Donald Wright* had always been fat. By the time he was a sophomore in college, he had packed 300 pounds onto his 5-foot-10-inch frame. That same year, he adopted a stringent diet-and-exercise regimen and lost more than a third of his body weight in four months. He continued working out after he reached his goal of 160 pounds, even became a marathon runner and dropped another 40 pounds.
But good nutrition and exercise couldn’t undo all the damage obesity had done. Folds of loose skin hung from his torso. The extra fat near his pectoral muscles wouldn’t go away.
“I’m a very good-looking man, but I never felt like taking my shirt off at the beach,” Wright, now a 36-year-old executive, remembers. “It’s not just hot and uncomfortable. You’re 160 pounds, but you still look overweight.”
Wright isn’t alone in his plight.
Up to 40 percent of males develop clinical gynecomastia, or abnormal enlargement of the breasts, at some time in their lives, says Dr. Michael Wojtanowski of the Ohio Clinic for Aesthetic and Plastic Surgery in Westlake, quoting a surgery textbook.
The number goes up to 50 percent in men over 40 based on the patients Dr. Mark Foglietti of the Cosmetic Surgery Institute in Beachwood sees in his practice. Those with true gynecomastia develop too much breast tissue because of genetics or a change in hormone levels during adolescence or middle age.
“In teens, it’s not unusual to see some gynecomastia, which generally resolves itself within a few years,” Foglietti says. Those with pseudogynecomastia have accumulated fat in the breast space as a result of weight gain or side effects of a drug they’re taking.
Certain medications used to treat heart conditions and prostate cancer “turn on fat cells and make them grow in certain parts of the body,” Wojtanowski explains. Marijuana and anabolic steroids can do the same thing.
“There’s often a combination, where men will have pseudogynecomastia and gynecomastia,” Wojtanowski says. “But the bottom line is, it’s puffy breasts, bulging breasts, a female-type breast on a male chest.” He compares the resulting self-consciousness to that suffered by women who believe their breasts to be too large or too small. “Some of these men won’t wear a pullover sweater or a polo shirt because they’ve got this bulge that shouldn’t be there.”
The solution is a one- to three-hour outpatient procedure in which fat is removed via liposuction. A blunt, rod-shaped surgical instrument called a cannula is inserted through an incision into the subcutaneous fat layer and used to suction it out. The breast tissue — Wojtanowski describes it as a disc between the size of a dime and 50-cent piece that sits under the areola — is then cut out through the same smile-shaped incision made at the juncture of the areola and the skin.
Foglietti says the skin on patients “in the A- to small B-cup range” usually contracts to the contours of their more manly physique. But men with larger breasts, especially those who are older, may require removal of excess skin at an incision made around the areolas or diagonally across each breast. “In a man with a hairy chest, it’s a lot more easily hidden,” he says.
To reduce the need for such surgeries, he asks patients to wear a compression vest, a light elastic garment that applies pressure to the chest and diminishes swelling as well as the risk of postoperative bleeding and fluid buildup, for four to six weeks after the procedure.
“The majority of times, if you put the patient in a compression vest and keep the skin smooth while it’s in there, the skin will tighten adequately,” Foglietti says. Men who do end up with skin folds and wrinkles often see additional improvement within six to 12 months — reason enough to delay additional surgery.
Other possible complications include contour irregularities and permanent numbness, both of which Wojtanowski says are rare. Most men experience minor bruising and swelling and temporary numbness and return to work or school after a week.
Foglietti also asks his patients to adhere to a four-week moratorium on exercise and other physical activities that raise the heart rate and blood pressure.
“It takes about three months for all the bruising and swelling to go away, the incisions to settle down, and the skin to shrink into its new place,” Wojtanowski says. “But you don’t look abnormal during that period.” In fact, most men are ready to go shirtless in about a month.
In February 2007, 15 years after his dramatic weight loss, Wright had his extra fat removed under a general anesthetic at Wojtanowski’s clinic, along with the existing folds of skin around his stomach. “I said, ‘I’ve kept the weight off. I might as well just do it!’ ” he says.
Although he admits the latter was painful, he says he experienced none of the bruising, swelling or pectoral muscle soreness Foglietti describes. In fact, he felt he looked good enough to go shirtless the next day. His only regret is that he waited so long to do it. Indeed, he hopes telling his story will help other men overcome their reluctance to schedule plastic surgery, especially if they’ve already done everything they can to improve their appearance.
“People have to understand that you can only do so much,” he says.
Achieving an ideal male look can be difficult for men who have experienced dramatic weight loss. Stubborn fat and excess skin are often problems.“Some of these men won’t wear a pullover sweater or a polo shirt because they’ve got this bulge that shouldn’t be there,” says Dr. Mark Foglietti.Although gynecomastia is a common condition, the treatment for it is slowly growing in popularity — mainly because many men don’t even know one exists. The following procedures are among the most requested in plastic surgeons’ offices.
Westlake plastic surgeon Dr. Edward Levy says it’s the most popular “body procedure” among his male patients, young and old alike. The most common areas to be relieved of stubborn fat pockets are the abdomen and hip rolls, better known as “love handles,” according to Dr. Mark Foglietti of the Cosmetic Surgery Institute in Beachwood and Dr. Michael Wojtanowski of the Ohio Clinic for Aesthetic and Plastic Surgery in Westlake.
Like liposuction, the “nose job” is big with all ages, whether it’s to correct breathing problems, repair a broken nose, or improve its appearance. Foglietti performs it on everyone from 18- to 50-year-olds.
“It’s something they have been concerned about their whole lives,” he says. “They can now afford to have the procedure.”
The “plugs” of yesteryear have been replaced by “single follicular units” harvested from the back of the scalp and placed in “pinholes” in the bald or balding areas, according to Foglietti. “You even put the hair follicle in so it is growing in the appropriate direction,” he says. Most of Foglietti’s hair-transplant clients are in their 30s, 40s and 50s, but he suggests starting the process when the hair line begins to recede or the bald spot appears.
Wojtanowski says men start to show up in his office during their mid- to late 30s. “More commonly, you get the 45- to 55-year-old who’s coming in because things are sagging.” Men gravitate to surgical procedures — an eyelid tuck, brow lift, face-lift — rather than nonsurgical options such as Botox injections, he notes.
“They say, ‘I don’t have time to come in here every six months. I’m just going to get it taken care of and call it a day.’ ”