It’s quite natural and rather common for male adolescents to temporarily develop enlarged breasts, also known as Gynecomastia. It is a problem for many young men as they have to get through gym class somehow, and enjoy their summers like everybody else. It can be a big emotional burden.
But then what happens if it doesn’t go away? What if it gets worse instead of better? Many men carry this problem into adulthood. It can be very difficult to conceal, and interferes with so many social activities that we all take for granted. Summertime is the worst, when clothing gets thinner and bathing suits are the norm.
The good news is that Gynecomastia is readily treatable. Removing the excess breast tissue is the fourth most common plastic surgical procedure among men. 18,000 such cases are performed annually in the U.S.
The condition, Gynecomastia, is not the same as the excess breast size seen in overweight men, known as Pseudogynecomastia. In the case of Gynecomastia, the excess growth is limited to only the areola, often referred to as a “puffy nipple”. More often the surrounding area is enlarged as well, as fairly obvious breast development. The glandular tissue can be painful also. This can be extremely difficult to conceal, and patients tend to wear loose fitting clothes and often adopt a hunched over or slouched posture. Removing one’s shirt in public becomes a problem, and it makes it more difficult to engage in sports. These effects become cumulative, and it factors large in a person’s self-esteem.
Both male and female breast tissue responds to the circulating levels of estrogen and testosterone. Both high estrogen and low testosterone can cause the breasts to enlarge. The balance of these hormones is disturbed during puberty, which explains adolescent Gynecomastia. Most cases that persist into adulthood, however, have normal hormone levels, and the fault seems to lie in the inability of the breast tissue to spontaneously regress.
Most cases of Gynecomastia are benign, and do not indicate any underlying serious problem. However, all of these other factors must first be addressed, and problem diagnoses ruled out, during the process of evaluation. Usually a good medical history, and a physical examination is adequate, and blood lab-testing is not indicated. If there is rapid or asymmetric growth, or the growth is particularly large, then a panel of lab work is ordered.
While the cause of Gynecomastia may be somewhat mysterious, the treatment is not. Surgical advances, particularly in the area of liposuction, have made Gynecomastia surgery one of the most effective and satisfying procedures we provide. The breast tissue can be removed with an excellent smooth contour, and the patient can be free to remove his shirt again without concern.
During surgery, there is always a varying amount of fat, which is soft, and gland, which is firm, to be removed. Hands down the best way to remove the fatty part is through liposuction. It doesn’t matter too much whether the liposuction is done with ultrasonic technique, Smart-lipo, or traditional methods. I personally prefer traditional tumescent (wet) technique, I find it is the best way to make a smooth contour. Liposuction is the most common cosmetic surgical procedure we as plastic surgeons perform, and applying it to Gynecomastia treatment makes the results very predictable and reproducible.
The procedure takes about an hour and there is no significant discomfort. I like to have my patients wear a compression vest for a few weeks to keep the area nice and flat against the chest. Activities like sports are restricted for about two weeks. Time off work varies. Office-type work can be resumed the next day, while more active jobs may need some extra time off, perhaps 3-5 days.
It doesn’t take long to appreciate the results. The compression vest keeps the area flat and the result is immediate. Patients with gynecomastia often have a forward, hunched posture to de-accentuate their chest. After surgery, it is very satisfying to see the same person stand more proudly and erect. More often than not I see a change in my patients’ attitudes toward exercise, becoming more interested in their physiques and hitting the gym more often.
I would say that treatment of Gynecomastia is one of the most satisfying procedures that I perform. Patients are uniformly happy, and it really changes the way they greet the world.
View Gynecomastia Before and After Pictures.
