American Society of Plastic Surgeons
For Medical Professionals

Gynecomastia, abnormally enlarged male breasts, becoming less of a taboo topic

Gynecomastia is a condition characterized by abnormally enlarged male breasts. There are multiple origins of the disorder. Some of them are congenital and some are acquired. One of the most common causes of gynecomastia is related to the endocrine system, and caused by excess female hormones. Gynecomastia can also occur simultaneously with testicular tumors and Kleinfelter's Syndrome. Steroid use can also contribute to the presence of gynecomastia, as steroids create an influx of testosterone, which the body reacts to by producing more female hormones which consequently results in a more feminine breast. The relation to steroidal consumption explains why gynecomastia is more prevalent in bodybuilders. There are also multiple medications which are strongly correlated with incidences of gynecomastia: Propecia and digitalis are among the most well-known. Some with elevated testosterone are susceptible to gynecomastia, but it does not necessarily develop in everyone with a hormone imbalance. In some cases, when gynecomastia is present, there is a need for an endocrinologist to rule out any other hormonal disorders.

There are three developmental stages in which gynecomastia is more prevalent. The first stage is during infancy, which could be due in part, to increased prolactin and may be more pronounced in breast-feeding infants. The second time frame is adolescence, which is when between 30-60% of all gynecomastia cases develop. Of those which develop in adolescence, 80% regress before the age of 18. The ones which do not regress are typically those which are most severe. Adolescence is also when gynecomastia generally has the most profound effects on their socio-emotional development and psychological well-being. The emasculating nature of the condition can leave some young men with doubts about their masculinity and with low-self esteem. The third developmental stage in which gynecomastia is most prevalent is during old age, in which men experience decreasing levels of testosterone and skin elasticity.

Those considering gynecomastia correction should be aware that there are two dominant types of gynecomastia: true gynecomastia and psuedogynecomastia. Most cases are a mixture of both. True gynecomastia is generally characterized by enlarged glandular tissue, whereas psuedogynecomastia is typically described as excess adipose tissue. True gynecomastia is treated using excision of the gland, whereas psuedogynecomastia requires liposuction. Surgical incision is the most reliable treatment and provides the most consistent results. According to the literature, there is about 10-35% recurrence if using only liposuction and with excision only, there is about 10% recurrence. As most gynecomastia cases are a mixture of both, most surgeons use both techniques. The most common place for incision is in the lower pole of the areola and incisions usually no bigger than 1" and 1 ¾" at most. Surgeons need to judge how much to remove, too little could result in a recurrence, and too much glandular removal or too much thinning of the areola could result in a depression.

A number of companies also produce medications to combat gynecomastia, such as Gynexin and Gynexorol. Based on my experience having performed more than 6,000 gynecomastia surgeries, patients who have tried this have found that the results of this medication are often inconsistent, and are in general, not terribly effective.

Fortunately, due to the increased awareness of gynecomastia among both the public and plastic surgery community, many men have empowered themselves to seek out treatment. Due to the emasculating nature of this condition, many men find it difficult to discuss, but because of the information available, and growing awareness of the condition, the subject is becoming less of a taboo and more men are better able to advocate for treatment.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.


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