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abdomen and chest of a 30-year-old Caucasian man

Gynecomastia, commonly referred to as gyno, is the enlargement of breast tissue in men. It is far more common than many realize, affecting men at all stages of life, from teenage years to adulthood. The condition can be caused by shifts in hormones, certain medications, weight fluctuations, or even genetics. What makes it particularly challenging for patients is that it usually involves a combination of fat, dense glandular tissue, and sometimes stretched or sagging skin. While weight loss and exercise may reduce overall body fat, they rarely address the dense gland beneath the nipple or the stretched skin that results from volume changes. This is why many men, despite their best efforts in the gym, find their chest still looks round, puffy, or feminine in appearance. The impact extends beyond physical appearance. Gynecomastia can lead to embarrassment in social settings, avoiding activities like swimming or sports, and even limiting wardrobe choices. For many men in San Antonio and across the United States, the emotional burden of gyno is just as heavy as the physical changes, and surgery provides a path to reclaiming confidence and comfort.

Why Liposuction Alone May Not Be Enough

Liposuction is an excellent procedure for reducing fat and sculpting the body. On the chest, it is often the first step in addressing gynecomastia. However, liposuction alone has significant limitations when glandular tissue is the main issue. Liposuction works by removing fat through small incisions, which can help contour the chest and reduce bulk. Yet glandular breast tissue is dense and fibrous, and liposuction cannot fully break it down or remove it. Even advanced technologies like ultrasound-assisted or power-assisted liposuction, while effective in some cases, still cannot eliminate gland tissue completely. Patients who undergo liposuction alone may initially see improvement in contour, but many remain dissatisfied because the puffiness at the nipple persists. This can be particularly frustrating for men who have already undergone a procedure elsewhere and find themselves still struggling with the same issue. Dr. Michael Baumholtz explains to patients that while liposuction is valuable, it is rarely enough for true gynecomastia. In his practice, chest liposuction is usually paired with an additional technique to ensure the results are smooth, natural, and lasting.

Why Gland Removal May Be Necessary

The most common reason men remain dissatisfied after treatment is the presence of glandular tissue beneath the nipple-areola complex. This tissue is firm and resistant to fat reduction efforts, which is why men with lean builds and low body fat can still develop puffiness in their chest. To effectively treat this, gland removal is often necessary. Traditional approaches involve a small incision at the edge of the areola, which allows direct access to remove the gland. While this can be effective, there is a risk of removing too much and leaving behind a hollowed appearance or divot, a complication that can sometimes look worse than the original problem. The challenge is in striking the right balance - removing enough tissue to flatten the chest but leaving enough behind to maintain a natural contour. Dr. Baumholtz’s approach to gland removal emphasizes precision, technique, and careful judgment. He has seen many patients referred to him for revisions after overly aggressive excisions, which underscores the importance of a thoughtful, measured approach. For most men, gland removal plays an essential role in achieving the chest shape they desire, particularly when performed in conjunction with liposuction.

Dr. Baumholtz’s Preferred Method: Combination Approach

In the majority of gynecomastia cases, Dr. Baumholtz finds the best results come from combining liposuction with gland removal. His preferred method starts with power-assisted liposuction to remove excess fat and create an improved chest contour. This step alone makes the chest flatter and begins the sculpting process. The next step involves arthroscopic debridement, a specialized tool that allows him to carefully remove glandular tissue without making a large incision across the chest. This approach means patients benefit from gland removal without the risks associated with aggressive excision. Once fat and gland have been addressed, the chest is dressed with a compression garment. This garment is worn for six weeks to encourage skin retraction, minimize swelling, and prevent fluid accumulation. Patients who follow this recovery protocol often notice their chest continues to refine over time, with the final results appearing gradually over several months. What makes this combination approach so effective is that it balances removal with preservation. The goal is not only to flatten the chest but to ensure it looks natural, smooth, and masculine. This method reflects Dr. Baumholtz’s extensive experience in complex and revision surgery, where careful planning and subtle technique lead to the most satisfying outcomes.

When Advanced Surgery Is Needed

For some men, gynecomastia is more severe, involving significant excess of both tissue and skin. These cases often occur after major weight loss, long-standing untreated gynecomastia, or in men whose chest resembles that of a female breast. In these situations, liposuction and limited gland removal are not enough. The best solution may be a mastectomy with free nipple grafting. In this procedure, the excess skin, fat, and gland are removed, and the nipple is repositioned as a free graft in a more natural location on the chest. While this technique involves longer scars, it is sometimes the only way to restore a truly masculine contour. Patients considering this approach are often relieved to learn that the trade-off of scars is balanced by the dramatic improvement in chest shape and confidence. Dr. Baumholtz is honest with his patients about the realities of advanced gynecomastia surgery, emphasizing that while scars are permanent, they fade over time, and most men find the psychological and physical benefits far outweigh this drawback.

Safety First: Dr. Baumholtz’s Surgical Principles

Patient safety has always been at the center of Dr. Baumholtz’s practice. His philosophy is shaped by years of training in both general and plastic surgery, as well as his extensive experience managing complex surgical cases. Gynecomastia surgery, while often elective, is still a significant procedure, and he applies the same meticulous attention to detail here as he would in life-saving surgery. For most patients, general anesthesia is recommended, as it provides comfort and allows for better surgical precision. Drains are rarely used, except in the largest cases involving mastectomy with free nipple grafting, because most gynecomastia procedures do not require them. Smoking and nicotine use are absolute contraindications in his practice, as nicotine significantly compromises blood flow and healing, increasing risks for poor outcomes. Patients are counseled thoroughly before surgery to ensure they are optimized medically, emotionally, and physically. This thorough preparation and uncompromising commitment to safety are why so many patients in San Antonio choose Dr. Baumholtz for their gyno surgery.

Recovery: What Patients Can Expect

The recovery period after gynecomastia surgery is as important as the procedure itself. Dr. Baumholtz provides each patient with a clear roadmap to follow, ensuring healing is smooth and results are optimized. Immediately after surgery, patients are placed in a compression garment, which they will wear for six weeks. This garment reduces swelling, encourages the skin to mold to the new chest contour, and prevents fluid accumulation that can compromise results. Walking is encouraged as soon as possible to promote circulation, but heavy lifting, pushing, or pulling is restricted for about six weeks. Most swelling subsides in the first few weeks, but final results take months to settle fully. Pain is managed with a multimodal approach that combines narcotic and non-narcotic medications, along with non-pharmaceutical methods like cold therapy or TENS units when appropriate. Unlike many practices where postoperative care may be limited, Dr. Baumholtz personally follows his patients closely. He sees them frequently in the first weeks and remains accessible for questions or concerns. This level of follow-up reassures patients that they are not alone in their recovery and that they have a surgeon committed to their long-term outcome.

Emotional Side Of Gyno Surgery

The physical correction of gynecomastia is only part of the story. For many men, the emotional weight of living with gyno is heavier than the physical burden. Patients describe avoiding the gym, refusing to swim, wearing baggy shirts, or even withdrawing socially because of embarrassment about their chest. The condition can erode self-esteem, limit relationships, and affect day-to-day confidence. Surgery offers relief not only by flattening the chest but by restoring a sense of normalcy. Men who once avoided the mirror find themselves standing taller, wearing fitted shirts, and reengaging in social activities they had previously abandoned. Dr. Baumholtz emphasizes honesty in setting expectations, reminding patients that while surgery can dramatically change the chest, the healing process and the final outcome depend on both surgical technique and the patient’s body. His straightforward mantra is simple but true: “I do the surgery, but your body and genetics do the healing.” This perspective helps patients understand their role in recovery and approach their journey with realistic expectations and optimism.

Why Choose Dr. Michael Baumholtz In San Antonio

Choosing the right surgeon is one of the most important decisions a patient will make when considering gynecomastia surgery. Dr. Michael Baumholtz is a dual board-certified surgeon in both general and plastic surgery, a background that gives him unique versatility and expertise. He is widely respected for his ability to handle revision and complex cases, often taking on patients referred from other surgeons who encountered complications or unsatisfactory results. His practice philosophy is built on patient-first care, honesty, and long-term follow-up. Unlike many surgeons, he devotes significant time to consultations and postoperative visits, ensuring patients feel informed, supported, and valued throughout the process. His San Antonio practice is built on accessibility - patients have direct contact with him and know their surgeon will remain involved in their journey from start to finish. Dr. Baumholtz’s Philadelphia roots also influence his communication style. He is straightforward, direct, and sincere, speaking to patients in the same way he would want someone to speak to his family. This combination of technical skill, experience, and approachable personality makes him a trusted choice for gynecomastia surgery in San Antonio.

Making The Right Choice: Liposuction, Gland Removal, Or Both?

One of the most common questions men ask is whether they need liposuction, gland removal, or both. The answer depends on the unique balance of fat, gland, and skin in each patient. In rare cases where the fullness is entirely fatty, liposuction alone may be enough. For men with firm glandular tissue, gland removal is essential, but if done in isolation it can sometimes lead to contour problems. For the majority of patients, the best results come from combining both approaches, removing fat with liposuction and carefully addressing gland tissue through arthroscopic debridement. Severe cases, where there is significant skin excess, may require a mastectomy with free nipple graft. Dr. Baumholtz’s role is to assess each chest individually, explain the options, and guide patients toward the choice that balances effectiveness, safety, and aesthetics. The consultation process is where these decisions are made, and Dr. Baumholtz ensures patients leave with a clear understanding of what their surgery will involve and what they can realistically expect.

FAQs About Gynecomastia Surgery

Can gyno return after surgery? 

If the glandular tissue has been removed completely, recurrence is uncommon, but changes in hormones, medications, or significant weight gain can alter the chest again over time.

Will my chest feel natural after surgery? 

Most men report that their chest feels normal after recovery. Some temporary firmness, swelling, or numbness is expected early on but typically improves within months.

Do the nipples change shape or sensation? 

In most cases, the nipples flatten naturally once the gland is removed. Sensation can be reduced temporarily, but permanent changes are less common and are usually discussed in detail before surgery.

What kind of scars should I expect? 

For combination liposuction and gland removal, scars are usually very small and placed discreetly. In more severe cases requiring a mastectomy and nipple graft, scars are longer but typically fade well over time.

How soon can I work out again? 

Light walking is encouraged immediately, but weight training, chest exercises, or strenuous activity are delayed for at least six weeks to allow proper healing.

Is there a difference between adolescent and adult gynecomastia surgery? 

Yes, younger patients may experience more natural skin tightening after surgery because their skin has better elasticity, while older patients may need additional surgical planning to address lax skin.

Can surgery correct uneven or one-sided gyno? 

Yes, but when only one side is enlarged, Dr. Baumholtz carefully evaluates other causes like hormonal imbalances or underlying conditions before proceeding with surgery.

Take The Next Step

If you are living with gyno and wondering whether chest liposuction, gland removal, or both are the right solution, you do not have to make this decision alone. At Baumholtz Plastic Surgery in San Antonio, you will meet directly with Dr. Michael Baumholtz, a Plastic Surgeon with extensive experience treating gynecomastia using advanced techniques tailored to each patient. From the first consultation to long-term follow-up, his focus is on patient safety, clear communication, and lasting results.

Visit Baumholtz Plastic Surgery in San Antonio, Texas to schedule your consultation.

Take the first step toward restoring your confidence and reshaping your chest with the help of Dr. Michael Baumholtz, a trusted plastic surgeon in San Antonio who is committed to delivering safe, thoughtful, and effective care.

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