He had glandular excision and liposuction of the chest.

For the majority of men with gynecomastia, the most effective treatment is surgical excision of the glandular tissue along with liposuction for fat removal and sculpting.  A small percentage of men have “pseudo-gynecomastia.” Pseudo-gynecomastia means their breasts are caused by fat and no breast tissue. In this case, liposuction alone may give them the desired results.

“Light Pull-Through” How it is Done

 

light pull-through procedure in San Francisco

There is another gynecomastia surgery known as the “Light Pull-Through Procedure.” This is an excellent choice for men with mild to moderate gynecomastia and good skin elasticity. Only a small

incision is made at the lower edge of the areola, about 3 to 5 mm. Through this incision, a cannula is inserted, and fat is removed by liposuction. Then, a special instrument similar to a “pickle fork” is used to free up glandular tissue by cutting connecting fibers. Next, the breast tissue is gently pulled through the incision, and the small amount of remaining tissue is blended with special scissors. In some cases, drains may be placed for 24 to 48 hours.

Fast Recovery

Candidates for this procedure will have less surgery time, and recovery is faster. Scarring is minimal and will fade to almost invisible.

Some patients who come to Dr. Miguel Delgado, M.D. for gynecomastia revision surgery had only liposuction to remove their male breasts. These men are unhappy with their results because the breast tissue was left behind giving them unsatisfactory results. Unfortunately, they may have been a candidate for the “Light Pull-Through Procedure” but now due to the scar tissue that naturally forms after liposuction; their revision surgery has become more complex.

Patient Selection is Critical

Patient selection for this procedure is critical. Schedule a consultation with Dr. Delgado now (415) 898-4161 to find out what gynecomastia procedure would give you the best results.


Will Liposuction Alone Remove “Man Boobs?”

Posted on: February 14th, 2018
Posted by Dr. Miguel Delgado

Liposuction and Gland excision Surgery in San Francisco

                                                      Before and After Gynecomastia Surgery

There are several different types of gynecomastia with varying degrees of severity. The amount of fat versus breast tissue varies greatly. Gynecomastia patients must be evaluated on an individual basis. Often the ratio of fat to breast tissue can’t be determined until surgery, and that will determine the surgical approach.

Liposuction Will Not Remove Breast Gland

Men with gynecomastia who research their options are lead to believe that liposuction alone may be their solution. Unfortunately, many plastic surgeons agree with this treatment. There are many different types of liposuction machines available today. Many surgeons claim they can remove fat and breast tissue with liposuction. However, no energy device can remove breast tissue that is found in almost 80% of gynecomastia patients. Breast tissue must be removed by surgical excision.

A small percentage of men have what is referred to as “pseudo-gynecomastia.” Pseudo-gynecomastia is where the male breast is almost all fat. For these men, liposuction is a great treatment. It is possible for these men to reduce their male breasts if they lose weight. If they are struggling with weight loss, liposuction or even CoolSculpting may be the answer. But men, who have breast tissue left behind after liposuction, will find they now have what is referred to as “puffy nipples.”

Liposuction May Leave Puffy Nipples

Puffy nipples are caused by breast tissue that remains behind the nipple. Without the fat as a buffer, the nipples protrude even more than before surgery. When researching gynecomastia surgery, check out unhappy patients who are seeking revision surgery on RealSelf.com and Gynecomastia.org.

Dr. Miguel Delgado, M.D. has been performing gynecomastia surgery for almost 30 years. He states that about 40% of his gynecomastia practice is revision surgeries, and most of them are for patients who had liposuction alone.

Make an Appointment Today!

Contact us now (415) 898-4161 for a consultation with Dr. Delgado for any male breast issues you may have.


Gynecomastia.org #1 Online Community

Posted on: January 29th, 2018
Posted by Dr. Miguel Delgado

Gynecomastia surgery in San Francisco

                                                Before and After gynecomastia Surgery

Gynecomastia or male breasts cause a lot of embarrassment and humiliation for many men. Women have always had an easier time talking to each other about any health issues than men do. Through the ages, men have needed to present a strong, macho demeanor, but it is difficult if the man has female-type breasts. Many men try to hide their condition and then there are the brave ones that seek help and choose to have male breast reduction surgery.

Talk to Your Surgeon

Talking to a doctor about their gynecomastia is a big step. For men to get much-needed information starts them on their journey to be free of the shame that many of them have lived with for years.

Today with the vast amount of information that is presented online, men have discovered that they are not alone in their suffering and that there are solutions available.

 #1 Website for Gynecomastia

In the privacy of their own home, men can sign on to the #1 online Community known as Gynecomastia.org. This site has an enormous amount of information on the website, but more importantly, there are forums where men can ask questions of each other and of gynecomastia specialists!

Gynecomastia.org has many categories such as; “Gynecomastia 101” which explains some of the known causes of gynecomastia, there is an “FAQ” section with answers to many questions and many more articles.

Wide Variety of Forums

The most popular section would be the “Forums.” All men are invited to participate in any of the forums which are quite varied. There are topics such as;
• Surgery questions
• Dealing with family members
• Puffy nipples
• Surgery success stories, to name just a few.

It is free to become a member, and as a member, you can post questions and share experiences. You may receive responses from other members or even from one of the member gynecomastia specialists’. There is also an international forum representing many countries such as; U.K., Canada, Asia, Europe, Australia, and more.

Gynecomastia Specialist are Members!

As mentioned there are gynecomastia specialists who are members of gynecomastia.org all of who are Board Certified Plastic Surgeons with a particular interest in gynecomastia. The surgeons are listed by state, and you can read their biography, philosophy and visit their website. This section is very valuable to men who are searching for a qualified Board Certified Plastic Surgeon in their area.

Many Before and After Pictures and Videos

Also, there is a vast amount of before and after pictures of many of the surgeon’s patients, along with educational videos. New blogs are frequently posted with updates on what is new with gynecomastia.

Call Now!

New gynecomastia patients who meet with Dr. Miguel Delgado, M.D. are advised to check out gynecomastia.org for support and educational purposes. Patients are always encouraged to contact Dr. Delgado if they have any questions or concerns. If you have wanted a gynecomastia consultation, call today for your personal meeting with Dr. Delgado. (415) 898-4161

 

 


What Causes a Seroma and How to Avoid it

Posted on: January 8th, 2018
Posted by Dr. Miguel Delgado

seroma and gynecomastia in San Francisco

26 year old male who presents with adolescent gynecomastia. He is 6 feet tall and weighs 245 pounds. He had 50 grams of breast tissue removed from his right chest and 77 grams  from his left . He had 250 cc. of fat and aspirate removed from each side of his chest. His post op course was uncomplicated.

A seroma is a collection of clear serous fluid most often at a surgical site where tissue has been removed. This can be a complication after gynecomastia surgery. The swelling and fluid may not happen right away but can develop several weeks after surgery.

Seromas Lead to Serious Complications

Usually, a seroma will resolve in a few weeks, but the accumulation of fluid will cause the skin to sag and may cause discomfort. In some cases, a seroma can lead to serious complications, such as infection, and delayed wound healing. If an infection should occur, it may have developed into an abscess requiring medical treatment. The patient will be instructed to notify the surgeon of any noticeable swelling or abnormalities.

Small seromas may resolve on their own, but if left untreated they may calcify and form solid knots. Larger seromas may require needle aspiration or even drain replacement.

Methods of Prevention

Drainage is the most accepted method of prevention along with a compression garment. A compression vest will help the skin and tissue heal faster, reduce swelling and bruising and reduce the risk of developing a seroma.

A hematoma is different than a seroma in that a hematoma contains red blood cells, and an abscess is different as it contains puss from an infection.

Drains and Compression Vests

Some surgeons do not use drains, and some do not use compression vests after gynecomastia surgery. Dr. Miguel Delgado, M.D. not only advocates the use of drains, he also is a firm believer in compression vests. Dr. Delgado designed his own compression vests that he makes available to his patients. His custom-made vests have pockets for the drain bulbs to rest in, instead of being attached with safety pins. These custom-made vests additionally aid in binding the chest tissues together, decrease post-operative pain, and increase blood flow.

Dr. Delgado has over 25 years of gynecomastia surgery experience, and he states that his incidence of complications is very minimal. Call today (415) 898-4161 for a consultation for any gynecomastia issues you may have.

 


Steroid Induced Gynecomastia in a Body Builder

Posted on: December 18th, 2017
Posted by Dr. Miguel Delgado

Steroid Use and Body Builders with Gynecomastia

                           Before and After Gynecomastia Surgery for a Body Builder

Steroids and Body Builder in 6 Part Video

Dr. Miguel Delgado, M.D. presents a 6 part video where he performs a double incision mastectomy with a free nipple graft. Dave, a body builder, has severe gynecomastia due to his steroid use. This procedure can also be used for a man who has had massive weight loss, or someone with severe gynecomastia with excessive skin.

The video series will take you through the pre-operative visit, live surgery, to post-op visits.

Dave’s Steroid Use and His Story

In Dave’s story, he tells us he had been on steroids a long time before he had any development of male breasts. He did not notice any changes in his breasts until he stopped the steroids. He tells Dr. Delgado that he did not take any anti-estrogen as he was unaware of steroid side effects.

After he weaned himself off steroids and losing some weight, he became aware of his breast development. He was hoping that if he lost weight his male breasts would also reduce but found that was not the case, he learned that only the fat around the breast tissue would increase or decrease but not the breast tissue. The breast tissue is permanent, and surgery is the only way to get rid of it.

Confidence Lost

Dave tells Dr. Delgado how he lost his confidence as a professional athlete and trainer, once he developed breasts. He comes to Dr. Delgado for help so he can regain his confidence and be able to wear tight fitting shirts again.

Dr. Delgado explains that with surgery not all of the breast tissue is removed in order to have an aesthetically sculpted chest. Dr. Delgado warns Dave that if he should continue with steroids, it is possible that he could have a recurrence of breast tissue although not to the extent he now has. Dave states that he wishes to continue in moderation with steroids because as a man in his 50’s it is difficult to maintain his muscles in the way he wants. Dr. Delgado tells him that some men can take steroids with no adverse effects while others can take small amounts and develop breasts.

Exciting Results After 5 Months!

In the last video, you will see Dave at 5 months post-op with an excellent result. He is extremely happy and has had no recurrence of breast development. View all videos below.

Call Now!!

If you have male breasts due to taking steroids or even unknown causes, call Dr. Delgado (415) 898-4161 today for a consultation.

 


The Best Time to Have Gynecomastia Surgery

Posted on: December 8th, 2017
Posted by Dr. Miguel Delgado

 

 

Before and After gynecomastia surgery in San Francisco

This man has suffered from adolescent gynecomastia. He underwent glandular excision and liposuction of the chest, total fat extraction of 500cc from the right side and 450cc from the left. Total glandular tissue removed was 17 grams from the right side and 14 grams from the left.

Considerations For Surgery

The best time to have male breast reduction surgery is when you have decided to do it! However, if you are flexible, there are some things to consider when scheduling your surgery.

After surgery, you will be wearing a compression vest for the first 6 weeks of your recovery. In the winter time, the compression vest will keep you warmer as you will be wearing warmer, heavier clothing that will hide the vest.

Hiding Male Breasts

Wearing baggy clothing is how many men hide their male breasts, and after surgery, to conceal their compression vest. The compression vest isn’t as difficult to hide, as Dr. Miguel Delgado, M.D. has designed his own compression garments that are more comfortable and functional than other vests. However, for the first 2 or 3 days you will have drains in place, and even with the convenient pockets in the Delgado vest for the drains, it is a little bulky and easier to hide under a heavy shirt.

Enjoy Your Summer

Summertime is when men want to spend more time outdoors wearing tank tops, T-shirts, and even going shirtless. Having surgery in the winter time will allow your recovery to take place before the summer months. Dr. Delgado recommends that you still use sunblock on your scars for a good 6 months and even up to a year. As long as the scars are still pink, you need protection with sunscreen of at least 30 SPF, to avoid hyperpigmentation (scars turning permanently dark). Regular shirts and T-shirts do not protect scars from the sun’s rays, use a good sunscreen.

After gynecomastia surgery, you will need to take a break from your exercise program for 4 to 6 weeks. If jogging, bike riding, or other outdoor activities are your exercise choice, missing a few weeks in winter may be preferable than the pleasant days of summer.

Call Now!

If you have been thinking about gynecomastia surgery, now is the time to schedule a free consultation with Dr. Miguel Delgado at (415) 898-4161.


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