The ABC's of plastic surgery:
Gynecomastia Surgery: When Male Breasts Grow.
By Dr. Mathew C. Mosher

You may have seen the humorous Seinfeld TV episode where Kramer designs “The Bro,” a bra for men, while George worries about the increasing size of his breasts. Yet George is not alone. Benign enlargement of the male breast, called gynecomastia, is a surprisingly common condition.

Gynecomastia is derived from the Greek words gyne, meaning “associated with women” and mastia, meaning “breast.”

The history of this condition and the descriptions in literature are quite interesting. Did you know that some of the earliest Egyptian art depicted gynecomastia in many pharaohs including Tutankhamen? Aristotle, among many other notables, recognized and described this condition in some men. But management of the problem with various medical and surgical approaches really wasn’t discussed until the early 20th century.

A common condition
A variety of studies have documented the prevalence of gynecomastia as occurring to some degree in more than one-third of adult males with a tendency for this to increase with age. The condition commonly occurs in three different age groups. The first peak occurs in the neonatal period and is believed to be a result of maternal hormones influencing breast tissue growth. Sixty to 90 per cent of newborns demonstrate this to some degree. The second peak occurs during puberty and can affect up to 70 per cent of young males aged 10 to 14 years. In most cases, the enlargement regresses over a period of one to three years but can persist in as many as eight per cent of males. The final group of males that show an increase in breast tissue development is in adult men over the age of 50.

“Most men with gynecomastia try to hide this portion of their
body from others and assume nothing can be done about it.”

As common as this condition is, there is very little discussion about it. Most men with gynecomastia try to hide this portion of their body from others and assume nothing can be done about it.

During puberty, our bodies go through a variety of changes at different rates. A small degree of male breast enlargement may not be noticed but larger degrees of gynecomastia are sure to draw the attention of unsympathetic peers. Fortunately, the condition usually gets better without intervention. What happens to the eight per cent of men with persistent breast enlargement? Some feel comfortable with these changes and are not bothered by the comments of their peers. For many, there is a conscious effort to conceal and de-emphasize this portion of the body to avoid embarrassment.

Many patients tell me they avoid taking off their shirt for sports or swimming. Some have extreme apprehension about what a girlfriend might think—making relationships more difficult. Some patients exercise their chest muscles excessively to try and improve the appearance of this area, or in some cases, they became generally overweight as an excuse to let the breast contours blend in with their other rolls. For those with more severe gynecomastia, discussion with their family doctor often takes place and options are presented. However, those too embarrassed to talk about it may never know good treatments are available.

“The success of newer liposuction techniques has made
getting rid of this source of embarrassment
safer and easier than ever.”

A variety of medical conditions and medications can cause this condition or aggravate the degree of changes. Medical causes of gynecomastia are not common but can be ruled out with a careful medical history and physical examination. In some instances, laboratory tests are essential to rule out hormonal causes. Some prescription medications, excessive alcohol consumption, anabolic steroid use and marijuana use are common reversible factors that can be modified. Obesity is another common contributing factor.

Once the benign nature of gynecomastia is confirmed, a consultation with a plastic surgeon is recommended to discuss treatment options.

The surgical management of gynecomastia is dependent on a number of factors. Surgeons consider patients’ general health, the severity of breast enlargement, the degree of fatty tissue in the breasts compared to the amount of glandular tissue present and the quality and tone of chest skin.

Until the 1980s, the only surgical option consisted of cutting the tissue out. The introduction of liposuction (suction assisted lipoplasty) revolutionized treatment for this condition. Liposuction alone is successful in many situations because most adult male gynecomastia is predominantly fatty tissue. However, a significant component of more fibrous glandular tissue may be present and is usually concentrated in the area directly behind the nipple. Consequently, a combination procedure of liposuction and direct excision may be necessary. The development of UAL (ultrasound assisted liposuction) and improved liposuction instruments have led to more successful treatments with liposuction alone. When liposuction is performed in isolation, there is less external scarring and potentially fewer and less serious surgical complications compared to traditional surgery. This also results in a shorter recovery period. The best surgical approach can only be determined after a consultation with your plastic surgeon. In most instances, the surgery is a day-surgery procedure and patients can return to most activities within seven to 10 days.

In summary, gynecomastia is a common condition in the male population. Although this is usually a benign condition, male breast enlargement causes sufficient embarrassment for many men to seek out cosmetic surgical treatment. The success of newer liposuction techniques has made getting rid of this source of embarrassment safer and easier than ever.

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