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How Age Can Affect the Development of Man Boobs

Gynecomastia is defined as a condition in which glandular breast tissue becomes enlarged in boys or men. In some cases, this condition can go unnoticed. However, for some patients, gynecomastia can cause pain and discomfort. Social repercussions may involve a decrease in self-confidence because of the enlarged male breast’s unsightly appearance.

Dr. Babak Dadvand understands how “man boobs” can negatively affect a person’s well-being. As a board-certified plastic surgeon who specializes in gynecomastia surgery, he has helped hundreds of men reclaim their confidence in his Los Angeles facility. He understands that men are typically reluctant to talk about their man boobs at first, which is why he makes it a point to make them feel at ease by taking them through each aspect of this condition.

Hormonal imbalance is the most common cause of gynecomastia. Other risk factors include the use of certain drugs (anabolic steroids, anti-depressants, H2 receptor blockers, etc.) or preexisting disease conditions that affect hormonal balance such as hyperthyroidism, kidney failure, or low testosterone levels.

Age and Gynecomastia

With hormones being the primary cause of gynecomastia, it is not surprising to learn that this condition can occur in puberty or mid to late in life.

Up to 70% of adolescent boys experience a form of gynecomastia with 25% of cases lasting until adulthood. Puberty is when both men and women experience a surge in hormones. Contrary to popular belief, both men and women have estrogen and testosterone in their bodies.

The only difference is the predominance of one hormone over the other with testosterone being the primary hormone present in men. Gynecomastia occurs when there is a shift in the hormonal balance, with an increase in estrogen or a decrease in the level of testosterone in the body.

Gynecomastia also occurs in up to 70% of older men. With this age group, gynecomastia can be drug-induced. In some cases, simply stopping or switching to another drug can reduce the symptoms. However, some drugs cannot be stopped due to their importance in maintaining one’s quality of life.

For example, patients who are taking anti-androgen drugs for prostate cancer cannot stop this drug just on the basis of developing man boobs.

Gynecomastia in the older male population may also be classified as idiopathic or without a direct cause. Experts speculate that the decline in testosterone levels at this stage may be the main culprit for the development of gynecomastia.

Gynecomastia Treatment in California

Whatever the cause, there is something to be done about this condition. Before considering surgical intervention, it is important to distinguish gynecomastia from, for example, breast enlargement due to fatty deposits.

Dr. Dadvand will conduct a thorough assessment of your condition and may order some tests to check your hormone levels. Once Dr. Dadvand determines if you in fact have gynecomastia, he will then discuss your treatment options.

Book an appointment with Dr. Dadvand at his facility located in the heart of LA and regain your confidence today.

Behind the Scenes: Steroid-Induced Gynecomastia

 

“So I just finished this gynecomastia surgery – large excisions! This is steroid-induced gynecomastia and you can see this tissue here – really thick! This was never going to come out with liposuction. It took a very meticulous dissection but he’s going to have great results, there’s a big difference in his chest already.”

This video shows the results of gynecomastia surgery in a patient who cycled steroids. Steroids are one of the most common causes of gynecomastia, or increased breast tissue in men. The surgery requires meticulous dissection to remove most of the breast tissue and restore a masculine chest contour. Liposuction generally does not work for this type of gynecomastia!

5 Questions You Should Ask Your Plastic Surgeon Before Gynecomastia Surgery

Certain questions come up over and over again during consultations for gynecomastia. Because of this I decided to list five of the most frequent with their answers. They are in no particular order.

  1. Q: What causes gynecomastia?
    A: There are many causes of gynecomastia from anabolic steroid use and underlying hormonal imbalances to genetic links, liver disease, and certain medications. However, one of the most common causes is idiopathic, meaning there is no actual cause. Most men who fall into this category noticed it during puberty. Some studies show up to forty percent of boys going through puberty can have increased breast tissue growth. Now, the vast majority of these cases resolve on their own in a few years but the rest of these men will go on to have persistent gynecomastia.
  2. Q: What are the surgical options for treating gynecomastia?
    A: There are fourth things that determine the best surgical technique: Is there excess breast tissue, is there excess fatty tissue, is there excess skin, and what is the nipple position? Depending on how many of these factors are present determines the best technique. For breast tissue, excising the tissue is the best treatment as liposuction will not remove breast tissue. For fatty tissue liposuction is the most effective technique. If there is excess skin or low nipple position, then further incisions would need to be made to address these in addition to the breast and/or fatty tissue.
  3. Q: Are there any non-surgical treatments that can effectively treat gynecomastia?
    A: There are studies looking at the use of Tamoxifin or Clomid, medications that block estrogen receptors, in treating gynecomastia. However, the degree of reduction is in the size of the breast tissue was variable from patient to patient and in some cases it recurred when coming off of the medications. In addition the medications are associated with side-effects such as mood swings, decreased libido, nausea, vomiting, diarrhea, and even some more serious side effects like stroke and seizures.
  4. Q: Can the gynecomastia come back after surgery?
    A: As long as there is no change in your hormone balance, the gynecomastia should not come back. Using steroids or developing some type of hormonal imbalance (either due to medications or endocrine disorders) after surgery can result in a recurrence.
  5. Q: What is recovery like after the surgery?
    A: The surgery is an outpatient procedure. Most patients will take 4 to 5 days off from work. Most patients have minimal to mild pain but moderate to severe pain is rare. Most patients will need to take four to five weeks off from strenuous activity but walking and light activity is strongly encouraged from the outset.

Male Breast Reduction: The Rising Popularity of Plastic Surgery

As a board-certified plastic surgeon specializing in gynecomastia surgery, I have seen a greater emphasis on male plastic surgery over the last five years. In the past plastic surgery was viewed by many as something mainly women or celebrities would get. As plastic surgery, not to mention plastic surgeons, were thrust into the spotlight of television shows and magazine articles, the public’s views on plastic surgery began to shift. There is an increase not only in the number of surgeries performed year after year but also the level of openness that people have in discussing their surgery.

Gynecomastia surgery has gained a significant amount of traction as a popular procedure in plastic surgery over the last few years. The leading reason behind this is education. In the not too distant past many felt that having enlarged breasts was a result of being lazy, not doing the right workouts, or eating poorly. With education both online and in doctors’ offices, the general public is beginning to realize that gynecomastia is a medical condition and not the result of poor eating habits or exercise habits. This, coupled with the fact that there is a safe and effective surgical treatment of gynecomastia, has led to the year on year increase in men undergoing this surgical procedure.

In addition to this, surgery is a very effective treatment for gynecomastia with very little pain and minimal time off from work. The chance of recurrence of the breast tissue is also exceptionally low. It is one of the few plastic surgery procedures that can have life-long results. This is in contrast to some surgeries, such as breast implantation, where the implant will need to be replaced at some point in the future.

GYNECOMASTIA AND STEROID USE - Before and After Photos

Why Your Workouts Aren’t Working for Your Man Boobs

One of the most common things patients tell me during the consultation for gynecomastia is that they tried to exercise in hopes of melting the tissue away. The fundamental flaw in this reasoning is that while exercise may have an effect on fatty tissue, it has no impact on reducing breast tissue. In every male chest there is two types of tissue between the skin and the pec muscle: fatty tissue and breast tissue. True gynecomastia is due to excess breast or glandular tissue. Pseudo-gynecomastia is due to excess fatty tissue but normal amounts of breast tissue.

Many patients tell me that they have tried everything from increasing their cardio workouts to various pectoralis workouts. While they may have seen a slight reduction in the size of their chest if they lost weight, the puffiness and overall feminine shape of the breast was still the same. In some cases, doing heavy pectoralis workouts would actually make the gynecomastia appear worse. The reason for this is that the breast tissue is sitting between the muscle and the skin. Workouts that target the pectoralis muscle will lead to the muscle increasing in size and in effect pushing the breast tissue outwards. While exercise can treat pseudo-gynecomastia, it will not be effective for true gynecomastia.

It is easy to understand the frustration a lot of men have when they are spending this increased time in the gym only to see their gynecomastia looking worse. Many men just stop exercising at this point and resign themselves to forever being dissatisfied with their chests. My suggestion to these men is to not get discouraged and to continue working out. Continue to maintain an active lifestyle and good eating habits. Surgery can fix the gynecomastia.

The Top 5 Myths About Man Boobs

These are my top 5 myths, or misconceptions, about gynecomastia in no particular order.

  1. MYTH: Gynecomastia is due to laziness, lack of exercise, or poor diet.
    FACT: Gynecomastia is not due to being overweight or having too much fatty tissue in the breast. True gynecomastia is a medical condition that is a result of having too much breast tissue. There are many causes, from hormone abnormalities to medications and steroids but a large group of cases have no known cause. Most of these patients develop gynecomastia during puberty, a time where there is a lot of hormone fluctuations.
  2. MYTH: Exercise will cure gynecomastia
    FACT: Since gynecomastia is due to an increased amount of breast tissue, exercise will not fully treat this condition. If there is excess fatty tissue then exercise can lead to a slight decrease in the size of the chest. However, the overall feminine shape is likely to remain. In an effort to rid themselves of gynecomastia, men do a variety of pec workouts. Because the breast tissue sits on top of the pec muscle, building up the pecs will only push the tissue forward and make the gynecomastia more noticeable.
  3. MYTH: Topical creams and supplements will cure gynecomastia
    FACT: There are no creams or supplements that will treat gynecomastia. The fact that supplements and homeopathic remedies do not have to answer to the FDA, they can state a lot of claims as to the efficacy of their products. The only thing supplements and creams will decrease is the size of your wallet.
  4. MYTH: Gynecomastia is purely hereditary.
    FACT: While there may be a role of genetics in developing gynecomastia, most men with gynecomastia have no family history of it. Many men develop gynecomastia during puberty, but a large percentage of these cases resolve after several years. In other men, there is a known cause, like steroid use, endocrine disorders, or liver disease.
  5. MYTH: 100% of the breast tissue has to be removed to treat gynecomastia
    FACT: Every case is different and so if all of the breast tissue is removed in every patient, there will be a number of patients who will have crater deformities. A crater deformity is when too much tissue behind the areola is removed leaving insufficient support. There needs to be some tissue under the nipple and areola to give it support and avoid it from sinking in. This is where the surgeon’s experience comes into play.

5 Things to Ask Yourself if You Think You Have Gynecomastia

As a board-certified plastic surgeon specializing in gynecomastia surgery, I ask patients certain questions during a consultation. This helps me try and figure out whether someone has gynecomastia and what the cause may be. Below is a list of 5 questions you should ask yourself if you think you have gynecomastia.

  1. When did I first notice it? If the answer is during puberty then you may have what is called physiologic gynecomastia. This occurs in up to 60% of males going through puberty. Although it gets better after 2-3 years in most males, in 2% of males it does not.
  2. Am I taking any medications? There is a long list of medications that can cause gynecomastia, from anti-depressants to heart medications to pills that grow hair.
  3. Do I or have I used steroids or testosterone boosters? This is a common cause of gynecomastia. The reason why steroids can cause gynecomastia is because the body will convert the excess testosterone you are injecting or swallowing into a secondary estrogen, which will then stimulate the breast tissue you have in your chest. Gynecomastia can occur even if you take estrogen blockers during or after a cycle.
  4. Does anyone in my family have gynecomastia? Gynecomastia may have a genetic component. Although not a common cause of gynecomastia, genetics can play a role.
  5. Is it getting bigger? If it came on during adulthood without any medical history or medication use, AND it’s getting bigger, you need to make sure the tissue is benign. This is done with a mammogram or ultrasound. Although the risk of breast cancer is extremely low in males, in certain cases it needs to be ruled out with an exam.

If after asking yourself these questions you feel you have gynecomastia, then seek consultation with a board-certified plastic surgeon who specializes in gynecomastia surgery.

To learn more about gynecomastia surgery and to see before and after photographs, visit www.losangelesgynecomastia.org.

Nipple Repositioning and Skin Excision: When is it necessary?

As a plastic surgeon specializing in gynecomastia surgery, I come across chests of all shapes and sizes. Gynecomastia can present in a variety of ways, from small glandular firmness under the nipple to full-on breasts with ptosis, or droopiness. For most gynecomastia cases, removal of the excess tissue, whether it is with excision, liposuction, or both, is enough to get the ideal contour. This is because the skin tends to tighten and re-drape over the deeper muscles.

However, in certain cases just removing the excess tissue is not enough to obtain the ideal contour. This is the case in males who not only have excess tissue, but also excess skin and nipples that are too low on their chests. In these patients, if the nipple position and skin excess are not addressed, simply taking out the excess tissue will likely leave them with a deflated and looking breast with sagging skin and nipples.

In these specific cases it is necessary to reposition the nipples to a normal location as well as remove the excess skin. This can be done by leaving the nipple on a base of breast tissue while removing the rest of the tissue around it and removing the excess skin. Another option is to remove the nipple and areola, excise all of the excess tissue and skin, then place the nipple and areola as a free graft in the appropriate position. The advantage of the first technique is that it may have a higher chance of maintaining nipple sensation and projection, but the disadvantage is that there will still be some fullness under the areola because of the tissue that needs to be left behind to provide blood supply to the nipple. The advantage of the free graft technique is that it will give the flattest contour with the disadvantage being numbness of the nipple, possible loss of nipple projection, and possible areolar depigmentation.

However, when the gynecomastia is severe with loose skin and low nipples, this is the best technique to perform. I always advise these patients that they need to be okay with the incisions necessary to obtain the results they are after. If they are not willing to accept the incisions, then they should not have gynecomastia surgery.

Before and After Photos: NIPPLE REPOSITIONING

To learn more about gynecomastia surgery and to see before and after photographs, visit www.losangelesgynecomastia.org.

Can Creatine Cause Gynecomastia?


As a plastic surgeon who specializes in gynecomastia surgery, I come across this question quite frequently in my consultations. Any male with gynecomastia who has been on forums may have come across this question as well. In light of this there have been some articles in the media that have even served to support the fact that creatine can cause gynecomastia.

To answer the question of whether creatine can cause gynecomastia, we need to first understand what creatine is. Creatine is an organic acid that helps provide energy to every cell in the body, and especially to skeletal muscle. It is made naturally in the body by the combination of 2 amino acids, arginine and glycine. It is a commonly used supplement in people who wish to gain muscle mass. Taken in excess, creatine can have adverse effects on the kidney and liver. However, multiple studies have shown that taking between up to 20 gm/day is safe. And more to the point of this post, there is not a link between creatine and gynecomastia.

Creatine - Monohydrate

To learn more about gynecomastia surgery and to see before and after photographs, visit losangelesgynecomastia.org.

Hard Lumps After Gynecomastia Surgery

As a plastic surgeon specializing in gynecomastia surgery, I spend a lot of time answering patient questions through emails and various internet forums. One of the most common topics of conversation is feeling firm lumps after surgery. Obviously men who have gynecomastia are all too familiar with firm lumps in their breast, especially under the areola. Thus it can be very disconcerting to feel these AFTER surgery. There is a simple way to differentiate what the lumps after surgery are:

  1. If the results of the surgery were initially very good with no lumps felt then the formation of these lumps (sometimes as early as 2 weeks after surgery) is usually scar tissue build up.
  2. If the lumps were palpable right after the surgery and have never reduced then it is likely excess tissue that was not removed.

Now not every lump needs to be treated. The most important thing is not whether it can be felt, but whether it can be seen. If it is scar tissue formation, then typically starting with finger massage can help break it up. If there is no improvement with this technique then careful kenalog injections can be performed to break up the scar tissue. In my practice this is not done frequently, however, when it is, it can take sometimes require 2 or 3 injections spaced 1 month apart to fully dissipate the scar. Only, and only if these two techniques do not help, do I then recommend surgery to remove the scar. This is extremely rare. Obviously, if there is excess tissue that is causing a visible fullness, then further surgery would need to be done to address this. I recommend, however, that patients wait six months to perform this surgery to allow not only proper assessment of what to remove, but also allow the original surgical area to settle.
To learn more about gynecomastia surgery and to see before and after photographs, visit www.losangelesgynecomastia.org.

Gynecomastia Surgery Recovery

As a plastic surgeon specializing in gynecomastia procedures one of the most important questions I get asked during the consultation is the recovery process. The most important thing to know about the recovery process is that it is just that…a process.  In this post I will lay out the general timeline for recovery. The keyword is general as some patients recover faster and some slower.

Day of Surgery: Go home and relax. Walk several times to help with circulation as well as to use the restroom.

Day 1: Walk without restrictions. Diet is unrestricted, with the exception of very salty foods.

Day 3 to 4: Okay to drive if not on pain medications. Okay to return to work if it doesn’t entail physical labor.

Day 6: Sutures come out and compressive dressings come off.  Continue wearing the compression vest.

4 weeks: Follow up to determine when to exercise and stop wearing compression vest (most men exercise between 4-6 weeks and scan stop wearing the compression vest around this time as well).

4 to 6 months: Final result of chest contour. Incisions look good much earlier than this but final incision healing is typically around 1.5 years.

Most men having this procedure go through this type of recovery process. It is important to have this discussion with the patient before surgery so they can plan their life accordingly. Many men spend years contemplating having gynecomastia surgery. It is important to carve out a small period of time to allow your body to heal after surgery.


To learn more about gynecomastia surgery and to see before and after photographs, visit losangelesgynecomastia.org.

Mondor’s Thrombophlebitis

From time to time, patients who undergo gynecomastia surgery come in for their 1 month follow up and say that they feel a firm, rope-like structure on their abdomen or chest.  They usually say they noticed it around 2-4 weeks after surgery. Sometimes it is painful, sometimes not. Obviously they are very concerned especially because in some cases it occurs in an area which did not even undergo surgery.

The most important thing I can do is to reassure them. What they are referring to is Mondor’s cords or thrombophlebitis. This is an inflammation of the superficial veins that run under the skin in the upper abdomen and chest. They can become inflamed which leads to that hard rope- like feel.  Mondor’s cords typically resolve on their own, although sometimes anti-inflammatories can be helpful with symptoms of pain. Below is an example of a patient of mine who underwent gynecomastia surgery without any procedures on his abdomen. One can see the Mondor’s cords on the image on the left at 4 weeks post-surgery. At his 3 month visit they are completely gone.

MONDOR’S THROMBOPHLEBITIS - Before PhotoMONDOR’S THROMBOPHLEBITIS - After Photo

To learn more about gynecomastia surgery and to see before and after photographs, visit www.losangelesgynecomastia.org.

Gynecomastia and Steroid Use

Gynecomastia is a condition caused by a hormonal imbalance of estrogen and testosterone, which affects the glandular tissue of male breasts. The chemical imbalance causes swelling of the breast tissue, making the region appear inflated and overgrown. Gynecomastia has been found to be directly related to steroid use. As a result, steroid users have an increased risk of developing the condition.

Though not life-threatening, gynecomastia can be both painful and embarrassing for men who are concerned about body image. Luckily, Dr. Dadvand, a Los Angeles-based plastic surgeon, specializes in treating patients who want to correct the condition for aesthetic reasons. Dr. Dadvand is here to help you look and feel your best–and regain your confidence.

GYNECOMASTIA AND STEROID USE - Before and After Photos

Why Do Steroid Users Suffer from Gynecomastia at Increased Rates?

Steroid users are among those with the highest risk of developing gynecomastia. Steroids work by increasing the production of estrogen, the female hormone associated with the development of breast tissue. This buildup of estrogen then binds to the receptors in the breast tissue, causing inflammation in the region.

Treatment Options for Gynecomastia in Steroid Users

Gynecomastia can begin to develop after just a single week of steroid usage but the length of time and severity of gynecomastia development varies from user to user. Unfortunately, once the condition starts to develop, changes in an individual’s body are permanent. Even after stopping steroids, gynecomastia may persist.

Many patients who start to develop gynecomastia try to treat the condition through compression shirts, pills, and natural supplements. These solutions are temporary and may not provide noticeable results. The only permanent and effective way to reverse the look of the enlarged breast tissue is to undergo gynecomastia surgery performed by a board-certified surgeon, such as Dr. Dadvand.

Your Gynecomastia Surgery

Gynecomastia caused by steroid use can be completely reversed in just one procedure performed by Dr. Dadvand.. After determining your candidacy for gynecomastia surgery, Dr. Dadvand will work with you to develop a plan of action to eliminate gynecomastia. The surgery involves the excision of breast tissue. If excess fat is an issue, liposuction may also be performed. Dr. Dadvand will formulate the best course of action based on the extent of your condition and your individual goals.

Anesthesia will be administered during surgery to ensure your utmost comfort. Dr. Dadvand will also go over the specifics of your recovery in full detail prior to the procedure. To ensure the best results and to prevent regrowth of breast tissue after stopping steroid usage, the user will have to permanently stop using steroids after surgery.

Gynecomastia Surgery in Los Angeles

Your gynecomastia surgery by Dr. Dadvand will be performed as an outpatient procedure, meaning you will be able to go home that day. As one of the leading surgeons specializing in gynecomastia surgery in LA, Dr. Dadvand is credentialed at several top-of-the-line surgery centers around the city, which are each fully equipped with the most advanced technology.

From pre-surgery appointments to post-surgery recovery, Dr. Dadvand and our office staff will be there for you to ensure that everything is going as planned. We look forward to meeting you and helping you achieve a new and improved version of yourself.

To learn more about gynecomastia, and to see before and after pictures, please visit www.drdadvandplasticsurgery.com or www.gynecomastialosangeles.org.

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