Babak Dadvand M.D.
Board Certified Plastic Surgeon
8500 Wilshire Blvd. Suite 615 | Beverly Hills, CA 90211
The male breast is composed of glandular tissue and fatty tissue. Excess in either type of tissue can cause the chest to take on the look of gynecomastia. Gynecomastia can affect men of all different body types. One particular subset of the patient is a male who is overweight.
Obesity is an issue that affects over 51% of the population. As with other males, obese men may also have gynecomastia. There are however some variations with the type of gynecomastia seen in males who are obese.
A majority of males with gynecomastia have a glandular component. This is breast tissue that is centered underneath the areola. There is usually also a variable amount of fatty tissue that surrounds this breast tissue as well. Men who are obese may have this form of gynecomastia. This is due to the increased conversion of androgens to estrogens by tissue aromatase. However, more often obese males have an excess of fatty tissue with little or no excess in glandular tissue. The distinction is important because it may respond to diet and exercise. In men with excess fatty tissue who do not show a response to diet and exercise liposuction is an effective technique to correct the problem.
Another issue with obese men is that they may have a degree of breast ptosis (droopiness) or even skin excess. The treatment for these patients will involve skin excision, areolar reduction, breast lift, or a combination of the three. These cases need to be addressed in an individual manner and the resultant scars and risks need to be explained fully to the patients. In some cases, the procedures will need to be staged. In the first stage, the excess breast and fatty tissue are removed and the skin is allowed to retract. In a second stage performed months later whatever remaining excess skin is removed. This approach may limit the number of extra scars that need to be made.
The most important decision to be made before performing any operation is whether the patient is a good surgical candidate. In our experience, we have observed that the best results are achieved when the patient is closer to their ideal body weight. Patients who are overweight or obese are more likely to have surgical complications and less likely to achieve a good aesthetic result. As such, we encourage overweight patients to lose weight before undergoing surgery. Normal body weight is different from one patient to another, and Dr. Dadvand consults with each patient regarding not just their target weight, but also how to achieve it.