5 Questions You Should Ask Your Plastic Surgeon Before Gynecomastia Surgery

Posted by Dr. Dadvand September 3, 2018

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.

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.