Gynecomastia, breast enlargement in men, affects an estimated 20-40% of men at some point in their lives. In a small number of men it is related to a genetic condition. It may also be caused by the use of marijuana as well as the prescription drugs Aldactone, Furosemide and Digoxin. Anabolic steroids and medications that contain or promote the effects of estrogen have also been implicated. In the vast majority of cases the cause is unknown.
Gynecomastia typically develops in adolescence and and may involve one or both sides. The degree of development may be from a small amount of swelling beneath the nipples to changes that resemble a woman’s breast. Men affected are typically apprehensive about their appearance and do not like to be seen with their shirts off. It decreases their self esteem.
Treatment involves removing the excess which consists of both glandular tissue and fat. If the tissue is mainly fat, liposuction alone will suffice. For most men, the use of ultrasonic liposuction followed by removal of the small amount of remaining breast tissue using a grasping instrument through the same, small incision in the armpit works best. This technique avoids scars on the breast or nipple. If it is small and primarily breast tissue, as is often seen in very fit individuals, excision through a small opening in the nipple is the best choice. In a few men excess skin must also be removed and is typically done by a donut shaped incision around the nipple leaving only a circular scar around the dark skin of the nipple.
The procedure takes about 1 1/2 hours and is usually described as minimally painful. Typically, three to seven days are taken off from work. A compression garment is worn for one to two weeks and small drainage tubes are removed in 4-7 days. A small amount of swelling is typically seen for a few months before final results are achieved. Before and after photos can be viewed here.
Scarring in the arm pit or around the nipple is usually minor. Temporary numbness may be present. Infrequent complications include infection, fluid accumulation and firmness in the area that may require injections to decrease.
Frank Richards, MD
Dean Jabs, MD