Miguel Delgado, MD - title

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San Francisco, California | Novato, California

Phone 415-830-8883

FAQ’s for Gynecomastia

__ How do I know if have man boobs or gynecomastia?

This is a very commonly asked question and difficult.  The decision is based on history and physical exam.

  • If it you developed gyno
  • If you were very heavy as a young man or maybe obese, it may be just pseudogynecomastia due to fat deposit. If so, this can be reduced with weight loss. Sometimes a heavy person can have gynecomastia underneath the fat layer and becomes apparent after the weight loss.
  • Steroid use is very common. Your chest is perfectly fine and you start to take steroid supplements either knowingly or unknowingly. Your chest gland tissue begins to enlarge, especially after you discontinued the drug. It may be tender and often very firm.
  • You’re older in life and notice male breast enlargement.  Men over 50 years old start to have reduced levels of testosterone. This imbalance will cause an increase in the female characteristic hormone estrogen and cause breast development.

 __ When should I have gynecomastia male breast reduction surgery?

The answer is fairly simple.  When you are socially embarrassed or depressed over the situation to the point that you are uncomfortable taking off your shirt. Your self-esteem is significantly affected, or you are not comfortable with intimacy in your relationships. When sports in school change from fun to no participation, no more shirts and skins, or swimming, it may be time to think about surgery.

 __ Is there a nonsurgical cure for gynecomastia?

You may see advertisements and stories in the news about easy nonsurgical treatments for gynecomastia, but Dr. Delgado says this is all hype and marketing.  He has seen many patients who have tried various things and they have discussed their dissatisfaction.  Much research is underway to find a medical alternative.  Some of these drugs can be viewed under the gynecomastia section.

__ Is liposuction by itself adequate treatment? I want to avoid surgery.

The use of liposuction by itself is not adequate treatment for true gynecomastia.  The exception is pseudogynecomastia, which is due to being overweight, and then liposuction is a good option. If only the fat is removed around the gland it will create an unnaturally looking bulb of breast tissue since the liposuction does not remove the glandular tissue. Treatment by liposuction alone leaves many patients dissatisfied. Dr. Delgado’s male breast reduction practice comprises of 40% of revision surgeries from patients who are not satisfied from other physician practices.  Many of these patients had liposuction only.

__ Is the entire breast gland removed during surgery?

Not in all cases, it is considered a cosmetic procedure. Enough tissue needs to be removed to create a well sculpted, contoured chest. In some cases all of the gland is removed, and in some cases only 80 to 90% of the gland is removed. Dr. Delgado will be glad to discuss all aspects of your surgical procedure with you.

__ Will the breast tissue come back after surgery?

Rarely, but the remaining breast tissue can still be stimulated and enlarged by steroids or other drugs. Of course weight gain can increase the fat content of the overall chest and body.

Gynecomastia seldom returns if enough of the gland is removed during the surgical procedure.

However, this is not a cancer procedure but a cosmetic one.  The goal is to have a nice male looking chest.  To achieve this, breast tissue often will remain.

Dr. Delgado has seen that treatment of adolescent gynecomastia can recur naturally because at this young age the hormones are still surging.  This can be unpredictable.

__ Is gynecomastia surgery covered by insurance?

 Insurance companies consider gynecomastia cosmetic surgery. Dr. Delgado disagrees with this determination and on multiple occasions has appealed to insurance companies, but it is rarely a covered procedure even for the most severe cases.

__ Is male breast reduction surgery painful?

 Most men state that they find gyno reduction surgery is not very painful and only take pain medication for 2 or 3 days. Removing drains can be uncomfortable but recently an improved technique has made the pain minimal. The Gynecomastia Center of Excellence is surprised how well our patients do and how the discomfort is controlled.

__ What is the Cost?

 Depending on the complexity of the surgery will determine the cost. The Gynecomastia Center of Excellence at Marin Cosmetic Surgery Center always uses a Board Certified physician anesthesiologist, who uses general anesthesia, and never local anesthesia. Dr. Delgado’s surgical staff is personally trained to the highest standards. The surgery center has Federal and California State accreditation for an outpatient surgical center.

All of this is important to remember when comparing the costs of various providers. The general cost range is $8500 to $12000 depending on the complexity and time required for surgery. Gyno-surgery is an investment in your future and even though the cost is significant, it does not compare with the lifelong enjoyment you will have from having a flat and contoured chest.

__ When will I be able to return to work?

 Within a few days patients are able to drive a car. Within a week or less, the patient can return to school or work, if it is a white collar job.

However, if the work is demanding physically, then 2 weeks of recovery will be required. Patients need to wait for 4 to 6 weeks after surgery before resuming formal exercise.

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__ What are Possible Complications?

 Gynaecomastia treatment is surgery of the skin, gland and fat tissue.  This is not considered major surgery. Complications do occur like with any surgery but men’s breast reduction issues are minimal.

  • A common complication is bleeding under the skin. Previously, it would occur in 8% to 9% of all patients, however, in the last 3 years, that figure has been reduced to about 5% to 6%. If patients live more than an hour away, we advise them to stay at a nearby hotel so that if bleeding occurs it can be handled immediately.
  • Over resection or under resection of the tissue can happen. With under resection re-excision can correct it, but with over resection, fat injections or rotation of a fat flap will be needed.
  • If an area is over resected centrally and not blended into the surrounding area a crater deformity may result.
  • Another complication may be a seroma, which is fluid accumulation. This may happen after tissue is excised and the space left will fill with fluid. Dr. Delgado rarely sees this complication because he uses drains.
  • Nipple-areola abnormality.  When the tissue is removed underneath the areola it will shrink to a degree and sometimes show irregularities.
  • Flexion deformities.  When the tissue is removed the scar tissue reattaches skin to the deep tissue and the muscle.  When the muscle is flexed the skin may show irregularities.  The result is judged by the standing non-flexed state and not the flexed state.
  • Sensation loss of the nipple areola complex. When having surgery, there is always a risk for change in sensation of the nipple. Most patients do not report a change in sensation. Merle Yost previously of gynecomastia.org surveyed men who had a change in nipple sensation after gynecomastia surgery. For patients that had the combination of surgical excision and liposuction for their gynecomastia surgery, (which is the approach Dr. Delgado uses most often), 21 stated no change in the sensation of the nipple and 29 said there was a change. 2 of the patients that said there was a change, said it was an improvement of sensation, and 27 patients said they had a loss, ranging from a half of a percent to one hundred percent, making thirty seven percent being the average loss. However, this is a survey not a scientifically controlled study. But, it does offer some interesting information. Dr. Delgado has not noted any significant issues with men regarding sensation.
  • Skin loss or poor healing. This can occur near the nipple-areolar incision and can be due to poor blood supply or possibly the elastic garment being a little too tight.

 Complications can happen with any surgical procedure; how they are managed determines the outcome. Having considerable experience associated with gynecomastia complications, Dr. Delgado is an expert in treating them.

__ How long do I need to take off from work?

The patient needs to refrain from driving a car for a few days after surgery, and be off all prescription pain medication. Returning to school or work is usually possible after one week, depending on how physically demanding the patients work is. Strenuous exercise needs to be avoided for up to 6 weeks.

 __ What happens if I am not pleased with the results?

Being exceedingly happy with your surgical result is Dr. Delgado’s goal. In some cases, if a minor revision needs to be done there will be no charge as it will be an office procedure. However, if it takes place in the surgery center under general anesthesia, you would be responsible for surgery center fees and a fee for the anesthesiologist, but Dr. Delgado will not charge for his services.

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__ Contact Us For a Consultation

To schedule a consultation with Dr. Delgado in San Francisco, California or Novato in Marin County call 415-830-8883. You may also send us a e-mail at info@DR-Delgado.com or fill out our quick contact form. Send photos of your chest for a virtual consultation TODAY. We have a complimentary travel package for out of town patients that include travel to and from the airport, four nights stay at the Novato Oaks Inn and travel from the hotel to the office.

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Dr. Delgado has offices in Marin and San Francisco for your convenience

San
Francisco

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450 Sutter Street Suite 2433
San Francisco, California 94108
(415) 989-2221

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Marin
County

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165 Rowland Way Suite 300
Novato, CA 94945
(415) 898-4161

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