Shame. Humiliation. Insecurity. These are some of the emotions experienced by men with enlarged breasts, or gynecomastia.
About half of all men today have excess localized fat and/or excess glandular tissue in one or both breasts. Surgery with or without liposuction may be used to treat enlarged male breasts.
While often not a serious medical problem, enlarged breasts in men can be painful. It can also cause embarrassment — especially among young boys who may be teased as a result of their breasts. The condition is especially common in teen boys. Up to 65 percent of 14-year-old boys have enlarged breasts. This is largely due to the fluctuations in sex hormones that occur during puberty. The excess breast tissue disappears without treatment in two years in 75 percent of these boys, and within three years in 90 percent of them.
Enlargement typically occurs on both sides of the chest, but if it is one-sided, firm and hard, see a doctor immediately to rule out male breast cancer.
In most cases, the cause of enlarged breasts is unknown. Among older men, gynecomastia often results from decreasing levels of the male sex hormone testosterone, which diminishes with advancing age. In addition, men experience an increase in body fat with age and a resultant rise in the ratio of the female sex hormones (estrogens) to the male sex hormones (androgens).
Medications may also cause enlarged breasts, including:
If you use drugs that may cause the condition, you are not a good candidate for male breast reduction treatment. Your doctor will likely first advise you to stop using these drugs or to switch to other medications that do not cause gynecomastia. However, never stop taking a prescription medication without talking to your doctor first.
Diseases may cause enlarged breasts as well. These may include:
In some cases the appearance of fat on the chests of men and boys is not gynecomastia, but pseudogynecomastia, a condition that may resolve with diet or exercise. By contrast, true gynecomastia will not improve with diet and exercise.
You may be a candidate for gynecomastia treatment if you are healthy, are of relatively normal weight and are bothered by the feeling that your breasts are too large. In addition, your breast development must have stabilized, and you must have realistic expectations about what the procedure can and cannot accomplish. Male breast reduction may be discouraged if you are overweight or obese and have not first attempted to lose weight.
In general, the best candidates for surgery have firm, elastic skin that will reshape to the body's new contours.
Teens may benefit from surgery if their gynecomastia has been present for more than two years or if the problem is severe. In some teens, secondary procedures may be needed down the road if breast development continues.
A consultation with a board-certified plastic surgeon is needed to determine if you are a good candidate for male breast reduction.
In addition to taking a thorough medical history, your surgeon will also perform a physical exam to measure the extent of excess fat and glandular tissue in the chest area. Your surgeon will also conduct diagnostic testing to determine the underlying cause of your enlarged breasts. This will include tests of your endocrine function. The endocrine glands secrete the hormones that have been linked to enlarged breasts.
Your surgeon may also take some "before" photos during this consultation process and should discuss your expectations with you.
Once you have scheduled your procedure, your surgeon will give you a list of preoperative instructions. This will include some lab testing such as routine blood work and a cardiac workup if you have any history of heart disease. Your surgeon will also discuss male breast reduction risks with you prior to surgery. He or she will likely ask you to stop taking certain medications, including aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) and blood thinners, all of which can increase bleeding risk.
Certain herbal remedies may also increase bleeding risk. For example, vitamin E, omega-3 fatty acids, green tea and gingko biloba all may increase bleeding risk during and after surgery. Make sure you tell your surgeon about everything that you are taking, even if it seems harmless. Most surgeons recommend that prospective patients quit smoking for the month before and the month after surgery. Your prospective surgeon should also discuss male breast reduction recovery with you to make sure you know what to expect.
Breast reduction surgery for gynecomastia is most often performed on an outpatient basis in an office-based or ambulatory surgical facility or in the hospital. Sometimes an overnight hospital stay is recommended. Time in surgery is typically an hour and a half, but a more extensive male breast reduction may take longer.
The procedure may be performed under general anesthesia. Your surgeon will discuss your anesthesia options with you once you have decided on surgery. If your enlarged breasts consist primarily of excessive fatty tissue, your surgeon may use liposuction alone. If excess glandular tissue is the primary cause, the tissue may be cut out with a scalpel. This excision may be performed alone or in conjunction with liposuction.
The incision is made either on the edge of the nipple (areola) or in the underarm area. The surgeon cuts away the excess glandular tissue, fat and skin from around the pigmented area surrounding the areola and from the sides and bottom of the breast by working through the incision. Major reductions that involve the removal of a significant amount of tissue and skin may require larger incisions and more visible scars.
If liposuction is also used to remove excess fat, a slim, hollow tube (cannula) is inserted directly through the existing incisions. The cannula is attached to a vacuum pump to suction out the fat.
For liposuction-only breast reduction, your surgeon will likely make a half-inch incision around the edge of the areola or in the underarm area. After surgery, a small drain may be inserted through a separate incision to remove excess fluids. Once closed, the incisions are covered with a dressing. The chest may be wrapped to keep the skin firmly in place.