Man-boobs. Moobs. B*%ch tits. As the crude terms that are used to describe it suggest, gynecomastia can have a profound impact on a man’s self-esteem. We asked the doctors about what causes the condition, and how it can be treated.
What is gynecomastia?
Gynecomastia is a disorder of the endocrine system that creates a swelling of the male breast tissue. It can affect one or both breasts, and stems from testosterone and estrogen hormonal imbalances.
The condition is mainly found in infants, adolescent boys and older men. Accordingly to the Mayo Clinic, the prevalence of gynecomastia peaks between the ages of 50 and 80 as a result of normal changes in hormone levels – at least 1 in 4 men in this age group are affected. It can also be the side effect of certain drugs and medications, namely among bodybuilders and other athletes who use hormone-based performance enhancers.
What is male breast reduction surgery?
Although a number of estrogen-blocking drugs are sold as cures for gynecomastia, none are approved for that purpose by the Food and Drug Administration (FDA). Surgery remains the most effective treatment for male breast enlargement.
The procedure’s popularity has surged in recent years. In 2015, men made up 40% of breast reduction surgeries (a 35% growth in the past 15 years), according to the American Society of Plastic Surgeons. There are two types of cosmetic surgery for gynecomastia: one is liposuction, which targets excess breast fat tissue while leaving the underlying breast tissue intact. The other is mastectomy, which involves the removal of breast gland tissue through small incisions over the side of the breast, in the underarm or near the areola.
It requires a masterful surgeon to remove the excess fat and glandular tissue. Explaining the procedure in layman’s terms, Dr. Gilbert Lee, a triple board-certified plastic surgeon in San Diego says, “This surgical procedure is most often performed using liposuction. In extreme cases, skin can be removed as well. Because the fat is permanently removed from the area, the results are permanent. The result is a flatter, firmer and more contoured chest.”
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What is the pre-operative experience like?
Dr. Rick Silverman is a Boston-based board-certified plastic surgeon who specializes in diseases of the breast in both men and women. He has also written several articles on the treatment of gynecomastia in bodybuilders. He gives these pre-surgery suggestions to his patients:
• Medication or supplements that can cause excessive bleeding such as aspirin or fish oil should be avoided.
• Some patients are encouraged to lose weight prior to surgery.
• Smokers should quit. For routine gynecomastia surgery, this is less critical than those cases which require skin removal, where smoking can compromise blood supply to delicate skin flap.
• Shaving is not required except around the incision site, on the nipple in most cases, unless extensive skin removal is required.
• Gym rats can work out up until the day of surgery.
Gynecomastia surgery recovery
Dr. Silverman says patients are usually up and mobile less than 24 hours after surgery. Most will have some discomfort in the early post-operative period and may use a narcotic for pain relief for a few days, and then at bedtime for a few more days to help with sleep, but rarely do they experience significant pain past a week.
Depending on their occupation, many patients can return to work after only a few days off. Those who do any sort of manual labor may have to take time off from work until they’ve recovered enough to safely resume strenuous activity.
As for exercise, Dr. Silverman stresses that all surgeons have their own approach. “I allow my patients to resume low-impact cardio activity after a week. They may resume weight training after two weeks, avoiding overhead maneuvers for the first week back, and no chest until a total of four weeks have passed.” Within four to six weeks, nearly all patients are able to go back to all normal activities.
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Does gynecomastia surgery leave scars?
Board-certified Miami-based plastic surgeon Dr. Adam J. Rubinstein says scarring is one of the top reservations men have when considering gynecomastia surgery. Yet, there is no need to worry.
“In my experience, 80% of cases can be improved with liposuction alone. Liposuction leaves very small discrete scars about the size of a grain of white rice,” says Dr. Rubinstein. “In the other 20 percent of cases, a small incision is made along the edge of the areola to allow access to remove the excess abnormal tissue.” This scar follows a natural line and is barely visible when fully healed.
How much does male breast reduction surgery cost?
Like every plastic surgery procedure, costs vary depending on the doctor, region and complexity. Under standard medical circumstances, it can range from $5,000 to $8,000.
These testimonials from men who underwent gynecomastia surgery offer examples of how transformative the procedure can be.
“I was very uncomfortable with my appearance since adolescence. After being mistaken for a girl when I was maybe 13 or 14, I spent the next decade and a half always wearing loose clothing. I wore a sweatshirt to school all through high school.
Several years after college, I found out I could have surgery and did it. It was life-changing. I became comfortable with my appearance. I would imagine this is common for all sorts of appearance changes. The difference is, in my opinion, that a big nose or a giant mole may be unattractive but otherwise benign. Nobody questions your gender or renders an opinion on anything else other than that one thing.”
“I went through with the surgery just a few days ago. It was my first time under general anesthesia so I was a bit anxious about it, but the doctors and nurses were excellent and made me feel very comfortable. The surgery was over in an hour (I don’t remember a thing), and I was awake and out the door after 30-45 minutes of recovery from the anesthesia. They gave me diazepam and hydrocodone to reduce the pain and help me relax and sleep for this week while I recover.
The total cost of all appointments and my surgery was just under $6500. However, I can already state that it’s worth it. I still have some moderate swelling and some gnarly looking bruises, but the flatness of my chest is already 90% better! In a few weeks, I am going to get back into running to lean up and will work on more chest exercises once I’m fully healed. In the meantime, I have to wear a compression vest, which is moderately annoying but not too uncomfortable.
Even at this early stage post-surgery, I am very happy with my results. I would really encourage any guy dealing with gynecomastia issues to go see a doctor. In some cases, it can be addressed through hormonal treatments without surgery. Even if it requires surgery, I think it is worth it for the benefit of feeling comfortable in my body.”
– tofur99 (source)
“After surgery it’s pretty surreal, taking the binder and under armor shirt off and seeing this flat small contoured chest staring back at me. My drive to lose all excess fat is very strong now, I’m already planning out the next year-15 months in terms of weight loss and muscle gain, feel so freed up now that I’m not having to work around the gyno, there’s no point in time where too much muscle or too little fat or any combination thereof will make me look ridiculous and self conscious anymore, it’s just full steam ahead.
My chest is just so damn flat, it’s changed the appearance of my whole upper body in a huge way, shirts hang so nicely off my shoulders that now the problem area is my stomach, which isn’t even that big.
I urge anyone who has gyno and is considering surgery to fu$*ing do it, scrape together the money, find the best gyno-specialized plastic surgeon you can and get it done. Life is too short not to, I’m 26 and wish I did this when I was 17-19. The self consciousness/low self esteem/lack of confidence never goes away.”