Summertime equals skin time; not just for the ladies but for the men who want to be liberated from their shirts and feel the sun on their chest. Many men do this without even a thought, but for many others doing so causes self-consciousness, embarrassment and discomfort. The first thing that is important for you to know if you are suffering with this problem is that you are not alone. Many of my male patients come in with concerns about enlarged breast tissue. Luckily social media provides a platform for sharing and removing the sense of isolation which sometimes accompanies this problem. I applaud people like Chris Pineda for making this video to share his struggle.
Do I have gynecomastia?
☑︎Do you have excess breast tissue?
x Are you obese?
If you are a male with excess breast tissue and you are not obese you most likely have gynecomastia. Gynecomastia consists of increased breast tissue and some fat. There are varying grades of severity of this enlargement.
Grade I Minimal increase in breast tissue, no sagging/extra skin
Grade III Moderate increase in breast tissue, with moderate sagging/extra skin
Grade IV Severe increase in breast tissue, with moderate or severe sagging/extra skin
What causes gynecomastia?
Some causes of male breast enlargement are transient and resolve on their own. Male breast enlargement is very common during certain stages of life: infancy, adolescence, and mature-age. The thought is that this is caused by an imbalance in hormone levels between estrogen (the female hormone) and testosterone (the male hormone). During pregnancy a male infant is affected by the estrogen from their mother’s blood causing an increase in the breast tissue. After birth the estrogen levels decrease and the gynecomastia resolves. As many as 66% of all male adolescents experience gynecomastia of one or both breasts at some point. So if you are a teenage male experiencing this problem remember that it is quite common. The teenage years are full of shifts in hormone levels, an imbalance between estrogen and testosterone for a limited amount of time can cause breast enlargement. As the hormone balance returns the breast enlargement usually resolves within 6 months to 2 years. Mature age unfortunately is the only exception here, the imbalance in testosterone and estrogen that comes with age ( > 65 years) does not resolve.
Some causes of male breast enlargement may be idiopathic, meaning inherent to the person with no specific cause. Others are due to medications, drugs, and illness.
What to watch out for:
Many medications can cause this problem for example Zantac (cimetidine), Prilosec
(omeprazole), Aldactone (spirinolactone), Vasotec (enalapril). Changing your
medication may be an option.
Drugs of Abuse
Drugs of abuse such as marijuana, heroin, anabolic steroids can cause breast enlargement, so remember that as you light up or shoot up you may be increasing that breast tissue.
High or low thyroid levels can also contribute to this problem.
Alcohol abuse and hepatitis are common reasons for liver failure. If you start noticing
yellowing of your eyes of skin you may be in serious danger of liver failure which can
lead to breast growth.
Tumors of the testicles can release hormones causing an upset in normal hormone
levels and increasing breast growth.
How do I get treatment?
It is important that you visit your PCP so that they can rule out medication side effects or severe illness.
1. See your PCP
Your PCP will review your medications, examine you including performing a testicular exam, send off any necessary labs, and possibly send you for some imaging studies as well.
2. Get a referral to a Plastic Surgeon
If all the possible causes of gynecomastia have been eliminated or there is no improvement within 1 year of removing the offending agent it means that you require surgical treatment for gynecomastia.
What is the Surgical Treatment?
This is the most common method of treatment for gynecomastia and can be used for most grades. One or two tiny access incisions are made and then liposuction is performed to remove the breast tissue. Even for those patients who have some sagging and extra skin we often start with liposuction alone and allow 6-12 months to allow for healing and shrinking of the skin. If additional skin needs to be removed or the nipple needs to be elevated that can be done during a second short surgery.
2. Direct Removal of Breast Tissue
At times there is very dense/thick breast tissue which cannot be removed with liposuction alone. In these instances a small incision is made under the skin of the areola and the breast tissue is removed directly through that incision.
What about Insurance?
Although it is the best method of treatment insurance companies do not cover the use of liposuction for treating gynecomastia. Some companies will however cover the costs for direct excision. Consult with a plastic surgeon to find out your options.