By Dr. Scott W. Mosser
Gynecomastia means enlargement of the male breast. This condition is present to some degree in about a third of the male population. Gynecomastia is a term describing the condition itself, irregardless of whether the cause is pathological, physiological, or a side effect of taking certain drugs.
More Common Than Generally Known
Physiological gynecomastia can occur even in newborns. It’s generally caused by placental hormones and resolves itself within a few weeks. During male adolescence, gynecomastia can occur as a result of alterations in the ratio of estrogen to testosterone. This also generally resolves itself after puberty, usually within a year or two. During the male aging process, gynecomastia commonly occurs as a result of testicular failure and can be treated by testosterone replacement.
Another increasingly common cause of gynecomastia, especially in the U.S., is obesity, with the conversion of androgens to estrogen in peripheral fat. Depending on the type of tissue involved, this type of gynecomastia can be treated by diet, exercise, and a weight loss program, combined with several surgical and non-surgical plastic surgery options.
Pathological gynecomastia can occur for various reasons: deficient production or action of testosterone, congenital defects, testicular infection, following testicular trauma, increased estrogen production, tumors within the breast or other organs, liver, adrenal or thyroid disease, or decreased serum testosterone resulting from kidney failure or hemodialysis. Pathological gynecomastia occurs most commonly around puberty and can be unilateral or bilateral. Usually the enlargement is centralized in the breast but occasionally it extends to surrounding areas. Gynecomastia arising before the onset of puberty requires a vigorous diagnostic workup because of the possibility of life threatening or life-shortening pathology.
Drug-induced gynecomastia may occur as a result of using steroids or any of a wide variety of prescribed medicines or from prolonged use of heroin or marijuana. Gynecomastia may also occur simply as a familial inborn error of metabolism.
A Wide Variety of Treatment Options
If you are a male experiencing obvious breast enlargement, you should be aware that it is a condition that requires evaluation by a qualified physician. A majority of gynecomastia cases are physiological or are a side effect of drugs taken for other health reasons. Drug induced gynecomastia can usually be reversed by discontinuing the causative drug. If the gynecomastia is resistant to treatment or is the adolescent type but persistent, then surgery may be required.
A consultation with a Board-Certified Plastic Surgeon can determine your options for correcting gynecomastia. You may already know from your primary care physician the cause of your gynecomastia, in which case your plastic surgeon will work together with him or her to find the best option to correct the condition.
A candid and open discussion with your plastic surgeon is the first step in alleviating what for many men may be an uncomfortable and embarrassing physical phenomenon.
The type of surgery indicated depends on the type of tissue contributing to the
breast enlargement. This can include:
- glandular: requires surgical removal of glandular tissue
- fatty-glandular: requires surgical removal of glandular tissue with or
without removal of adjacent fat to give the best overall shape
- simple fatty: requires diet/exercise for weight loss, with auxiliary surgical removal of fatty tissue
There are several ways to approach surgical male breast reduction: using liposuction only, using liposuction combined with small incisions near the nipples; or with more extensive surgical incisions to remove excess skin and reposition the nipple to an appropriate location.
In cases where diet, exercise and a weight loss program have failed to achieve the chest area shape desired, simple liposuction techniques alone may be used to eliminate or reshape firm tissue. The patient’s age and skin elasticity play an important factor in choosing liposuction alone. As in using liposuction on other parts of the body, the procedure is performed on an out-patient basis, usually in your doctor’s office or clinic. Treatment time is short and virtually painless, and scarring is minimal. Recovery time is also very fast, and you can resume most normal activity within a few days.
When the underlying cause of male breast enlargement also affects glandular tissue, liposuction alone may not be sufficient to achieve a normal body contour. In this case, small incisions may be made around the nipples to remove residual breast tissue beneath the nipples. In this case, also, treatment time is short, with little or no pain involved. Scarring is minimal as incisions are hidden along the areola of the nipple. If skin elasticity is good, very esthetically pleasing results can be achieved.
If the surgery is being performed following extreme weight loss, or there is a large amount of both glandular and firm breast tissue to be removed, or if treatment or weight loss has resulted in loose or flabby skin, then a surgical approach is indicated. Surgical incisions would be made in natural skin folds and around the nipples, or the nipples may have to be repositioned to a more normal configuration. Such surgery would be performed under general or local anesthesia and recovery time would be longer than with liposuction alone or liposuction and limited incision surgery. In the hands of an experienced and skilled plastic surgeon scarring would be unobtrusive, but detectible.
With the first two procedures for gynecomastia there would be minimal or no scarring, which in time may become undetectable, but the third procedure has some scarring as a trade-off to achieving often dramatically improved esthetic results.
The decision on the most appropriate procedure to achieve maximum positive results is one which would be made only after determining the cause of your gynecomastia. A full physical evaluation is required as well as a full and candid disclosure of your health history. Weight fluctuations, your life style, age, skin type and elasticity, and muscle and skin tone all play a part in determining the plastic surgery procedure that will achieve realistic results.
A New Openness and Higher Expectations
Surgery to correct gynecomastia is the third most common plastic surgery procedure performed on men in the United State, only exceeded by general face and body liposuction and rhinoplasty.
With the continuing increased social acceptance of plastic surgery for women has come a corresponding increase in demand from men seeking a more normal or pleasing body contour. An increased preoccupation in Europe and the West with physical fitness and health has also contributed to the increased popularity of male breast reduction surgery. More revealing fashions, a longer life expectancy, and the expectation of a more physically active retirement have also played a part.
Copyright © 2006 by Dr. Scott W. Mosser. This article may not be copied or reproduced in any form without the written permission of Dr. Scott Mosser. Internet links to the www.drmosser.com sub-page containing this article are permitted.