Gynecomastia is breast growth in males. It is present in approximately 1 in 3 men and it affects 2 in 3 adolescent boys. Only 3 of every 4 cases are bilateral. The cause is a relative or absolute excess of circulating estrogens (female hormones) versus a decrease of androgens (male hormones). Most cases are idiopathic (doctor word for “we don’t know”), but some are due to liver disease, endocrine tumors, testicular masses, marijuana, anabolic steroids, and various other prescription medications. There is no risk of cancer unless associated with a rare genetic syndrome. The condition is graded I to IV.
Most gynecomastia associated with puberty resolves, but if it is present for more than one year, it is likely to be permanent. The condition is emotionally distressing to both adolescents as well as adults. A complex endocrine blood test work up is not indicated, but abdominal and testicular exams are necessary. Ceasing any drugs asscociated with gynecomastia is manadtory and weight loss to a healthy level is encouraged.
Surgery may be performed on adolescents who have had the condition for greater than one year and on adults who have met the above conditions is appropriate. Liposuction is used for lower grades of gynecomastia while additional skin and fibrous breast tissue excision is required for higher grades. Excisions may be avoided in boderline cases if liposuction is done first and the skin allowed to retract, but most patients are not interested in 2 stages of surgery. Removing tissue is not the hardest part; making a smooth contour to blend into the rest of the chest is.
For plastic surgeons, insurers do not cover the procedure as the consider it cosmetic. Patients go home the same day of surgery and wear a compression garment to minimize bleeding and help form a smooth contour. Recovery is several weeks. Most patients with realistic expectations are happy with their results and accept any scarring as they understand that this is a scar versus contour trade off operation.
Mark D. Wigod, MD, FACS
Plastic Surgery for Boise, Meridian, and the greater Southeastern Idaho Region
