Current treatment for enlarged male breasts (gynecomastia)
Gynecomastia (“man boobs”) is a condition in which the fibro-glandular structures centered under the nipple areolar complex on men may result in a wide range of enlargement deformities. Many males find that it occurs around puberty and will persist despite maintaining ideal body weight and good exercise habits. Certainly the enlargement can be made worse with excessive weight gain. Men may also experience new onset of this condition any time during their life time. Medications may potentiate gynecomastia such as exogenous testosterone replacement due to the fact that testosterone can be converted in fat to estrogen particularly if the testosterone levels are in excess of normal values. Some have argued using an estrogen blocking agent at the same time as giving testosterone if men developed increased in breast size. With legalization of recreational marijuana in many parts of this country there will undoubtedly be an increase the incidence of gynecomastia due to marijuana’s potentiating effect on male breast size. Older gentlemen may also experience increase in breast size as natural hormonal changes occur resulting in an increased estrogen/testosterone ratio leading to this deformity. In my practice I commonly see a full spectrum of ages ranging from young teenage boys who are embarrassed to go shirtless or wear tight fitting shirts to twenty somethings who participate in cross-fit and body building but still see an enlargement of their breasts that detracts from their well- earned physique, and finally men who had been overweight and have lost weight either from bariatric surgery or lifestyle changes and desire to eliminate a large amount of excess skin on the breast and chest region to regain a healthy masculine appearance.
Treatment options for gynecomastia
As with any deformity that has a wide spectrum of presentations the treatment varies as well. For the male who has excellent skin quality with minimal or no stretch marks and a normal nipple position with respect to the chest wall and has enlargement of the breasts, these are excellent cases for suction assisted lipectomy with an additional energy source such as an oscillating motor (PAL – Power Assisted Liposuction) or ultrasonic energy. The reason regular liposuction has limitations is that the male breast has lots of fibrous tissue encasing fat and glandular elements which help to tether the overlying skin to the chest wall to keep the tissue from excessive movement. Regular cannulas utilized in liposuction cannot break up and penetrate this tissue to extract the fat and glandular elements effectively nor can it release the fibrous tissue to allow for re-draping of the skin for a smooth contour postoperatively. Either ultrasonic energy or the oscillating motor in conjunction with liposuction provides the ability to breakup this tissue to both extract tissue and provide smooth contours. However, I have found that even after aggressive liposuctioning of the area, at least twenty five percent of patients require me to make a peri-areolar incision to perform direct resection of the residual fibro-glandular tissue under the areola to provide an ideal appearance. My experience with men who have enlarged areola (nipple) diameters is that with skin retraction after liposuction, the size generally contracts eliminating the need to surgically reduce the areola diameter such as a mastopexy (breast left) technique thus avoiding risk of scaring.
I have seen a number of teenage boys who are overweight and have loose skin, breast tissue herniating into the areola with the nipple-areola complex hanging down creating a matronly appearing female breast. This deformity requires not only liposuction but at least a peri-areolar mastopexy technique to reposition the nipple complex and reduce the areolar diameter to achieve a more masculine appearance.
Gynecomastia is a fairly common condition and many men find that it detracts from their appearance and leads to self-confidence issues. Fortunately surgical treatment can be very easy and effective to achieve wonderful, very natural results. Please consult a board certified plastic surgeon to discuss gynecomastia repair – there is no need to cope with this disfigurement.