Gynecomastia, sometimes (and rather unkindly) referred to as “man boobs,” is a medically benign condition in which the male breast glandular tissue becomes enlarged owing to genetic, chemical, and/or environmental factors. Anywhere from 30% to 65% of boys and men can be affected by gynecomastia at some point in their lives. Increased breast tissue can cause boys and men to feel anxious, embarrassed, and fearful of developing breast cancer.
Gynecomastia Is a Hormonal Condition
Gynecomastia arises when the normal male hormonal balance is disrupted or changed. An imbalance between estrogen (a hormone that is highest in females ) and the androgen testosterone (a hormone that is highest in males) causes the feminization of the breasts.
Gynecomastia can appear at any age, but certain points in the life cycle are associated with an increased risk. Male infants are sometimes born with the condition owing to their exposure to their mother’s estrogen in the womb, which stimulates the growth of breast tissue. This generally resolves within a couple of weeks.
When boys go through puberty, the rush of hormones may lead to a temporary development of gynecomastia. In these cases, the breasts usually return to normal size within months to a couple of years. The incidence spikes again in older men, between the ages of 50 and 69, when more than a quarter of men are affected.
Males who have liver, kidney or thyroid disease, hormonally active tumors, or Klinefelter's syndrome, or other conditions that shift the hormonal balance toward estrogen are also at increased risk for developing gynecomastia.
It’s Not Just Fat
While some men with gynecomastia may have excess fatty tissue in addition to breast tissue, true gynecomastia is not caused by obesity and cannot be resolved by fat-removal techniques such as liposuction. The enlarged male breasts in gynecomastia are due to an expansion of firm, rubbery male breast tissue, which extends concentrically outwards from the nipple. When examined under the microscope, this tissue demonstrates benign proliferation of glandular male tissue.
Men with enlarged breasts that are composed of fat rather than male breast tissue are considered to have pseudogynecomastia. A first treatment option in these cases is an effective and sustainable weight loss through diet and exercise. Liposuction can also help.
For true gynecomastia, male breast reduction surgery is the best solution. Breast reduction not only removes the excess breast tissue, it also helps restore hormones to a normal male balance. Dr. Julio Garcia, a Las Vegas plastic surgeon, has helped hundreds of men with gynecomastia regain a masculine breast appearance through breast-reduction surgery.
Symptoms of Gynecomastia
Boys and men with gynecomastia may experience symptoms in addition to enlarged breasts, such as:
- Swollen breasts
- Tender breasts
Symptoms that require immediate medical evaluation include:
- Breast or nipple pain
- Nipple discharge
Multiple Causes for Gynecomastia
In addition to age and certain diseases and conditions that may increase risk, there are many factors that can disrupt the hormonal balance in men, leading to the excessive estrogen production that can cause gynecomastia.
Some pharmacologic hormone disruptors include:
- Anti-androgens, such as finasteride, flutamide and spironolactone
- HAART for AIDs or HIV
- Antidepressants and anti-anxiety medications, such as diazepam
- Gastric motility drugs and ulcer medications, such as cimetidine and metoclopramide
- Heart medications, such as digoxin, and calcium-channel blockers
Use of alcohol and most street drugs, including marijuana and heroin, can increase risk.
Even some common herbal oils, such as lavender and tea-tree oils, that are added to soaps and grooming products can be weak estrogen promoters.
Exposure to chemicals, especially endocrine disruptors, may put you at higher risk for gynecomastia.
Treatment of Gynecomastia
Although gynecomastia is caused by a hormonal imbalance, rectifying it through hormone therapy is not usually recommended. If a medication is at the root of the condition, some pharmacologic adjustments may be required. However, in most cases the most effective and long-lasting treatment is surgical removal of the excess breast tissue.
Once the excess breast tissue has been removed, breasts are restored to their normal male appearance. Excising the breast tissue also removes the excess estrogen expressers, thereby allowing for the production of more testosterone.
Preparing for Male Breast Reduction
If you’re considering cosmetic surgery in Vegas for gynecomastia, the process is the same as it would be for a female breast reduction. Dr. Garcia brings an artist’s eye to your procedure to ensure that your reconstructed breasts are masculine looking and in balance with the rest of your body.
Because male breast reduction is a major surgical procedure, you must be sure that you have the resources to allow yourself a full and healthy recovery period. Before undergoing surgery, make sure you can:
- Take off at least 2 weeks of work
- Make arrangements for a friend or family member to take care of meals and household tasks for 1 to 2 weeks
- Arrange for child care or pet care, if necessary, for 1 to 2 weeks
- Have someone drive you home from the procedure
You will need to curtail many activities for up to a month, including swimming, running, and going to the gym.
After your procedure, you will have scars around the areolas that will fade over the time. You can also improve the look of the scars with lasers and microneedling.
Reclaim Your Body
Whether you have pseudogynecomastia that can be resolved with liposuction alone, or hormonal gynecomastia that requires breast-reduction surgery, Dr. Garcia, an expert Las Vegas cosmetic plastic surgeon, can help you reclaim your male physique. He is happy to consult with you and decide what treatment options are best for you.