All About Gynecomastia
Many men have gynecomastia --enlarged, female-like breasts--caused by excess glandular tissue or fat(or both).
Why Can Normal Men Develop Breasts?
The male chest has muscle, fat, and even little buds of breast tissue. In fact, if one were to squeeze a newborn baby’s nipples –even a boy – a couple of drops of milk can come out due to stimulation of the tissue by its mother’s hormones. So both men and women have this breast tissue, only in women the surge in estrogen during puberty causes it to grow into a full-fledged breast (but when it doesn’t, some women consider having a breast augmentation.) In addition to the buds of breast tissue, a man obviously also has some fat in his chest, and if that fat grows disproportionately to the rest of his body, it can also contribute to gynecomastia.
The raging levels of testosterone during puberty are always accompanied by an increase in the level of estrogen in every male. That is because testosterone production is not a perfect process; when the body makes a large amount of testosterone, some estrogen is also made. Likewise, even the most feminine women also produce testosterone. Testosterone is also converted into estrogen by fatty tissues, thereby increasing the growth of the breast buds on top of the additional chest fat seen in overweight young men.
It is said that over 80% of boys develop some degree of gynecomastia during puberty. That means that it is actually more normal to get it than not to get it. Usually it subsides as men enter their twenties, but for at least a quarter of them, some degree of gynecomastia persists. It can persist in any man, even the thin, healthy, and fit, but it is more common in boys and men who are or who have been overweight. Anabolic steroid use in weightlifters can also increase gynecomastia, as can heavy marijuana use. There is also a long list of prescription drugs that can cause gynecomastia.
That being said, the majority of gynecomastia patients have no identifiable cause. The bottom line is that it is so common that it is really a variation of normal and should not be a cause of embarrassment.
Psychology of Gynecomastia
Like starting to shave, the lowering of one’s voice, or developing an Adam’s Apple, a flat and strong looking chest is seen as a sign of masculinity. It is humiliating to have a chest that looks even the slightest bit feminine. Many women seek breast augmentation because they say, “I look like a boy and just want to feel feminine.” And though men never make the opposite statement – probably because the words are too hard to say – it is probably in the back of their minds. As shy as some flat-chested women are about men seeing their chest naked, they tend not to have the same level of shame or humiliation as do men with gynecomastia. It is very common that even men with the mildest forms of gynecomastia never want to take their shirt off, wear loose clothes over a tight undershirt, and spend time in front of a mirror pushing their chest back to make it look flatter.
Men are also much more hesitant than women to undergo plastic surgery in general, and gynecomastia surgery in particular. Perhaps they still believe in stereotypes that have long since been abandoned about plastic surgery not really being for men. Or they remain in some degree of denial about their gynecomastia, privately hiding their embarrassment, but not wanting to look the problem squarely in the eye.
Types of Gynecomastia Patients
Many gynecomastia patients are men who never lost the extra bit of puffiness they had on their chest during puberty. They may be fit or work out, but no matter what they do, they cannot see the outline of their pecs. Others may have taken steroids for weight lifting, and these steroids can cause a rapid growth of the breast tissue. In the case of weight lifting, usually there is a very firm marble or walnut that they can feel. Many others suffer from gynecomastia as a side-effect of prescription medications or recreational drugs.
Surgical Options
There are two methods for treating gynecomastia: liposuction and excision. In the pre-liposuction era, the only thing to do was to cut out the tissue (“excision”), usually using a small incision around about half the diameter of the areola. This worked great when there was a small and well-demarcated and circumscribed gynecomastia mass under the areola. But it didn’t work well when there was fat spread throughout the chest. Liposuction is ideal for the reduction of fat, because fat is soft and is easily removed through the liposuction instrument (much like a straw.) However, firm and glandular gynecomastia issue cannot be removed by liposuction; it needs to be excised.
