What is Gynecomastia & What Causes It?
Gynecomastia, the enlargement of the male breast, is believed to be caused by an imbalance in the sex hormones (testosterone and estrogen). The most common cause is the persistence of chest fullness after breast development in adolescence. Less common causes are medical problems, medications, and the utilization of pro hormones by weight lifters. Regardless of the cause, gynecomastia is a benign condition that doesn’t harm you apart from the inconvenience and embarrassment factors.
When Does Gynecomastia Occur?
Most patients seen at the AGC fall into two groups. The first is made up of patients who developed gynecomastia during puberty that didn’t go away as it normally does, and those who developed gynecomastia secondary to the use of prohormones or hormones used for body building or hormone replacement therapy.
When is it gynecomastia, and when is it normal?
Gynecomastia is not confirmed with a blood test, and there are no clinical criteria to definitively confirm the diagnosis. It’s just as much a matter of the patient’s perception as a doctor’s diagnosis, and there are a number of facts to keep in mind when diagnosing this condition.
- Men with gynecomastia often carry a heavy burden that affects their lives in a negative way.
- All men have some breast tissue behind their nipple-areola complexes. This is normal.
- Some men complain of gynecomastia, but they actually look perfectly normal.
- Many men over age 50 develop more female-like breasts because of changes brought on by aging.
- Acute gynecomastia is obvious when a doctor sees it (the chest area looks round and full like a female breast).
- It’s often difficult to convince a patient who thinks he has gynecomastia that he is “normal.”
- Psychological counseling will not always “cure” men with gynecomastia.
- Extremely fit and muscular men can have gynecomastia.
- Men with minimal evidence of gynecomastia can suffer tremendously while others who look like they have breasts couldn’t care less about their appearance.
The bottom line is that gynecomastia is all about perception—and perception is reality. If you think you have it, you certainly will behave like you have it, and you will suffer for it.
Patient satisfaction with this procedure is very high. It is essentially like a “rebirth.”
Choosing Your Surgeon
Choosing the right surgeon is very important because this will determine the quality of your outcome. Experience matters when it comes to any procedure, and in the case of gynecomastia, most surgeons don’t see many of these cases. At the AGC, we see over 100 patients every year for treatment, and they come from across the nation and from overseas.
Only consider surgeons who have proven expertise in this area and who have a reputation for treating gynecomastia successfully. Think twice about the surgeon who only occasionally treats gynecomastia in his or her practice.
Timing It Right
The timing of gynecomastia surgery is important. When gynecomastia occurs during adolescence and does not resolve within a year or so, it is highly recommended that treatment be considered. This is a critical time in the emotional and social development of young men. The longer the gynecomastia persists, the greater the negative psychological impact on the individual. To delay is to deny yourself the benefits of treatment. Diet and exercise rarely improve the appearance of gynecomastia. It is a surgical problem that you really don’t have much control over. In fact, building muscle and losing weight usually makes gynecomastia look more prominent. Resist the temptation to try Internet-promoted pills or diets, as they will not improve gynecomastia and may, in fact, make you sick. It’s snake oil—don’t fall for it.
Treatment of gynecomastia is straightforward but requires great skill and artistry. Every case is different to some degree, challenging your surgeon to make appropriate adjustments and modifications so the best result is realized. The primary focus is on the reduction of excess volume in the chest area. This is usually performed with a combination of liposuction and glandular tissue removal. The need for skin removal, producing chest scars, is uncommon. It is quite impressive how well skin retracts after the removal of excessive chest tissue, even in patients who have saggy skin. If loose skin persists after treatment, it is always possible and even advisable to contour the excess skin as a secondary procedure.
Gynecomastia treatment may not be limited to the breast area. Some patients have fullness under their arms and around the abdomen and love handle areas. Expert treatment means seeing the whole picture and treating all the areas that need contouring so your result is the best it can be. Do keep in mind, however, that abdomen and flank fat will go away with weight loss.
Surgeons use different techniques to contour the tissue. Fat is contoured with some type of liposuction, and the dense glandular tissue that cannot be removed with liposuction requires removal through an incision or the use of a “shaver” technique (this uses a drill-like device to remove the tissue from an incision in the breast). Ultrasonic liposuction has proven to be a tool particularly suited to treat gynecomastia. My use of the Vaser ultrasonic liposuction machine has improved my treatment of gynecomastia compared to standard liposuction. Focus on the skill level and experience of your surgeon and not on a particular technique or device. Your goal is a smooth end result—keep your eye on the big ball. Beware of marketing gimmicks to get your business.
Anesthesia alternatives depend on the amount of tissue to be removed and the complexity of the procedure, as well as on the patient’s personal wishes and comfort level. Small accumulations of breast tissue (localized tissue under your nipple and areola) can be removed under local anesthesia. Larger volumes usually require the use of IV sedation or general anesthesia for your comfort. Adequate pain-free anesthesia is needed so that your surgeon can appropriately and carefully contour the tissue and minimize the chance for irregularities. Many patients who choose local anesthesia for their treatment report that they probably should have chosen IV sedation or general anesthesia because the procedure was somewhat uncomfortable. Why not have your procedure performed without pain or anxiety? Why not fly first class if you have the choice? Most procedures take less than an hour and a half to complete.
Revision gynecomastia – Refers to additional procedures to enhance the results from previous gynecomastia surgery. There are many reasons why someone would want additional treatment, the most common being glandular material that was incompletely removed, poor overall contouring with significant irregularities, and over- or under-resection of chest tissue.
Non-surgical treatments – Non-surgical alternatives offered for treating gynecomastia are not particularly effective. Several studies have shown a small reduction in the size of gynecomastia and less pain, if present, when anti-estrogens are used. But treatment must be started early in the course of the condition to be effective. After a year has passed and the tissue becomes more “fibro fatty,” it is unlikely that medical, non-surgical treatment will result in much improvement, and it’s very unlikely that a gynecomastia patient could be completely “cured” with non-surgical treatment alone. Successful, satisfying outcomes involve gynecomastia surgery.
Patient satisfaction with this procedure is very high. It is essentially like a “rebirth.” This is a great opportunity to start your life off with a new you, no longer hindered by gynecomastia. Most patients agree that the procedure has positively impacted their lives. In many cases, it has been revolutionary.