Male Breast Gynecomastia

Man-boobs making you hesitant to remove your shirt?

We want you to be confident, not embarrassed. If gynecomastia (enlarged male breasts) are bothering you, we have solutions! First we look for a cause and then we fix the problem. See below if you want to know more.

Or just come in for a consultation.

Gynecomastia is excessive prominence of the male breast area. This can be due to an increase in breast tissue and / or excess fat in the area. Below are some questions and answers to help you explore this issue.

Q: Is gynecomastia only a problem in teenage boys?

A: As teenage boys "develop", the breasts can look prominent as their hormones are adjusting. This should be temporary. If it lasts more than a year, there is a risk of the gynecomastia being permanent as more fibrous tissue is laid down, and it is less likely to get better by itself. At that time, it is worth investigating and possibly treating surgically. If the gynecomastia has been present for more than two to three years, it is very unlikely to resolve without intervention. Besides the teenage years, gynecomastia can occur later on in men. Before treating it, it is always best to look for an underlying cause.

Q: What causes gynecomastia?

A: Some factors that cause gynecomastia are:

• Tumor / cancer: tumors especially of the testes can produce hormones that cause gynecomastia, so be sure to have this area checked. Labs may be helpful too.
• Kidney / liver disease: the liver and kidneys are important in "cleaning" your blood, and long-term disease of these organs can result in hormonal and nutritional issues.
• Obesity: being significantly overweight is associated with an increase in fat in the chest area as well as more estrogen being present.
• Hormonal imbalance: this can be due to an internal source of imbalance such as hypogonadism or externally administered hormones.
• Steroids and testosterone: Both steroids and testosterone can increase the breast gland in men, and some supplements can increase activity of the aromatase enzyme which increases estrogen, also resulting in enlarged breast size. 
• Marijuana: use of marijuana as well as some illegal drugs such as heroin can cause gynecomastia.
• Medications: some prescription medications can have the side-effect of increasing breast tissue. These include select types of antidepressants, ulcer medications, cardiovascular medications, some antibiotics, and chemotherapy and other cancer medications, especially those used to treat prostate cancer. Consult with your physician to see if this could be the case in your situation, and if alternative medications can be provided should you develop gynecomastia.

If you have a precipitating cause, it is best to try to change the root cause, but sometimes even doing that does not resolve the gynecomastia. At that point, we turn to surgical intervention. We may order labs and an ultrasound or mammogram prior to proceeding with surgery. 

Q: What types of surgery do you do for gynecomastia?

A: The type of surgery required depends on the type and extent of the gynecomastia. If the tissue is soft or mostly fatty, liposuction is a good option. However, if it is mainly fibrous breast gland tissue, direct excision will be needed. Both of these options can be done "awake", but in children we usually use general anesthesia. Also, if the gland is very large or skin resection is needed, it may be better to do the surgery under general anesthesia.

Q: What happens during a typical gynecomastia surgery?

A: We start with liposuction if appropriate, which is done through a few small (about 6mm each) incisions. After putting in numbing medicine under the skin, the excess fatty tissue is removed as much as possible. This also makes the glandular resection a little easier. If we need to remove some of the breast gland, more numbing medicine is placed in that area. Usually, the area under the nipple areolar complex (from 3 o'clock to 9 o'clock) is incised and the excess tissue removed through this incision. Care is taken not to remove too much tissue because a "caved in" look is also not what we are going for. 

Q: What if you have a lot of excess skin to deal with as well?

A: If there is a lot of excess skin from the area being stretched for a long time, skin resection may be required. We also consider the elasticity of the skin. In young men with good quality skin, a lot of it can shrink down without requiring skin removal. If skin removal is needed, we can remove some of the extra skin from around the nipple areolar complex (NAC). If a lot of skin needs to be removed, it is better to make an incision at the lower fold where the chest muscles meet the upper abdomen. 

Q: Is nipple sensation affected?

A: There may be change in nipple sensation from the gynecomastia surgery. Very rarely, a "free nipple graft" may be needed, in which case sensation is lost. This is usually only done when we are removing a lot of skin, and need as flat a result as possible.

Q: Can gynecomastia recur?

A: As we do leave some breast tissue under the nipple area to avoid indentations, there is a small chance of recurrence, depending on what caused the gynecomastia in the first place and if that precipitant has been taken out of the picture. 

Q: Can we re-do surgery if the result isn't what you wanted?

A: If gynecomastia surgery was done elsewhere and you are not happy with the result, we can do a corrective surgery. This may involve release of scar tissue and / or fat grafting to fill any contour irregularities, as well as possibly re-doing the liposuction / gland excision. Fat grafting means taking fat from elsewhere and injecting it into that area. This does require you to have enough fat to donate!

Q: What is recovery like?

A: Following surgery, we try to avoid drains but this may be necessary for very large gland excisions. We do recommend use of a snug "garment" or vest to compress the area for two weeks to three months depending on what surgery was done. Be careful with the vest to avoid any edges that can create indentations - sponges for cushioning or a different style of vest may be needed to ensure great results if liposuction was done. We recommend avoiding upper body exercise for two to four weeks, until cleared to do so by your surgeon. Premature exercise can result in a fluid collection, called a seroma, that may need drainage. As in all surgery, there are risks of bleeding, infection and scars, so a few days off work is recommended depending on the nature of your work. We will continue to guide you as you heal. Nicotine exposure should be avoided three months before to two months after surgery.

Please contact the office for a consultation if you would like to learn more.