Gynecomastia for Men

Conveniently located to serve the areas of Marin, San Francisco, Sonoma and Napa

Gynecomastia is defined as swelling of breast tissue in boys and men, occurring in hundreds of thousands of patients in the U.S. each year. Dr. Poulos and Dr. Hvistendahl are specialists in treating gynecomastia with a number of surgical options including male breast tissue removal, ultrasonic liposuction, and power-assisted liposuction using the SAFELipo technique.

Discover why patients travel from all over the Bay area to our Center of Excellence for male breast reduction surgery. We invite you to request a consultation online or call us at (415) 925-2880 to schedule an appointment.

What is Gynecomastia?

Gynecomastia occurs when the breast tissue in boys and men swells as a result of reduced levels of testosterone and higher levels of estrogen. Over 200,000 cases are reported annually in the U.S., and the fluctuations can be caused by exposure to new medications, puberty, age, marijuana use, and other health issues relating to the body’s hormonal balance. Gynecomastia is common among middle-aged and older men. In this population, up to 65 percent of men are affected.

Our board-certified surgeons perform male breast reduction surgery to treat gynecomastia at Plastic Surgery Specialists in Marin County. The procedure removes excess fatty tissue and tightens the skin. Gynecomastia is a purely aesthetic concern that usually begins during puberty, although it sometimes occurs in adults who suffer certain medical conditions. It can be embarrassing and stressful for boys and men, who may develop low self-confidence in their bodies.

Pseudogynecomastia vs. Gynecomastia


Gynecomastia occurs when a shift in hormones cause the breast tissue to undergo an excessive amount of growth. In the case of pseudogynecomastia, however, the growth of fat is the underlying issue. Although a small distinction, the underlying cause difference calls for different treatment methods. During a patient consultation Dr. Poulos or Dr. Hvistendahl will conduct an exam of the area to determine whether it is gynecomastia or pseudogynecomastia, which will dictate the recommended treatment.

What Can Cause Gynecomastia?

Gynecomastia is caused when male hormones like testosterone are lowered, while levels of female hormones such as estrogen rise. This change causes increased growth in the patient’s breast tissue, resulting in an appearance similar to female breasts. Though an individual’s endocrine system usually regulates hormone levels in the body, a disturbance in the system can lead to higher levels of estrogen and androgens, particularly during puberty. Many cases of gynecomastia in adolescent boys – between the ages of 10 and 13 – resolve in less than two years without the need for surgical intervention. For teenagers, the condition can be psychologically damaging and warrant intervention once examined by the doctor.

In adult patients, heightened levels of estrogen and androgens can be caused by a number of factors, including improper nutrition, medications affecting the endocrine system, or a chronic disease like kidney failure or cystic fibrosis. In some rare cases, it may be caused by genetic factors.

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  • Over 50,000 procedures performed
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Our experienced team of board-certified plastic surgeons combines a unique aesthetic perspective, the ability to listen closely to your needs, and the skills to achieve those desires. This combination sets PSS apart as a world-class plastic surgery clinic, located in Marin County, CA.

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How to Treat Gynecomastia (Male Breast Reduction Surgery)

Dr. Poulos and Dr. Hvistendahl specialize in male breast reduction surgery as a treatment for gynecomastia. There are various surgical options including mastectomy (either subcutaneous or with the help of liposuction), laser liposuction, and laser lipolysis. Depending on the severity of the condition, the doctor will recommend different surgical solutions. More pronounced cases will involve the removal of the glandular tissue affected by hormonal imbalance.

Less severe cases can be addressed with liposuction alone; ultrasonic liposuction like VASER Hi Def Lipo can be extremely effective. Frequently patients take additional measures to improve the appearance of their chest, like repositioning the nippleremoving excess skin, and tightening the muscle below for a more sculpted look.

Good Candidates

Potential candidates for surgery to correct gynecomastia are men who feel their condition is impacting their self-esteem and, in rare cases healthy teenage boys (once they have stopped growing). Patients should be old enough to be certain that their condition is not temporary, as is often the case with younger men who still have “baby fat.” Men should be at a stable weight, within a normal range for their height and build. Good skin elasticity is also helpful.

Before & After Photos


A proper assessment of medical needs requires open communication between patients and our staff. Based on your consultation, the doctor may require that you receive further evaluation before deciding to undergo a surgical procedure.

Preparing for Your Male Breast Reduction Surgery


After your evaluation with Dr. Poulos or Dr. Hvistendahl, you may be asked to alter or temporarily halt your current medications to avoid any complications with the upcoming procedure. It is also important that you avoid smoking and anti-inflammatory painkillers like aspirin and ibuprofen, as these thin the blood and may cause a higher risk of bleeding during and immediately after surgery. Certain health supplements and vitamins that potentially increase risks should be eliminated; this may include vitamin E or any multivitamins containing it, fish oil, and omega-3 supplements. Specifics can be discussed in detail with the nurse during your pre-operative consultation. 

The Procedure

We perform male breast reduction surgery at our state-of-the-art surgical center. The procedure combines fat removal, tissue reduction, and muscle and skin tightening. The surgery is customized for each patient, and in some cases Dr. Poulos or Dr. Hvistendahl may use liposuction to remove excess fat from the breast area. Once the fat is removed, underlying muscle is tightened along with the breast skin to achieve a more sculptured appearance. In some cases it also may be necessary to remove excess skin to get optimal results. In other cases, the size of the areolas — the dark skin surrounding nipples — may need to be reduced, too.

After Your Procedure

Gynecomastia surgery requires general anesthesia and is typically completed within two to four hours. Surgical drain tubes may be needed, along with dressings and an elastic bandage. Swelling gradually subsides and discomfort is managed with pain relief medications. We remove drains and bandages within two days after surgery and external sutures in one to two weeks. Patients should avoid vigorous exercise for a few more weeks, especially exercise of the pectoral muscles. Oftentimes patients are given a compression bandage to help reduce swelling and facilitate healing in the area; these can be worn for several weeks after the procedure.


The cost of male breast reduction surgery to treat gynecomastia will also be discussed during your consultation with Dr. Poulos or Dr. Hvistendahl. The total cost will depend on your specific procedure, and each surgery is completely customized to your needs and aesthetic preferences. Additions such as skin removal and areola reduction will determine the total cost of surgery.


Is gynecomastia dangerous to my health?

Gynecomastia is not harmful, nor is it painful. However, it is possible that the buildup of excessive breast tissue could be a symptom of a more serious health issue. Dr. Poulos or Dr. Hvistendahl can let you know during a consultation visit whether they recommend further evaluation; gynecomastia itself does not pose a threat to your health.

Can my excessive breast tissue be removed with liposuction alone?

In most cases, gynecomastia can be significantly improved, if not eliminated, with liposuction alone, especially with the use of ultrasonic liposuction (VASER Hi Def Lipo.) The breast can be adequately contoured with this technique. It does require some skin elasticity so it can retract once the excessive tissue is removed. A small incision near the nipple may be needed to remove more fibrous breast tissue. If there is significant sagging of the skin or breast size similar to a female breast, it may be necessary to reposition the nipple to achieve the best contour. This could result in additional scarring.

Will my excess breast tissue recur?

In most cases, surgically correcting gynecomastia
is permanent, providing the patient’s weight remains stable. Reducing the appearance of “male breasts” is an incredible confidence booster for most men.

How long does the surgery take and what is recovery like?

Surgical time varies from an hour to two or more hours, depending on what is required. It usually takes 3 or 4 days before normal activities can be resumed. Vigorous activities are permitted within 1 to 2 weeks after checking with the surgeon. Bruising in the first week to ten days is a normal part of the recovery process.

What are the possible problems associated with male breast reduction?

Slight skin irregularities can occur following liposuction or excision for gynecomastia. If there is a significant amount of fibrous breast tissue, an incision could be required in order to remove it. Temporary numbness or hypersensitivity of the breast can occur but usually resolves within weeks.

How to Find Us

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