Gynecomastia 411

Posted in: Gynecomastia, Q&A | October 4, 2010 | 2 Comments »

Gynecomastia, enlarged breast tissue in males, can be very emotionally devastating.  My patients tell me they feel embarrassed by their “man boobs” and have to wear oversized clothing.  They wear t-shirts in the pool and at the beach.  Overall their enlarged breast tissue makes them extremely self-conscious.

1.  Who does it affect?

Gyencomastia is most frequently seen in teenage boys and in older men because of hormonal changes.  In more than 90% of young boys, the condition resolves spontaneously.  However, up to 40% of ADULT men are affected to by some degree of gynecomastia.

2.  Workup

You will likely be referred to an endocrinologist “hormone specialist” to rule out conditions that can cause gynecomastia.  These include diseases like hepatitis, various cancers, or thyroid and testosterone imbalance.  Street drugs like marijuana and heroin, as well as many prescription drugs, have been associated with gynecomastia.  Steroid can also cause gynecomastia.  Your physician must always rule out the possibility of breast cancer.  Obesity causes enlarged breasts from the accumulation of fatty tissue. Once the serious medical conditions have been eliminated, many patients choose to proceed with surgery.

3.  Surgical options

The goals of surgery are 1) to reduce the volume of the breast and 2) to remove and shape the redundant skin as needed.

To reduce volume, I start with liposuction.  If there is firm fibrous breast tissue, I use power-assisted liposuction or PALS.  This is where the liposuction cannula has a vibrating tip that helps break up thicker tissues.  If there is residual tissue under the breast, I may also perform a “direct excision.”  I make a small crescent shaped incision placed at the edge of the areola.  Through this incision, the remaining breast tissue is removed.  The scar usually heals nicely.  For younger patients with good skin elasticity, this is usually all they need.   The skin slowly tightens and forms a nice flat contour.  Patients should know that this process of skin tightening takes time, and for many months they may have skin bagging or wrinkling.

In a few cases – usually older patients with poor skin elasticity, or in cases where a large volume of breast tissue or fat is removed, there is excess skin that needs to be removed.  The safest way is to first perform liposuction to remove the volume, and then several months later perform the skin excision.  The skin excision is tailored to the patient’s individual anatomy but can consist of removing a circle around the areola, removing a vertical section of skin under the nipple, removing an ellipse of skin near the armpit where the skin folds, or removing a large section of skin and moving the nipple as a free graft.  All patients undergoing surgery should understand that they will have a significant improvement in their breast appearance but that there can be visible scars, skin depressions, and persistent skin wrinkling.

Overall my patients have been extremely happy with their results.  They feel comfortable going to the beach or wearing a t-shirt for the first time.  Gynecomastia surgery can often improve a man’s quality of life and help him feel more confident.