I take care of more women than men with issues related to their breasts, just as more attention is given to women’s breast issues in our society. We have Breast Cancer Awareness Month and Breast Reconstruction Day as we should, but men too have issues with their breasts/chests. Although these are generally not life-threatening problems (male breast cancer can occur, but the risk is about 100-fold less than for women), male breast concerns certainly can be life-altering.
The issue here is gynecomastia, or male breast development and it affects up to 60% of males in our population. While there are some factors that can contribute to this, such as anabolic steroid use, excessive marijuana use, and certain prescription drugs, the majority of cases happen with no apparent underlying cause. I have seen jokes about “man boobs” in several TV shows and movies. Betty White’s appearance on Saturday Night Live was one of the most notable examples. Believe me, if this affects you it’s no laughing matter. It’s for real and a real problem.
About Male Breast Development
For most individuals gynecomastia begins in the teen years when an adolescent male goes through puberty. The amount of enlargement can increase with weight gain, but generally the size of the breast mass is unaffected by weight reduction or level of fitness. It’s just always there. For some the amount can be very little with just some fullness under the nipple areolar complex. In others it can look like a fully-formed female breast. For the unluckiest there can be full breast development, as well as sagging of the breast tissue and skin.
Recent studies have shown the intensively negative psychological affect this can have in young men on both their self-esteem and sexual identity. I can remember growing up as an adolescent intensely aware of what my body looked like compared to my peers, especially during sports, and in the locker room. I cannot imagine how difficult these settings are for men with severe gynecomastia. The adolescent passage is hard enough without this added burden. It’s not just developing males that struggle with this – it’s adults as well. Men I see with gynecomastia are reluctant to take their shirts off at the beach, on family vacations, or wear compressive shirts to conceal the breast fullness.
Options for Treatment of Gynecomastia
As difficult as this condition is, the good news is that we have some very effective treatments for it. Most involve surgery, and what is done depends upon the type of breast development that a man has. In normal breast tissue there is a combination of both fat and denser breast tissue. In some there is also skin looseness that must be addressed. If the only issue is fatty tissue, liposuction alone is quite effective. There are even a few men who can be managed with CoolSculpting, or non-invasive fat reduction.
The majority of men also have some denser breast tissue which cannot be removed with liposuction. In most cases this tissue can be removed with a small incision at the base of the areola, leaving a fairly well concealed scar. For men who have excess skin that must be removed, there will be additional scars. Certainly men with considerable hair growth can conceal these scars better, but there are still some scars for some men. However, I have had very few complaints about the scars given the degree of improvement that can be achieved with these surgeries.
A Weight is Lifted that is Greater than the Tissue Removed.
What is so gratifying is the effect that correction of gynecomastia can have on how men feel about themselves. Sometimes patients can be quite emotional as a huge burden they have carried all their lives is removed. It is very freeing, and in fact, life changing for those with the most severe cases. Despite any scars, most men are extremely happy with the shape of their chests, the improvement in their self-esteem, and their new found freedom in terms of lifestyle and activity.
When a man who has been bothered by this all his life has the courage to come in and talk with me about this, I feel a great responsibility to be sensitive to his journey, and to work with him to find a good solution to the problem. If you are a man who is similarly affected, know that you have options. When you are ready, seek out a Board-certified Plastic Surgeon who can help you remove this burden from your life.
No joke, we can help.
All the best,
David B. Reath, MD