Gynecomastia (Male Breast Reduction)

By Mordcai Blau, M.D. & Ursula Strauss, Ph.D.

Not so long ago, it was taboo for anyone to utter the word breast out loud. Whenever breasts came up in a conversation, vulgar synonyms were uttered, perhaps in an effort to mask the eroticism women’s breasts evoke in our culture. Teenage girls, embarrassed when their bodies blossomed, could be seen rolling their shoulders forward to camouflage their burgeoning breasts. Nowadays, it has become more commonplace to use the proper terms for these female secondary sex characteristics, and rather than hiding their female endowments, the fairer sex is taking pride in them and is even seeking to enhance then in various ways.

Women’s Self-Consciousness Gives Way to Consciousness-Raising
With the eventual loosening of censorship in the media, female celebrities have been flaunting their implant inflated breasts and telling us all about it. Frank discussions in magazines and on television talk shows have brought the subject of women’s breasts out of the Victorian Age and into everyday conversation. Women have succeeded in shedding their self-consciousness about having breasts and now take pride in them, even in public. With their consciousness raised and thrilled by prospect of overcoming their own genetic shortfalls, many a woman has included breast augmentation in her personal makeover. And all this, with the general societal approval.

Men’s Self-Consciousness Comes to Light
But, what about men who find themselves sporting one or more unwanted breasts? Male psyches equate breasts with female sexuality, not withstanding the fact that as many as 40-50% of males suffer from a condition called Gynecomastia, the medical term for women-like breasts.

A teenage boy or adult male burdened by unwanted breasts typically feels like a freak, is sometimes confused about his masculinity, and frequently suffers from social embarrassment and emotional distress. Understandably, such self-consciousness can also put a wet blanket on intimacy with members of the opposite sex.

Whether he calls them breast or gives them some other more vulgar label, for a male who develops them on his own chest, self-consciousness and obsessive thinking become the order of the day. Unlike women who seek to enlarge their breasts and are happy to show them off, men with gynecomastia only desire to be rid of them and often withdraw to avoid exposure. Yet, in spite of their anguish, these men and boys “don’t want to talk about it.”

The Cover-Up
As common as this condition is among males, magazine editors and television talk show hosts have not picked it up and run with it as they have the silicone solution for females. Such media indifference might be explained by the fact that breasts on a male body do not make up for a sexy story. Anyway, males with gynecomastia are intent upon keeping the problem, literally, under wraps.

Men with gynecomastia work overtime to camouflage the unwanted protrusions: they wear several loose shirts in layers even in hot weather and avoid social activities that require baring their chests. Consciousness raising has given “the ladies” a boost for their self-images. Women are now aware that they have a right to improve their breasts and they do it. The same kind of education is needed for men with gynecomastia before they are ready to help themselves.

Consciousness-Raising through Knowledge
Step One for the solution to this male problem is for them to learn about it: its prevalence, its causes and its remedies. This would induce them to view their unwanted breast development as the common male condition that it is, rather than as a freakish anomaly. Then a visit to the physician would more than likely be their next move.

Parents of male teenagers and adult men need to know that about half of all males develop gynecomastia in either one or both breasts. The condition may arise in boys as young as twelve years of age, when their sex hormones are beginning to shape their adult sexual characteristics and may temporarily go awry. In such cases, physicians generally recommend that nothing be done until a young man reaches 17, anticipating that by then it will disappear.

The Case Study of a Young Teenager
In spite of the boys youth, the embarrassment he experiences from taunting classmates and the social isolation he is likely to self impose, sometimes make early surgical intervention for gynecomastia a necessity. Dr Blau, who has performed hundreds of operations for gynecomastia, recalls such a case. A 15-year-old from Scarsdale was enrolled in an exclusive prep school where he proved to be an outstanding athlete. His tall and wiry stature made him a skillful football player; yet, after a few months he refused to take part in the sport and became despondent. His parents were alarmed at what seemed to be a sudden change in their son. Then the young man told them about the embarrassment and torment he had been experiencing in the locker room on a daily basis. He said that he could no longer take the jibes from his teammates about his “tits.”

The boy’s parents consulted with the plastic surgeon. The physician suggested that, although their son was still quite young, the best course of action was to surgically remove the boys‚ excess breast tissue. The 15-year-old returned to school within several days after surgery and happily rejoined the football team within several weeks. Had his parents waited to take action, a more complex series of psychological and social problems could have ensued.

Consciousness Raising is a must for Males with Gynecomastia
There is an urgent need for consciousness raising for both the victims of gynecomastia and for their important others. Embarrassment and fear of rejection can keep them frozen in their misery, perhaps for a lifetime. What’s more, avoiding treatment can lead to other, more serious physical, emotional, and social complications. That is why the television and print media need to educate the public about this silent, but distressing condition in males.

Men need to know that once its causes have been identified, gynecomastia can sometimes be reserved with a simple change of diet or the elimination of certain drugs. In most cases, any residual breast tissue can then be surgically removed with a little visible scaring. Since men compared to women, have been shown to be more sensitive about chest scars, it is vital that only an expert Board Certified plastic surgeon with significant experience with Male Breast Reduction – Gynecomastia be consulted for this procedure. During the consultation, extensive medical histories will be taken, a number of tests made, causes identified, and recommendations for treatment offered.

Obesity As a Cause of Gynecomastia in Male Adults
Women-like breasts can develop in men for a variety of reasons, not the least of which is obesity. In obese men with gynecomastia exercise and weight loss are recommended as a first course of action. A regimen of diet and exercise for obese men can sometimes reduce the pseudo gynecomastia (fatty, non glandular breast tissue) to reasonable portions.

An obese young physician presented with pseudo gynecomastia. His breast size was the equivalent of a “C” cup in a woman‚s bra size. His resulting weight loss after dieting and exercise had left unsightly flabbiness, which required surgical correction. His plastic surgeon removed enough of the remaining fatty breast tissue to induce the breast nipples to shrink and disguised the surgical scars around the man’s nipples.

Another formerly obese patient, a chiropractor, presented with sagging breast tissue after successfully losing a great deal of weight. Dr. Blau used a special surgical technique to improve the appearance of the man’s chest, making an inverted, “T-shaped” incision that leaves little visible scarring.

Anabolic Steroids As the Culprits
The goal of a body builder is to compete with other men for the best male physique. They often use muscle-building hormones to enhance their chances of winning. But, many an athlete has developed true gynecomastia, mammary glands in one or both breasts, as a result of steroids. Ironically, this women-like endowment then leads to disqualification from competition. Dr. Blau, a Westchester based plastic surgeon reports that he performs surgery on more than 40-50 body builders each year, all of whom had developed unilateral or bilateral glandular breasts due to their habitual use of anabolic steroids. The United States and Canadian body builders champions have been among his patients.

Gynecomastia & Excessive Drinking & Smoking
Smoking marijuana and drinking alcohol in excess can also produce glandular breasts in men. The obvious first course of treatment is to eliminate the offending drugs. Then, ninety percent of the underlying breast tissue is removed, using a surgical technique that discourages new glandular breast growth, should the patient resume his offending drug habit.

Some Other Causes of Women-Like Breasts
A theory has been proposed in some scientific circles that the use of estrogen to stimulate weight gain in farm animals such as chicken and cattle has caused more cases of gynecomastia among teenage boys and men than ever before. Seeming to bolster this theory, it has been shown that prescribed estrogen-containing medications can have that same unpleasant side effect. The prolonged use of aspirin, digitalis, and many other medications has also been implicated in the production of excess breast tissue among men. In each case, when specific substances are determined to be the cause, the plastic surgeon eliminates them from the patient’s regimen and surgically removes the unwanted gynecomastia.

Quick Solutions for Long-Suffering Men
Surgical procedures related to gynecomastia are often done in the plastic surgeon‚s medical office surgical suite, which has been certified by The Joint Commission on Health Care Organizations. Most procedures for gynecomastia take about 1-1/2 hours, preferably with a Board Certified Anesthesiologist on board.

After surgery, heavy work is not recommended for at least seven days. Recovery is usually swift, with about three days of down time. There is usually little discomfort, but pain medication is available, if needed. This surgical procedure ranges in cost, from $5,000 to $8,000.

Why Should Men be Different?
Just as every woman has the right to enjoy her femininity, so every man should be able to revel in his masculinity. Like women who have been taught to own their right to self-improvement, men need reassurance that they have the right to make their bodies more congruent with their chosen sexual identity.

Education about women-like breasts, its causes and treatments, should be given the same media attention as have female breast underdevelopment and augmentation. More knowledgeable victims of gynecomastia will take personal responsibility for correcting this ego-busting condition. Then, at least 50% of the male population will have a better shot at a happy life adjustment. Men should be different from women, not from other men.

Dr. Ursula Strauss is a psychologist in private practice in Riverdale. Dr. Mordcai Blau is a Board-Certified plastic surgeon in White Plains.