What is Gynecomastia?
Gynecomastia is a condition in which men and boys experience an enlargement of the breast tissue. The condition is commonly (and crassly) referred to as “man boobs.” Although many outgrow it, approximately 60-70% of teenage boys experience gynecomastia due to hormone fluctuations. An estimated 35-65% of men experience the condition, especially between the ages of 50 and 70 due to hormonal changes, medications, or underlying health conditions.
Unless caused by an underlying medical condition like kidney disease, gynecomastia is generally not harmful. Men often seek treatment, however, as the condition can cause embarrassment, lower self-esteem, and create body image issues. Gynecomastia can also cause tenderness around the breasts, which can be uncomfortable. When men do seek treatment, both surgical and non-surgical options are available to them.
What Causes Gynecomastia?
Gynecomastia has several potential causes, but it is important to distinguish between true gynecomastia and pseudo-gynecomastia. True gynecomastia is caused by a medical condition or hormonal change. Pseudo-gynecomastia occurs when the male breasts are enlarged by excess fat or obesity. Both are treatable but require different approaches. Causes of true gynecomastia include:
- Hormonal imbalances (either elevated estrogen or decreased testosterone levels)
- Age-related hormone changes naturally occurring during puberty or later in life
- Certain medications such as steroids and antidepressants
- Health conditions such as liver disease, kidney disease, and thyroid issues
Symptoms and Signs of Gynecomastia
Gynecomastia presents with several signs and symptoms, often both physiological and psychological in nature. Knowing the signs can help you know what to look for and when to seek treatment.
Physical Symptoms
- Swollen tissue in one or both breasts
- Tenderness or sensitivity in the breasts
- Puffiness around the nipples
- A change in nipple color
- A localized, disc-shaped lump beneath the nipple
Psychological Impact
Unfortunately, gynecomastia can be an embarrassing problem and lead to altered behaviors such as keeping your shirt on at the pool or beach. Psychological difficulties to watch out for involve:
- Anxiety
- Low self-esteem
- Decreased confidence in social settings
When to Seek Treatment
As previously stated, gynecomastia is generally more of a cosmetic issue than a health problem unless it is caused by an underlying disease. Because of this, it can be difficult to know whether you should seek treatment or not. You should absolutely do so if you experience:
- Persistent gynecomastia that lasts more than 12 months
- Nipple discharge of any kind
- Pain
- Hard, immovable lumps in the breast
- Avoiding once-loved activities like swimming or hitting the gym due to embarrassment
Distinguishing from Other Conditions
If you do seek treatment, it’s important that your doctor makes sure you truly are experiencing gynecomastia. It’s rare, but men can develop breast tumors and cancer. At Mia Aesthetics, we don’t remove tumors, but we can help you get tested for one if we suspect a malignancy. To distinguish between gynecomastia and other conditions, your plastic surgeon may do some or all of the following:
- Obtain a complete medical history
- Perform a physical examination
- Request blood tests
- Order an ultrasound
- Send you for a mammogram (yup, guys can get them too)
Non-Surgical and Lifestyle Solutions
Gynecomastia doesn’t always require surgical intervention. There are several other treatment options that you may wish to try first. These include:
- A diet and exercise program to help reduce excess fat (used to treat pseudo-gynecomastia)
- Medications that can block estrogen receptors
- Hormone replacement therapy to replace lost testosterone
- A change in medication if a prescription drug is likely the culprit
- Avoiding triggers such as anabolic steroids
- Compression garments to hold the chest back and make breasts less visible
- Testing for and treating underlying medical conditions such as liver or kidney disease
When Surgery Becomes Necessary
Unfortunately, non-surgical gynecomastia solutions are sometimes inadequate. Fixing the problem is likely to require surgery when:
- Gynecomastia refuses to resolve within one to two years despite non-surgical treatments
- Pain or discomfort are present
- Severe cases where the breasts are very enlarged or sagging
- The patient is suffering emotional distress such as embarrassment and low self-esteem
- Medications have proven ineffective
- Male breast cancer is present or suspected
Surgical Treatments for Gynecomastia at Mia Aesthetics
If you do decide to take a surgical approach to your gynecomastia, the appropriate treatment will largely depend on the reason for your condition.
Liposuction for Gynecomastia
When gynecomastia is caused by excess fat (pseudo-gynecomastia), power-assisted liposuction (PAL) is often the best treatment. You may choose to undergo liposuction while asleep thanks to general anesthesia or while awake using a local anesthetic. Either way, all of our skilled surgeons use PAL to break up and remove unwanted fat. PAL makes it easier to break up the fat so you experience less tissue trauma and heal faster.
If you’ll excuse the use of such a technical term, your excess fat is not removed all willy-nilly during the PAL procedure. Instead your surgeon will work carefully and artfully, sculpting your breasts in a way that creates a more aesthetically desirable and masculine shape. When they are satisfied with the results, they will close their incisions and complete your surgery.
Excision Surgery
Sometimes gynecomastia is caused by the development of glandular tissue rather than excess fat. It’s also possible for there to be excess skin around the breasts. In both cases, surgical excision (removal) of the excess tissue is required. Performed using general anesthesia, your plastic surgeon will cut away the excess breast tissue, reshape your breasts to create a more desirable size and shape, and then close your incisions.
Combination Approach
Sometimes surgeons use both excision techniques and PAL to provide the most optimal results. If you have glandular tissue as well as some extra fat, your surgeon can excise the glandular tissue and then use PAL to further sculpt and shape the chest area.
Incision Placement and Scar Management
During a PAL procedure, your surgeon will make a small incision through which they will pass the tube that removes your unwanted fat. This incision and the subsequent scar will be very small and hidden either in or around your areola, in your armpit, or beneath each breast in a natural body crease.
As is true for PAL, your plastic surgeon will hide their incision in the areola when possible or in the chest crease when performing excision surgery. Whenever possible, the same incision is used for both parts of a combination procedure to minimize scarring.
What to Expect During Gynecomastia Surgery Recovery
When facing surgery, it’s helpful to know what to expect after. This helps to ease stress by letting you know what is normal and expected.
Recovery Timeline
Recovery from gynecomastia surgery is generally not difficult or lengthy. It is important to follow the timeline your doctor gives you, however, to ensure a smooth recovery free of complications. Here is what to expect:
- First Few Days: Swelling, bruising, and discomfort are common. You will likely see a visible change in your chest, but this is by no means your final result, so don’t be discouraged if things don’t yet look the way you want them to.
- 1-2 Weeks: You can resume light activity, and most patients can return to work. Continue avoiding strenuous activity, however, and refrain from returning to a physically demanding job.
- 3-6 Weeks: Swelling reduces, and you may gradually return to normal routines, including exercise.
- Final Results: Full recovery and final results can take up to 6 months to appear as residual swelling eases.
Compression Garments
After your surgery, your surgeon will ask you to wear a compression garment. This tight-fitting garment is worn under your clothes and helps to reduce swelling and ensures your body holds and adjusts to its new shape. You will likely have to wear this garment for several weeks, so make peace with it early.
Follow-Up Appointments
Your surgeon will want to have a follow-up appointment with you within a week after your surgery. This appointment is critical as it allows your doctor to check your healing progress and make sure all is going well. If applicable, any non-dissolvable sutures are usually removed at this appointment. Remember that Mia Aesthetics requires out-of-town patients to stay in the city for five days after surgery so we can ensure follow-up care.
Gynecomastia Surgery Results: Before and After
The results of gynecomastia can truly be transformative for both mind and body. There are a few things you should keep in mind, however.
Realistic Expectations
It’s important to have realistic expectations. Plastic surgery can achieve many things, but it doesn’t provide absolute perfection. You must also remember that you have to do your part. Great plastic surgery results require a team effort between a skilled surgeon and a patient who carefully follows their aftercare instructions during recovery. Remember too that it can take six months before you see the final results of your surgery, so you must have patience.
Potential for Recurrence
Gynecomastia generally doesn’t come back after surgery, but it can in some cases. If excess weight or obesity caused your gynecomastia, you could see your surgical results change if you fail to maintain a healthy weight going forward after your procedure. The removed fat cells won’t ever come back, but your body will make new ones if it needs to.
The condition may also reappear if there is an underlying cause that was not addressed prior to surgery. To keep gynecomastia at bay, you may need to change a medication, avoid marijuana and other drugs known to cause gynecomastia, or stay on a hormone replacement therapy.
When to Consider Revision Surgery
If you’re not happy with the results of your gynecomastia surgery, you can undergo revision surgery to address your remaining concerns. It’s generally best to wait for at least six months before doing so, and many surgeons recommend waiting a year. Common reasons for revision surgery include:
- Residual excess tissue
- Unevenness or asymmetry
- Thick or noticeable scars
- Recurrence of gynecomastia
Next Steps
If you’re considering gynecomastia surgery or have questions, we encourage you to take advantage of our free virtual consultations. This will allow us to assess your suitability for surgery and answer all of your questions. A consultation absolutely does not obligate you to undergo surgery and is an excellent way to find out if surgery may be an option for you.