Male breast surgery has recently developed following the advent of high definition male abdominal etching. Previously, men were observed desiring a defeminization surgery that would essentially flatten their chest, called gynecomastia surgery. Traditional gynecomastia surgery involved the complete removal of the mammary glandular tissue as well as conservative removal of the fatty breast tissue in the peripheral chest region. Removal of the glandular tissues could be accomplished with liposuction and/or direct excision of the glandular tissues. The area of removal would then be smoothened with the breast periphery with conservative liposuction. Instead, today men are desiring masculinization surgery that demands a strong and bold chest contour. A masculine chest contour requires the creation of an armor plate appearance that has a flat central region but a prominent perimeter much like the appearance of a plateau.
The nuances regarding male breast plastic surgery are several. The first requires a reduction of the glandular tissues located typically under the nipple and areola. Since the entire chest is not being flattened, some retention of glandular tissue is acceptable in order to ensure a smooth contour line. As such, patients may undergo liposuction of the glandular tissue rather than direct excision. This technique of glandular reduction rather than excision avoids a potential surgical scar. It is important to note that VASER liposuction utilizing ultrasound energy is the preferred liposuction technique as it assists with the removal of firmer glandular tissues. The second component is the creation of bold and linear borders that are best characterized by a pentagonal shape. The pentagon includes a horizontal lower border, a small oblique, and longer vertical medial border, and a vertical oblique, lateral border. The upper border is defined by the horizontal collar bone. Just under the clavicle, there is an infraclavicular triangular concavity that is aesthetically unique to the chest which should not be altered.
The goals of male breast and chest surgery include not only reduction of the central glandular tissues but also fat transfer to the above inferior, the lateral oblique and medial oblique and vertical borders. To create these strong borders two maneuvers are required. The first requires intramuscular fat grafting of the chest border to not only strengthen the perimeter but also transform curved lines into straight lines. In addition, the chest borders, i.e. adjacent areas, must be debulked. These debulked areas include the removal of fat from the upper abdominal inscription line, the axillary region, and the sternal line using liposuction techniques.
In summary creation of the armor plate, chest appearance is critical to creating a masculinized chest that is harmonious when interposed on a high definition etched abdomen. Male breast and chest surgery has undergone an evolution in aesthetics that is inherent in the male body contouring transformations available today.
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