I want to start off first by saying that I feel that gynecomastia (enlarged breast tissue in males) and male breast reduction is not something to be snickered at. I do not find the subject even remotely funny so I always consider someone’s feelings as I would like my own to be considered. If you are reading this blog, you more than likely have an insecurity about a body part, so you know how it is to feel self conscious. A little empathy goes a long way 
I was in L.A. last week and saw a teenager who prompted me to write an article on male breast reduction this week. Now, before you think me rude, I already had it on the schedule to write about. Of course, since it was on my mind, this weekend I noticed a few more older males who seemed to all have the same characteristics. Perhaps there is no connection, but it seemed to me the males I had observed did all have the same variables. They seemed slightly overweight, weak chins and jawlines, and were slightly effeminate. This in no way implies that I believe there is a standard for all patients with gynecomastia, rather this was just based upon the observation from the last week alone. I am not sure if this is a cause and effect issue of increased estrogen, so much as it was simply a coincidence. But I do know that higher levels of estrogen can create excess breast tissue in males. Of course there were still the uber-masculine, once-upon-a-time-weight-lifter males which also suffered from enlarged male breasts.
What Is Gynecomastia?
Gynecomastia is the condition in males that defines the presence of excess glandular breast tissue, and/or fat. The result is what appears to be prominent breasts in males and can occur in one or both breasts.
What Causes Gynecomastia?
True gynecomastia is a glandular tissue problem. It is most often seen in adolescent males, but can also be present in the elderly and even infants. Breast tissue in males commonly forms due to the presence of excess estrogen, the female sex hormone. In infants, estrogen is commonly caused from a direct transfer from the mother in utero. In adolescents it is often caused from hormonal imbalances. In the elderly it can be caused from hormonal imbalances as well. Although aging seems to increase fat deposits in some places and decreases it in others.
Other factors may contribute to gynecomastia such as drinking excessive amounts of alcohol or possibly smoking considerable amounts of marijuana. Although this hypothesis is still not widely accepted. Certain medications, such as (spironolactone, and finasteride) can also cause gynecomastia.
Gynecomastia can also be a result of higher body fat percentage. Although higher fat levels increase estrogen levels, when the problem is primarily fat, then it is often called psuedo-gynecomastia.
In body builders and swimmers, the “problem” can arise from muscle hypertrophy (the building of muscles, and the increase in size of muscle cells) and subsequent atrophy after retiring due to lack of exercise. When body builders have experimented with anabolic steroid use, the size increase (and estrogen imbalance) can become exacerbated. This is caused by your own body’s reactions to the increased amount of testosterone being introduced to the body. The body attempts to balance these levels and increases its production of estrogen. Although even without the use of steroids, when the muscle building stops and the atrophy begins, loose skin and deflated tissue can also cause the appearance of prominent breasts. Increased testosterone levels due to exercising and bodybuilding can also cause the hormone shift.
The Psychological Effect of Gynecomastia
It is no secret that males with gynecomastia are teased by the peers in school and in adult life. You may have heard the off-color remarks such as “manboobs”, “man breasts”, “moobs” and “b*tch t*t”. Again, please consider someone’s feelings before even thinking of making these comments. I assure you, if the person could change it, they would. Making fun of another’s physical attribute is not only rude, it has contributed to anti-social behavior, depression, and even suicide. We are all different and in most cases do not fit some pre-packaged physical norm.
Options in Treatment
In adolescents suffering from a natural hormonal issue, this will often correct itself in 1 -2 years. Usually, nothing is necessary but patience.
In medication-induced gynecomastia, speaking with your doctor about adjusting medications can help, but may not eradicate the problem until you cease taking said medications. This includes anabolic steroid use.
In cases of psuedo-gynecomastia, if you feel that you have a higher body fat percentage than you’d like, reducing this by diet and exercise, and building muscle will help you determine if your issue is true breast tissue, or fat.
In the elderly, and although often par for the course, discussing the problem with your health care provider may help you determine a cause of action. Liposuction is common for those who have fatty deposits only.
Bottom line, an attempt at determining the cause of your gynecomastia may be beneficial to you in other areas of your health profile. Testicular tumors can increase estrogen levels, so a physical stemming from your dissatisfaction with gynecomastia should not just be considered “vain”, it is also smart.
In those who wish to turn to surgery, glandular tissue can be excised through a small incision. In those who have fatty deposits, can resolve the issue through standard liposuction, or lipoplasty, also through a small incision.
The Surgical Procedure
Your doctor will make a small incision in the nipple areas and use a scalpel to excise the glandular pad, as well as possibly use liposuction to reduce the fatty deposits. This can be done under local (a shot, and a mild oral sedative), or under light sleep sedation (mild anesthesia, where you sleep and do not feel pain, but are not on a breathing apparatus), and sometimes under General Anesthesia when other procedures are performed.
The Recovery Period
Since surgery is still surgery, you will be slightly sore afterwards, perhaps even feel a burning sensation. You will be prescribed pain medications to get you through this time, and should not feel any pain which is extreme or out of the ordinary, but do expect discomfort.
You will commonly be instructed to wear a compression vest for 4-6 weeks to reduce swelling, reduce the occurrence of fluid and subsequent scar tissue build up and promote tissue adherence.
You may also have sutures if excision was performed, and sometimes when liposuction only is performed. These sutures will commonly be removed in a week at your follow up appointment.
Risks of Gynecomastia Surgery
Other than risks associated to the anesthesia itself, a risk from the surgery itself may be infection. Other risks include hematoma (a sort of internal bruise where a pocket of blood may form), and seroma (a pocket of fluid formation), and although uncommon, necrosis (death of tissue from lack of blood supply). Please discuss with your doctor the full list of risks associated with this procedure.
Dissatisfaction may also be an issue, so please discuss this with your surgeon after you are finished healing. Remember you will be swollen and bruised during your recovery period so don’t even begin to judge your result until you are healed.
Costs
The costs of gynecomastia surgery, or male breast reduction, really depends upon the doctor, the region, and the needs of the patient. With excision the cost may be more than standard liposuction. Generally the costs are between$4,000. and $6,000. Although I have seen this surgery go for $3,000.
Whatever the case, if you are self-conscious about having gynecomastia, there are options. Just remember that although cosmetic, this is still surgery. Mental and physical health are both paramount before deciding to undergo a plastic surgery procedure.
