COOL CASE OF THE WEEK
GYNECOMASTIA REDUCTION BEFORE AND AFTER

This pleasant 30 year old man came to see Dr. Medalie at his Beachwood, Ohio office to discuss gynecomastia reduction. He had evidence of breast tissue on his chest since adolescence and even with losing weight had not noticed a big difference. After careful consultation he decided to undergo a male breast reduction surgery (gynecomastia procedure) as an outpatient at the Brainard Surgery center where Dr. Medalie performs most of his operations. The surgery lasted around 1.5 hours and was an outpatient procedure. It involved a combination of liposuction and direct excision of the sub-areolar glandular tissue. The patient is now shown 6 months after his gynecomastia surgery and has an excellent post-operative contour. He is very pleased with his result. Plastic surgery results can vary. Below is information from the American Society of Plastic Surgery concerning gynecomastia and male breast reduction surgery. For more information please visit Dr. Medalie's main photo gallery.
What Is Gynecomastia Surgery?
Gynecomastia surgery reduces breast size in men, flattening and enhancing the chest contours.
In severe cases of gynecomastia, the weight of excess breast tissue may cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple). In these cases the position and size of the areola can be surgically improved and excess skin may be reduced.
Plastic surgery to correct gynecomastia is technically called reduction mammaplasty.
What Is Gynecomastia?
Gynecomastia is a condition of overdeveloped or enlarged breasts in men that can occur at any age. The condition can be the result of hormonal changes, heredity, obesity or the use of certain drugs.
Gynecomastia can cause emotional discomfort and impair your self-confidence. Some men may even avoid certain physical activities and intimacy simply to hide their condition.
Gynecomastia is characterized by:
- Excess localized fat
- Excess glandular tissue development
- Sometimes excess breast skin
- Presence unilaterally (one breast) or bilaterally (both breasts)
What Are The Steps Of A Gynecomastia Procedure?
A gynecomastia procedure includes the following steps:
Anesthesia
Medications are administered for your comfort during the surgical procedures. The options include intravenous sedation and general anesthesia. Your doctor will recommend the best option for you.
Liposuction Technique

In cases where gynecomastia is primarily the result of excess fatty tissue, liposuction techniques alone may be used. This requires insertion of a cannula, a thin hollow tube, through several small incisions.
The cannula is moved back and forth in a controlled motion to loosen the excess fat, which is then removed from the body by vacuum suction.
There are various liposuction techniques that may be used; the technique most appropriate in your case will be defined prior to your procedure.
Excision Technique

Excision techniques are recommended where glandular breast tissue or excess skin must be removed to correct gynecomastia. Excision also is necessary if the areola will be reduced or the nipple will be repositioned to a more natural male contour. Incision patterns vary depending on the specific conditions and surgical preference.
Combination Of Liposuction & Excision Techniques

Sometimes gynecomastia is treated with both liposuction and excision.
This 26 year old patient from Youngstown, Ohio contacted Dr. Medalie of Cleveland Plastic Surgery for labia minora reduction and vaginal rejuvenation.She had asymmetric labia minora with the right side being much larger than the left side and complained of extreme irritation while exercising and wearing tight clothing. She was most concerned about post-operative symmetry. She had visited Dr. Medalie's websites, ClevelandPlasticSurgery.com and LabiaplastySurgery.net and also read reviews of him on Realself.com and felt that he would be able to perform the kind of labia reduction that she desired. Her goal was to have a wedge resection with preservation of the natural labia contour, and in their consultation, Dr. Medalie assured her that this was possible. The labia reduction surgery was performed at his Cleveland west side clinic under local anesthesia with mild oral sedation. The second picture shows the patient 3 months after the labia reduction surgery with a pleasing contour and dramatic reduction in labia size and contour. There is excellent symmetry between the two sides.
Labia Minora Reduction Before and 3 Months After

This 34 year old mom from Youngstown, Ohio came to see Dr. Medalie at his Cleveland, Ohio east side office. She desired bilateral breast augmentation with silicone breast implants to help fill in the volume that she had lost after childbirth. After careful discussion with Dr. Medalie she elected to have 371 cc smooth round silicone breast implants placed in the partial sub-muscular position. The surgery was performed as an outpatient at Dr. Medalie's east side location and the patient is shown three months after the breast enhancement surgery with an excellent contour. She is very pleased with her breast enlargement and new breast size.
Breast Augmentation pre and post-op pictures front view

Breast Augmentation pre and post-op pictures side view

This 49 year old patient from New York City, New York contacted Dr. Medalie of Cleveland Plastic Surgery for vagina rejuvenation. She had visited Dr. Medalie's websites, ClevelandPlasticSurgery.com and LabiaplastySurgery.net and also read reviews of him on Realself.com and felt that he would be able to perform the kind of labia reduction that she desired. Her goal was to have a wedge resection with preservation of the natural labia contour, and in their consultation, Dr. Medalie assured her that this was possible. She also desired clitoral hood reduction and tightening of the labia majora. She mentioned that her labia majora had gradually deflated and become loose after her several pregnancies.The labiaplasty with reduction of both the labia minor and majora as well as clitoral hood reduction were performed at his Cleveland west side clinic under local anesthesia with mild oral sedation. The labiaplasty (minora) incisions were central wedges, and the majora incisions were ellipses designed to leave the scar in the inter-labial sulcus between the minora and majora. The last picture shows the patient 3 months after the labia reduction surgery with a pleasing contour and dramatic reduction in labia minora, majora and clitoral hood size and contour.
Labiaplasty, clitoral hood and labia majora reduction before and after photos

This patient is a female to male transgender patient who contacted Dr. Medalie of Cleveland Plastic Surgery in Cleveland, Ohio in regards to FtM "top surgery". The patient desired a complete mastectomy with the goal of having a masculine chest that appeared as if he were genetically male. The various types of operations were explained to him and it was decided to proceed with a double incision approach with free nipple grafting and reconstruction . The surgery was performed as an outpatient at MetroHealth medical center, and the patient is shown nine months after the procedure with excellent contour and acceptable visibility of the scars. He has good nipple graft survival and placement. He is very happy with his "top surgery" and subsequent gender change.
Female to Male transgender "top surgery" before and after double incision mastectomy

This 28 year old patient came to see Dr. Medalie at his Cleveland, Ohio west side office. She desired bilateral breast augmentation with silicone breast implants, and after careful discussion with Dr. Medalie elected to have 400 cc smooth round breast implants placed. The surgery was performed as an outpatient at Dr. Medalie's west 150th street location and the patient is shown three months after the breast enhancement surgery with an excellent contour. She is very pleased with her breast implants and new breast size.
Breast Augmentation with Silicone Implants Before and After Pictures


This patient is a female to male transgender patient who contacted Dr. Medalie of Cleveland Plastic Surgery in Cleveland, Ohio in regards to FtM "top surgery". The patient desired a complete mastectomy with the goal of having a masculine chest that appeared as if he were genetically male. The various types of operations were explained to him and it was decided to proceed with a peri-areolar approach (keyhole approach) to the surgery. The patient had very good skin tone with good elasticity and Dr. Medalie felt that only a partial incision at the skin-areolar junction would be necessary. The surgery was performed as an outpatient at MetroHealth medical center, and the patient is shown five months after the procedure with excellent contour and minimal visibility of the scars. He was very happy with his "top surgery" and subsequent gender change.

Dr Medalie is pleased to announce that once again he has been elected one of America's top doctors. He is proud to serve Cleveland and Ohio as a premier plastic surgeon and will continue to strive for best results for his Cleveland plastic surgery patients.

- Dr. Medalie is one of Americas top doctors
Dr. Medalie of Cleveland Plastic Surgery is happy to announce that he has been selected for the 2013 Best of Cleveland Awards for Plastic Surgeons. He is proud to serve his community and will continue to strive for the optimal outcomes for all of his patients.
