Men are keen on breasts… unless they start growing their own. Breast enlargement in men, known as gynecomastia, is a common occurrence amongst males of all ages.
According to Cape Town plastic surgeon, Stuart Geldenhuys, the reduction of male breast enlargement, (known as gynecomastia surgery), is ranked as one of the top five cosmetic procedures performed on men. Gynecomastia surgery, otherwise known as reduction mammoplasty, is the removal of excess glandular tissue or excessive fatty tissue in the male breast. In more severe cases removal of lax skin is also required.
Gynecomastia is the abnormal enlargement of one or both breasts in males due to the benign proliferation of breast glandular tissue. In some cases lactation / milk production may be present.
Pseudo-gynecomastia is a different condition distinguishable from gynecomastia in that it occurs in obese men and refers to enlarged breasts due to fat deposition, without glandular proliferation.
Gynecomastia on occasion must be differentiated from breast cancer, which is far less common and is typically unilateral.
How do I know if I have gynecomastia?
Gynecomastia, a male condition, is any growth of the glandular tissue in a male breast. Carefully feeling the area beneath the nipple areolar region, often by pinching the deeper tissue, will reveal a discreet area of thickening.
In some publications it is arbitrarily defined as a palpable sub-areolar gland or mass greater than two centimetres. In severe cases this area of thickening is larger and the chest looks more typical of a typical female breast.
Keeping it covered up
Men sporting a pair of enlarged breasts inevitably feel uncomfortable taking their shirts off in front of others, and may avoid certain physical activities and even intimacy, in order to hide their condition. Simple, everyday clothing choices are influenced by having gynecomastia, avoiding circumstances where the excessive breast protuberance is more evident.
In Dr Geldenhuys's experience, gynecomastia is a source of embarrassment, intense frustration and mental anguish necessitating modifications to many aspects of a patients daily routine and lifestyle.
Thankfully, gynecomastia surgery offers sufferers the opportunity to regain their confidence. Despite this, many men are too self conscious to seek assistance.
What causes breast enlargement in men?
There are a variety of reasons for the over-development of male breast tissue. Gynecomastia is a complex condition resulting from alterations in hormone levels, which act on breast tissue. Oestrogens strongly stimulate breast tissue development, while androgens inhibit breast growth.
Several explanations exist including attributing it to increased levels of oestrogen, too little free testosterone or the sensitivity of breast tissue to circulating hormones.
Physiological breast development can occur in three distinct age groups. It is estimated that in the perinatal period 60 to 90 percent of males at birth have some degree of breast development due to trans-placental passage of oestrogens.
At puberty, 50 to 60 percent of boys aged between 10 and 16 years may have some breast tissue growth but the true incidence, although not known, is thought to be less than five percent. This means that most pubertal gynecomastia resolves spontaneously and is usually not operated on. Unfortunately, it can have a negative impact on the personal image of adolescents and may lead to depression, so it should be monitored all the same.
The last age group which can experience breast development, the condition is called "involutional" meaning that it is caused in men due to falling androgen levels - typically when a man hits the age of 50.
Medications such as anti-anxiety medications, antidepressants, antibiotics, ulcer medications, anabolic steroids, androgens, growth hormones, the use of oestrogen creams, chemotherapy, certain heart medications and drugs prescribed for HIV, drug and alcohol abuse, can all influence the development of breast in men.
Street drugs such as marijuana, amphetamines and heroin, and alcohol abuse are also known to have some affect on the development of breast in men. Conditions that interfere or change normal testosterone production such as hypogonadism, hyperthyroidism, are also commonly associated with enlarged breasts in men.
Geldenhuys cautions that if breast enlargement was caused by the use of certain prescription medications, drugs including steroids or weight gain, the patient must be fully free from these substances and remain at a stable weight in order to maintain the results.
Kidney and liver failure, cirrhosis, injuries to the chest wall or spinal cord, genetic disorders and certain tumours have also been shown to be the underlying causes of enlarged breasts. Hormone-secreting tumor of the lung, or other organs may rarely be implicated.
Don't confuse it with breast cancer
The most important differentiation is between gynecomastia and breast carcinoma. Male breast cancer is rare but should not be missed. It is generally unilateral, does not necessarily occur behind the nipple, is hard or firm, and may be associated with skin dimpling, nipple retraction or discharge.
Getting a breast reduction
The first step in the clinical evaluation of gynecomastia is the elimination of any more serious underlying causes such as cancer. This will mean that the doctor will conduct a formal examination and if necessary, imaging tests to identify the cause.
Brace yourself, because tests for assessing liver function tests, kidney and thyroid function, blood testosterone, Luteinizing hormone (LH), Human chorionic gonadotropin (HCG) and oestrogen levels may also be required.
How is Gynaecomastia surgery performed?
Gynaecomastia is usually treated by a combination of liposuction and surgical excision. In cases of pseudogynaecomastia (known as excess fatty tissue), liposuction techniques alone may be used.
These procedures are usually performed under general anaesthesia or deep intravenous sedation and patients are generally not required to stay in hospital overnight.
"Liposuction involves inserting a cannula (a thin hollow tube) through a small two to three millimetre incision. The cannula, attached to a vacuum device, is moved back and forth, in a controlled motion to both mobilize and remove the excess fat. The liposuction also serves to contour the chest shape, further enhancing the overall result," says Geldenhys.
Surgery is employed in most cases of gynaecomastia. The specific technique used varies depending on the size of the breast or glandular tissue present and the amount of skin excess that needs to be removed. Where possible, the surgeon will confine the incisions to the areolar border to limit visible scarring.
Before and after…
You can expect a flattened natural male breast shape and enhanced chest contours specifically removing the appearance and stigmatization associated with the female breast. In most cases the scars can be concealed in the areolar margin or natural contours of the breast.
Whilst not typically a particularly painful procedure (return to work that isn't physically taxing after a week is usual) swelling does persist for many months and skin contraction and remodeling are required to attain the final result.
What are the risks?
Like any surgical procedure gynecomastia surgery carries its own risks but Geldenhuys emphasizes that complications are relatively uncommon, especially when the procedure is performed by an experienced surgeon.
"As with all procedures, bruising and swelling are to be expected from gynecomastia surgery, but it usually dissipates within two to three weeks following the procedure. Some patients also report itchiness and dry skin, especially around the incision sites. Post operatively scar management regimes including taping, topical creams and silicone are employed.
"It is not at all uncommon to experience discomfort and altered sensations in the breasts following the procedure. However, this is temporary and usually goes away after the operation."
The most common complications include hematoma (collection of blood) which may necessitate a return to theatre for drainage.
Gynaecomastia is typically asymmetric and as each side of the chest needs to be worked on separately; contour and shape irregularities may occur after gynecomastia. If this occurs, revision surgery may be required - but you'll only make that decision six months after your initial surgery.
All surgery leaves scars, some more visible than others. Although good wound healing after a surgical procedure is expected, abnormal scars may occur within the skin and deeper tissues. The amount of scarring usually depends on the extent of tissue to be removed. In the event that scarring is too prominent, many treatments are available to reduce their visibility.
Breast is not always best
The occurrence of enlarged breasts in men is increasing and its impact on self-image is not to be underestimated. Thankfully, gynecomastia surgery is a safe and effective solution to an embarrassing problem for many men.