A photograph recently surfaced of Rocker Steven Tyler’s chest. I am writing this blog, not to poke fun at the Aerosmith frontman’s chest, but as an opportunity to discuss a very common problem among men. Gynecomastia, or male chest enlargement, is a complaint of men of all ages. It can develop anywhere from puberty to the 80’s. It can range from only mild chest enlargement or severe chest enlargement resembling female breasts. I have seen countless patients who report that they have not taken their shirt off in public for years, because of embarrassment. Imagine being a teenage boy and being so embarrassed that you will not go to the beach or the pool, or even change in the locker room. Surgical correction is possible and is life-changing!
So what is gynecomastia and what is the cause? It is the enlargement of the male chest as a result of breast tissue growth. Yes, it is actual breast tissue, not simply fat. All men have some small amount of breast tissue normally. Hormonal imbalances can cause an increase in the level of estrogen (also normally found in men but in much lower levels than women) to rise, signaling breast tissue to enlarge. The hormonal imbalance can occur from prescription medication such as many anti-depressants, psychiatric medications, and weight loss medicines. It can also occur from anabolic steroid use of chronic marijuana smoking. Interestingly enough, when the offending medication or drug is eliminated, the chest may decrease in size but rarely goes away entirely. Obesity triggers the conversion of testosterone to estrogen and can result in male chest enlargement. A more rare cause of male chest reduction is tumors, such as testicular cancer that can secrete abnormal hormones. Enlargement of both sides is most common, although one may become larger than the other. If there is enlargement of only one side, the possibility of male breast cancer must be considered although it is rare.
If you suffer from male chest enlargement, you should be evaluated by a physician. Your physician will perform a history to determine the possible causes. This will include a detailed history of all drug use, both legal and illegal. Also, a physical exam may help determine whether tumors or cancer is a cause. Your physician will also test your blood for hormone levels and possibly have you seen by an endocrinologist. Approximately 80% of the time, there is no detected cause for this and it is termed “idiopathic” – a fancy medical term for “we have no idea why”.
After treating any underlying medical condition or in the case of “idiopathic gynecomastia”, you may be referred to a plastic surgeon for discussion of the options for correction. Gynecomastia reduction surgery is one of the most common procedures among my male patients.
The treatment will revolve around removing the excess tissue. This may be done with liposuction to suction out the breast tissue and fat. Often, there is a hard lump of breast tissue that is felt under the nipple and areola. This is called the “breast bud” and is very resistant to liposuction. The tissue is just too dense to be removed by suctioning alone and needs to be removed through an incision around the areola. In severe cases, there is excess skin as well as underlying breast tissue. In these cases, reduction usually involves removal of breast tissue with a combination of liposuction and excision, as well as removal of the excess skin.
Gynecomastia is extremely common and a major source of embarrassment, no matter what the age. There are many options for correction. You should see a board certified plastic surgeon to learn about these options. To see some of my before and after gynecomastia pictures Click Here.
To learn more, or to schedule your consultation, contact me or call 212-289-1851.