February 19th, 2011
Most men that suffer with gynecomastia, had it develop when they reached puberty. Puberty is an extremely sensitive time for young men without the addition of the gynecomastia breast. A few young men are able to deal with the condition without it impairing their life style, they go to the beach, and take their shirts off for gym. Although, they almost always have to deflect cruel remarks until such time that the condition resolves itself or they seek gynecomastia treatment. But the majority of young men with the male breast suffer silently, most are too embarrassed to even get support from their parents. They refuse to remove their shirts, and they learn to stand with their shoulders rolled forward. Unfortunately, years of this type of behavior can cause great damage to one’s psyche. It is not unusual for young men to become obsessed with their condition and find that they can blame almost all of their problems on the gynecomastia breast.
At some point in their adult life, many men are able to get gynecomastia treatment, which involves the surgical removal of most of the male breast tissue and fat. For most men this is a life altering experience, the relief and immediate joy is profound. But for a very few, there can be some disappointment that not all of their problems in life have disappeared. They may have an unrealistic expectation of what their results should be, and find almost an obsession for constant minor revisions. Dr. Delgado stresses that this is a very small minority, and these men would most likely benefit from psychological counseling.
Merle Yost, LMFT
If you happen to be in the San Francisco Bay area, there is an excellent psychologist,Merle Yost, LMFT who specializes in the effects of gynecomastia, he has experienced it firsthand.He has a private practice in Oakland, California. There is a wonderful website that he developed in 1999, www.gynecomastia.org with abundant information, and forums that allow you to contact others who are considering gynecomastia treatment, or have already had surgery.
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January 15th, 2011
Be wary of a surgeon who says he/she is only doing liposuction for removal of the gynecomastia breast. There is only a very small percentage of men that will get a good result from liposuction only, and they have what is known as “pseudo gynecomastia”, which means they do not have excessive male breast tissue, mostly just fat. Breast tissue is too dense to be removed by liposuction, it must be removed by excision. I would say that 25% to 30% of my gynecomastia practice in the San Francisco and Bay Area is “redo” surgeries originally performed by surgeons who have done liposuction only. Having to do “redo” surgery is much more challenging as now there is scar tissue involved making dissection more difficult, plus the added difficulty of less skin contraction also caused by the scar tissue. Save yourself the expense, the time and frustration of having to have the surgery done again by doing your homework, research very carefully and find an experienced Board Certified Plastic Surgeon that specializes in gynecomastia.
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November 28th, 2010
FACT OR FICTION
There has been some discussion on gynecomastia.org recently regarding diet, exercise and medications and whether or not it will help the gynecomastia breast, also referred to as “moobs”. I would like to address these issues from my perspective. In terms of diet and exercise, diet will definitely alter the fat content of the male breasts. Gynecomastia is composed of glandular tissue and fatty tissue. The fatty tissue can be altered by diet and exercise; however, the glandular tissue will not be affected. Exercise will help with the development of the pectoralis in terms of making it more bulky or
enhancing its definition. This will not alter gynecomastia except pushing it more outward.
In terms of drugs and medication, there has been a lot of false advertising regarding drugs and pills over the internet, stating that they will enhance the removal of gynecomastia. There is no scientific evidence to support these claims, there are no pills or drugs available to reduce gynecomastia. However, drugs that help weight reduction will reduce the overall fat content in the body and in the chest as well, but, as I said earlier, not the glandular component. If one is going through adolescence and one’s hormones are off balance, it is possible that an endocrinologist can possibly adjust them during the early developmental stages. However, once the gynecomastia is established, past puberty and the teenage years, usually it does not resolve. Even action heroes, such as Tom Cruise can develop “man boobs”.
In a good portion of boys with gynecomastia in puberty, it will go away in many cases on its own; therefore, often times we advise patients to wait until the end of puberty unless it is a severe case or has significant psychological issues. For some patients with a milder case, they may be a candidate for the “Light Procedure“. For more information, go to gynecomastiaspecialiast or Dr. Delgado’s website. Dr. Delgado sees patients for consultations at his Bay Area offices, in San Francisco and Marin county.
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October 27th, 2010
For men with the mild to moderate gynecomastia breast, there is a much less invasive procedure available to correct their male breast, also known as “moobs”.
The “Light Pull-Through Procedure” starts with some liposuction through a small 2 to 3 millimeter lateral incision near the areola. Then an instrument, like a pickle fork, is inserted to free up the glandular tissue by cutting the connecting fibers above and below and then it is able to be pulled out gently though the incision, as in the photo below.
Advantages for patients having this procedure are; less surgery and recovery time, minimal scarring, and no drains.
Many men have asked Dr. Delgado if liposuction alone will correct their gynecomastia breast. In some cases this is possible, however for most men removing fat only will exacerbate the problem and make the remaining gland more prominent. It is possible that initially the patient might have been a good candidate for the “Light Pull-Through Procedure”, but once liposuction alone has been done, it becomes a more complex procedure to correct. A large percentage of patients that come to Dr. Delgado, are patients needing corrective surgery after a failed attempt at liposuction alone from another facility.
The best way to determine if you may be a candidate for this procedure is to schedule a consultation at either Dr. Delgado’s San Francisco office or Novato, in the Bay area of Northern California.
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September 27th, 2010
GYNECOMASTIA (MALE BREASTS) BEGINS AT A YOUNG AGE
The cause of gynecomastia is not known, but there are several factors that may exacerbate the condition, such as use of steroids, or marijuana. Other things such as lavender oil, tea tree oil and soy milk are under study as possible causes. It can be hereditary or present during puberty only to be out grown at a later date. For young adolescents developing breasts, this can be a very frightening condition. Most young men do not understand the condition and do not realize how common it is. Thirty to sixty percent of young boys are affected by this condition, and as many as thirty percent of them will have it for the rest of their life.
It is important for parents to be aware of their son’s condition and how it is affecting their emotional state. Most young boys are very embarrassed and try to hide their chests. Many will keep their shoulders hunched, and make excuses not to go swimming or avoid situations where they may need to remove their shirt. What may not seem a difficult condition to a parent, can be most traumatic to a young boy. Students are known to taunt boys and humiliate them in gym class where they regularly need to remove their shirt. Boys going through puberty are already very self conscious. It is hopeful that there is a family member aware of such situation and would be able to take their child to a physician for an evaluation.
In most cases, young men will outgrow the condition, but many times they will not. A qualified plastic surgeon that specializes in gynecomastia, would be able to advise the parent and child of what he can expect. The good news is, if it is a permanent condition, it can be corrected by surgery once the boy has gone through puberty. Some boys with a milder case may be a candidate for the “Light Procedure“. It is a wise parent that will help their son through this stressful time and get a consultation once they are aware the situation exists.
We know of one young man that was so disturbed by his “moobs” that he asked his father if instead of spending the money set aside for his college, if he could have gynecomastia surgery. The father was so surprised to find that this was even an issue for his son. He was able to get a loan for the surgery and his son went on to college. Unfortunately not all young men are so lucky to have such a compassionate parent. Emotional support is so important but not always available by a family member. If this should be the case, there is an excellent website that has been around since 1999. It is www.gynecomastia.org here you will find many young men in similar situations that give support to each other. It is set up with chat rooms where there is tons of information available, and members can post questions. You do need to sign up, but there is no charge. This website is invaluable as a source of information and support.
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August 23rd, 2010
MORE TO CONSIDER PRIOR MALE BREAST REDUCTION SURGERY
Below is a continuation of the last blog that addresses frequent asked questions to Dr. Delgado by his patients.
Question #6: Is it painful?
Answer: Gynecomastia reduction surgery is not particularly painful. Most men find they need pain pills for only two or three days. Drain removal can be a little uncomfortable, but recent, improved techniques have made it less so.
Question #7: Will the nipple sensation be lost?
Answer: With surgery, it is always possible to have a change in nipple sensation. Some patients have reported changes in sensation, but most do not mention it. Merle Yost of gynecomastia.org has surveyed men who had gynecomastia surgery and a change in nipple sensation is one of the subjects addressed in his survey. If you sign onto the site, gynecomastia.org, you can read comments by post-surgical patients regarding the changes they have experienced with nipple sensation.
Of patients who underwent the combination of liposuction and surgical excision of gynecomastia, the approach most often used by Dr. Delgado, 21 reported no change in nipple sensation and 29 reported there was a change in nipple sensation. Two of the patients who reported a change said that they had an improvement in nipple sensation. Twenty-seven patients reported a loss of sensation ranging from 0.5% to 100%, with the average loss being 37%.
Remember, this is a survey and not a scientific controlled study. It does, however, offer interesting information.
Question #8: How much does it cost?
Dr. Gaynor, anesthesiologist
Answer: Costs depends on the complexity of the surgery. Gynecomastia reduction surgery at Marin Cosmetic Surgery Center is always done with a board-certified physician anesthesiologist, never under local anesthesia. Our facility has national and state accreditation as an outpatient surgery center. These are important facts to consider when comparing costs with various providers. Cost usually falls between six and eight thousand dollars.
Question #9: What could go wrong?
Answer: This is real surgery and the risks associated with that cannot be overstated. Bleeding under the skin is one of the most common complications. It used to occur in about 8-9% of patients, but over the past three years we have been able to reduce that figure to approximately 5-6%. We now require blood clotting tests and prescribe a regimen of Vitamin K to boost the body’s clotting mechanism. We advise patients to stay at a local hotel if they live over an hour away.
Complications do occur. This is a fact in the practice of medicine. It is how the complications are managed and handled that determines the outcome. Dr. Delgado has vast experience with gynecomastia surgery and is very comfortable in treating any complications that might occur.
Over or under resection of tissue can occur. Under resection can be handled with re-excision, but over resection requires fat injections to the involved area.
Question #10: When can I go back to work?
Answer: After gynecomastia surgery a person can drive a car within a few days and can return to school or work within a week. (If a person’s work is physically demanding, two weeks of recovery will be needed.) Formal exercise regimens should not be resumed until six weeks after surgery.
Question #11: What is the policy if I am not happy?
Answer: Dr. Delgado’s goal is to have you be extremely satisfied with your results. If a revision is needed, and it can be performed in the office, he will do it at no charge. If general anesthesia is required, Dr. Delgado does not charge the patient for his services, but there may be a fee for the surgery center and the anesthesiologist’s services.
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July 21st, 2010
THINGS TO CONSIDER BEFORE SURGERY
On March 23, we had a blog on FAQ’s for the gynecomastia patient recovering from surgery. There are many questions patients ask Dr. Delgado prior to making the decision to move forward with surgery. Below are several questions he is frequently asked, and we will be posting a few more in our next blog.
Question #1: Are there any nonsurgical treatments for gynecomastia?
Answer: Although you can read about easy, non-surgical cures in the news and advertisements, and there is considerable ongoing research aimed at finding a way to reverse it without surgery, no effective medical treatment actually exists at this time.
Question #2: Is liposuction adequate treatment? I do not want a surgical procedure.
Answer: Liposuction alone is not a good treatment for gynecomastia. Only with cases of pseudogynecomastia is it an adequate technique. Removing the fat around the gland only creates an unnatural bulb and patients are not satisfied with the aesthetic result from this technique. There are some patients that are candidates for the “Light Procedure” which is much less invasive Redo surgery from other establishments comprises 25-30% of Dr. Delgado’s gynecomastia practice and most of these cases have had liposuction alone.
Question #3: Will the entire gland be removed during the surgery?
Answer: Not necessarily. Male breast reduction surgery for gynecomastia is a cosmetic procedure. Therefore, enough is removed to create a good looking, flat, but contoured chest. Sometimes the entire gland is removed and sometimes only 80% or 90% is removed. After surgery, Dr. Delgado is happy to discuss this aspect of your procedure with you.
Question #4: Will it come back after surgery?
Answer: Rarely, but the tissue can be still stimulated and enlarged by steroids or other medication use. 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.
Question #5: Will insurance pay for the gynecomastia surgery? 
Answer: This is a very difficult question to answer even though Dr. Delgado has dealt with insurance companies on hundreds of occasions. It is unusual that gynecomastia reduction surgery is covered, even in the most severe and unfortunate cases. Most insurance companies consider it cosmetic surgery. Dr. Delgado has occasionally received approval for cases in which a medical condition or syndrome has caused the gynecomastia. Even symptoms of pain and tenderness usually fail to warrant coverage in the opinion of the insurance carrier.
Nevertheless, Dr. Delgado is always willing to write a letter and send photographs to the insurance carrier on behalf of the patient, with the hope that insurance coverage for the surgery might be granted.
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June 18th, 2010
GYNECOMASTIA.ORG
THE BEST
Gynecomastia.org is the best website for information on gynecomastia, male breast reduction in the entire world. I have followed and participated in the website ever since it’s inception in 1999, and admire Merle Yost for his dedication and efforts to educate the public regarding gynecomastia. The website he has introduces the entire spectrum of issues regarding gynecomastia, nicknamed “moobs” from the psychological impact to the post-surgical results. This website has an array of qualified physicians, a wonderful forum for men to discuss their condition, to get advice and share stories. The website also offers valuable information regarding physicians around the country and the pros and cons of their practices from a patient’s perspective.
There is a “Find a Surgeon” section to help you locate a board certified plastic surgeon that specializes in gynecomastia surgery. There is a “FAQ” section, medical articles, treatment options, gynecomastia gallery with before and after pictures. Also, post surgery workout information and much more.
You need to sign up to participate in the forums, but there is no charge.
I highly recommend that men with gynecomastia use this website for its completeness and its in-depth coverage of this medical condition.
Miguel Delgado, M.D. 
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May 18th, 2010
WEBCAM ALLOWS PERSONAL CONSULTATION
We all know the world has gotten smaller with the incredible progresses of technology. We are able to do things unheard of even ten/twenty years ago. The popularity of Skype has opened doors and opportunities for all of us. Dr. Delgado now offers complimentary consultations via Skype for out of town patients which allow them the opportunity to have the next best thing to a personal consultation for male breast reduction. Gynecomastia surgery techniques can vary from patient to patient, depending on the severity of their case. With Skype,Dr. Delgado can evaluate a patient, and answer questions, saving the cost of travel for that initial consutation.
For those who have never experienced Skype, it is easier than you may think. Most computers come with built in web cams, but if your computer doesn’t have one, they are very inexpensive to purchase and will attach right to your computer. Radio Shack has them for $20 and up. Amazon.com has them for less than $10. Less than the cost of a consultation!
Registering for Skype takes only a few minutes, and it is free. So not only do you get to speak directly with Dr. Delgado you will be meeting him face to face, a great opportunity to get to know him. After your consultation, his patient coordinator will be able to email a quote to you. If you are interested in having a consultation this way with Dr. Delgado, please call the office and set up a time. (415) 898-4161.
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March 31st, 2010
DESPITE RECESSION SURGERY FOR MEN INCREASES
According to the “American Society for Aesthetic Plastic Surgery” (ASAPS), cosmetic procedures dropped only 2% from 2008. Compared to all surgical procedures, which had a drop of 17%. Of all cosmetic procedures done, men make up a total of 9%, but for men there was actually an increase of 8%.
Dr. Miguel A.. Delgado, Jr. is a member of ASAPS which is the leading organization of plastic surgeons certified by the American Board of Plastic Surgeons, who specialize in cosmetic surgery. On March 9, 2010 the 13th Annual Cosmetic Surgery Statistics from the Aesthetic Society were published. You will note that gynecomastia surgery, male breast reduction, also known as Moobs, is in the top 5 procedures for men.
This can most likely be explained by the fact that many people realize the importance of feeling good about themself and how it projects into their lifestyle and work place. In these challenging times we are all facing, a good attitude and self image is of utmost importance.
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