Millions of boys and men have bigger breasts than normal, which is commonly known as "man boobs" or "moobs," but a lot of people do not know that this is a medical condition called gynecomastia. It is characterized by the presence of enlarged breasts in male patients, without being related to age.
This medical condition can cause psychological problems in the patient, affecting his self-esteem and confidence. The condition can be so severe that the patient tends to avoid some activities, including being shirtless in public areas, or it can even create intimacy problems with his significant other. This condition is not usually a threat to the man's health; however, it can be indicative of other diseases, or it can simply be embarrassing for the patient.
The characteristics of this condition are an excess of fat localized in the breasts, excessive glandular breast tissue, and in some cases, excessive skin in one breast (unilateral) or both breasts (bilateral).
What causes gynecomastia?
Usually, the enlargement of breasts in men is a consequence of excessive fat tissue due to obesity; however, this is not the only reason—sometimes the patient gets his amount of glandular tissue increased due to a hormonal disequilibrium.
Gynecomastia is mainly caused by a lack of testosterone in comparison with the level of estrogen; these hormones are in charge of developing the male and female sex characteristics. Testosterone is in charge of developing male characteristics, like the amount of muscle mass and the distribution and amount of body hair; on the other hand, estrogen is in charge of developing female characteristics, including the development and size of breasts.
The causes of this testosterone decrease can be one or more of several conditions that block the effects of testosterone, or a condition that increases the estrogen level. Several things can upset the hormone balance, including:
- Excessive alcohol, marijuana, or other drug intake (by liver failure)
- Using some drugs, especially steroids, like the stomach acid drug cimetidine, the heart drug spironolactone, the prostate cancer drug bicalutamide, and several other drugs
- Congenital diseases—the patient can have this condition from birth
- A dramatic weight loss; in this case, the main problem is excess of skin
- Diseases like an overactive thyroid, cirrhosis of the liver, cancer, etc.
- Gynecomastia in infants: It is very common for boys to have this condition from birth.
This is caused by the transmission of estrogen from the mother to the infant; it acts on the baby's breast tissue, causing enlargement. This condition commonly recedes by itself after three weeks.
- Gynecomastia during puberty: During puberty, the body suffers a lot of changes, potentially including gynecomastia. Once the level of hormones is stabilized, the gynecomastia disappears between 6 months and 2 years later.
- Gynecomastia in men: There is an increase in the appearance of gynecomastia between 50 and 80 years of age. At least 1 in 4 men in this age group are affected; in this case, it is mainly due to the diseases discussed above.
There are cases when the cause of gynecomastia is not easy to determine, but in any case, it is important to consult a doctor. Even when gynecomastia is not an aesthetic or psychological problem for the patient, it can indicate endocrine diseases that need to be treated to avoid other consequences.
Can gynecomastia be prevented?
There are a few factors the patient can control that may reduce the risk of gynecomastia:
- Do not use illegal drugs (nonprescription steroids and androgens, amphetamines, heroin, and marijuana).
- Avoid alcohol. Don't drink alcohol, or drink in moderation.
- The patient should review his medications. If he is taking medication known to cause gynecomastia, he should ask his doctor if there are other options.
How is gynecomastia treated?
If gynecomastia is caused by obesity or cirrhosis (liver disease caused by excessive alcohol consumption), the patient should try to eliminate the excessive fat tissue in the breasts with a balanced diet and exercise. However, if gynecomastia is caused by an underlying condition, the treatment for that disease should be indicated. If a man is taking medications that can cause gynecomastia, his doctor may recommend stopping them or substituting them with other medications.
When these options fail, surgery is recommended. Before undergoing surgery, the patient should visit a doctor to consider other methods and treatments.
Ideal candidates for gynecomastia surgery are:
-Patients who have tried to correct the condition using traditional or alternative medical options without success
-Patients who are physically healthy and near their ideal weight (this includes not suffering from chronic diseases that may increase the risk of complications during the surgery or the recovery period)
-Men with realistic expectations and defined goals who are optimistic about the procedure
-Men who might have emotional problems as a consequence of the size of their breasts
Even adolescents can benefit from this surgery, but in some cases, they need subsequent procedures to correct new enlargements in the breasts.
What is a male breast reduction or gynecomastia surgery?
This is a plastic surgery that reduces the man’s enlarged breasts, makes his chest flatter, and enhances his contours. When the patient has a lot of fatty tissue, the nipple-areola complex may be enlarged too. If this occurs, the surgery can also correct this problem. Medically speaking, this surgery is called reduction mammaplasty.
What is the general procedure of a gynecomastia surgery?
Gynecomastia surgery is usually carried out under general anesthesia and takes around 90 minutes or more. The plastic surgeon begins by making an incision around the nipple-areola complex; for this, he/she can use 2 techniques:
- Liposuction: When gynecomastia is mainly caused by an excess of fatty tissue, the liposuction can be performed alone. This surgery removes the fat but not the breast gland tissue.
In this technique, the plastic surgeon inserts a cannula or micro-cannula (a narrow tube) through some little incisions; after that, the surgeon moves the cannula back and forth to loosen the fat tissue which can then be removed through suction.
Different liposuction techniques can be used. The method used to facilitate removal of fat can vary; among the options are: suction assisted, ultrasound assisted, power assisted, water assisted, laser assisted, tumescent, etc.
- Mastectomy or excision: This type of surgery removes the breast gland tissue. The surgery is often done endoscopically (meaning only small incisions are used); this less invasive type of surgery involves less recovery time.
If the patient has too much tissue to be removed, the incisions can be extended from the areola contour and down into the chest, for later repositioning of the nipple-areola complex. This technique is very useful when the nipple-areola complex should be resized and reshaped to obtain a more masculine shape in the breasts.
- Combinations of liposuction and mastectomy techniques: In some cases, the plastic surgeon combines both techniques to achieve better results.
Advantages of gynecomastia surgery:
- The man can feel comfortable revealing his chest contours, clothed or unclothed.
- The man can gain more social confidence.
- The man can enjoy permanent results.
Disadvantages of gynecomastia surgery:
- Scarring may make the patient feel self-conscious.
- The man may be disappointed with his final results.
- Weight gain following this surgery will compromise results.
How much does a gynecomastia surgery cost?
The average cost of gynecomastia surgery is $3,333, according to 2014 plastic surgery statistics from the American Society of Plastic Surgeons; however, the costs can vary widely because the average cost referenced above does not include anesthesia, operating room facilities, or other related expenses; likewise, the surgeon's cost may be based on his experience and the type of procedure used. In most cases, correction of gynecomastia is not eligible for insurance coverage.
What should the patient do before a gynecomastia surgery?
During the consultations prior to the surgery, there are some things that the patient should discuss with the plastic surgeon. It is important for the patient to make his desires clear, and the surgeon should know the complete medical record of the patient, including allergies, current medication, supplements, and habits, and if he has undergone surgeries before.
After the medical record is complete, the plastic surgeon proceeds to the physical exam to determine the patient's health condition and to discover any condition that may represent a potential risk; likewise, he/she will examine the patient's breast to determine the skin quality, shape and size of the breasts, and the position of the nipple-areola. Some laboratory tests are required to determine the cause of gynecomastia.
During the consultation, the patient and plastic surgeon should also decide the technique that will be used to correct all the characteristics that cause concerns on the patient, and discuss both the benefits and the risks of each technique, and the type of anesthesia that will be used.
It is important for the patient to take some precautions before the procedure, including neither smoking nor drinking alcohol, and not using drugs that could increase the risk of bleeding. A responsible adult should take care of the patient during the first days after the procedure.
What are the results of a gynecomastia surgery?
The results of a male reduction surgery are visible immediately after the procedure. However, when the swelling has completely disappeared and the scars have become less visible, the patient can then observe the final results. Satisfaction with the patient's new image should continue to grow as he recovers from surgery. The plastic surgeon tries to mask the incision scars, hiding them in the natural contours of the man’s chest; however, some visible scars may remain after the procedure. In any case, when the patient is comfortable about how the upper part of his chest looks, his self-esteem and confidence will be restored, and he will be able to perform activities with his chest uncovered.
The results are usually permanent, but weight gain, hormonal imbalances, and the use of certain drugs can cause the breast area to enlarge again. In general terms, the patient is normally satisfied with the results of the procedure. With plastic surgeries there are no guarantees, and some patients need extra procedures to achieve their desired results; usually, during subsequent surgeries, the plastic surgeon will repair again the deep tissues or solve any complication that may appear.
What is the postoperative care of a gynecomastia surgery?
During the recovery process, the patient should use some dressings and compression bandages, especially over the incisions, in order to help reduce the swelling and bring support to the chest during the healing period. In some cases, the plastic surgeon leaves drains under the skin, helping to eliminate an excess of blood or fluids from the treated area.
The plastic surgeon will explain all the steps of the healing process to the patient, including the time that he should spend resting, and when to resume his normal level of activity; the rhythm of healing is different for each patient. However, the patient should rest the first three days though it is allowed for the patient to walk short distances and to sit. Movement of the shoulders and arms should be restricted and gentle during the first days after the procedure, and lifting the arms vertically is completely prohibited.
Some oral medications will be suggested to control the pain and avoid the risk of infection (painkillers and antibiotics, respectively). The patient should also know when to visit his plastic surgeon again (5 to 7 days after the procedure). The surgeon will provide detailed instructions about the normal symptoms the patient will experience and any potential signs of complications.
When the 2 techniques are combined, the patient usually recovers in a week, and at this point he can go back to work; in most cases, the healing process is mild for the patient.
It is recommended for the man to wait 2 to 3 weeks after the procedure to resume exercises of low impact; however, for exercises that involve resistance in the arms, he should wait between 3 and 6 weeks postoperatively to guarantee an adequate healing time. Likewise, direct sun exposure should be avoided for at least 6 weeks in order to prevent the scars from becoming more visible.
Usually, patients notice alterations in the sensation of the treated area and adjacent tissues. Changes in sensation are more frequent in patients who undergo liposuction or who need a lot of tissue removed. However, patients commonly recover their normal sensitivity levels approximately a year after the procedure.
Does gynecomastia surgery have risks?
All surgical procedures have some degree of risk; however, serious complications are uncommon in this type of surgery. The specific risks of gynecomastia surgery for each patient will be determined during his consultation. Among the most common complications are: bad or allergic reaction to anesthesia, excessive accumulation of blood or fluids in the treated areas, infection, alterations in the skin sensation, scarring problems, injuries in deeper tissues or organs, unsatisfactory results after the procedure, and the formation of clots.
If the patient follows the instructions of the plastic surgeon and is careful during the recovery process, he can avoid complications both during and after the procedure.
Dr. Amjadi MD, DDS, FACS
Certified by the American Board of Plastic Surgeons
915 Gessner Rd #870
Houston, TX 77024