by Miguel Delgado, MD | Oct 8, 2015 | Gynecomastia
A condition little talked about but widely apparent is gynecomastia, the overdevelopment of the male breast. A reaction to too much estrogen or too little testosterone, gynecomastia can occur in newborns, teenagers, and adult men.
In babies, preteen, teenage boys, and young adult men gynecomastia is a reaction to estrogen from the mother or changes in hormones caused by puberty. It usually resolves within 18 months and is not a cause for concern. In older adult males, however, gynecomastia is usually caused by the natural decline in testosterone production or being overweight provides more fat cells which convert testosterone to estrogen. Of course, screening for much less common conditions such as liver or lung cancer, thyroid or hormone problems, or drug use can cause gynecomastia as well as certain medicines:
- Steroids
- Medicines used to treat ulcers or epilepsy
- Digitalis and other heart medicines
- Chemotherapy drugs, especially alkylating agents
- Antiandrogen drugs (such as flutamide, cyproterone, and spironolactone)
- Antianxiety and antidepressant medicines
- Products containing tea tree oil or lavender oil
Luckily, gynecomastia is not harmful and easily treated. If caused by hormonal imbalances, it will usually go away on its own. If caused by a medicine or disease, discontinuation of the medicine or treatment of the disease will usually cure gynecomastia. If you find a one-sided breast lump, it is extremely important to consult a physician, particularly if you have any close relatives who have had breast cancer. A doctor can check the lump with a biopsy or surgery.
In extreme cases, surgery may be necessary. This surgery is similar to breast reduction. The average cost of gynecomastia surgery is $3,100, not including anesthesia or other related. After surgery, patients usually notice some discomfort and pain which can be alleviated with prescribed medication. Typically a week recovery period is recommended. The patient will wear a compression vest beneath clothes for two to three weeks to control swelling and help shrink the skin. Patients should refrain from physical activity for two weeks. They may notice some slight scarring, but results will be visible within the first two weeks after swelling goes down, with continued improvements for six months.
Gynecomastia can cause some men to feel insecure. If you notice an enlargement of your breasts, and diet, exercise, and discontinuation of medicines have failed to produce results, male breast reduction surgery can give you a flatter, firmer, and more masculine chest and profile.
by Miguel Delgado, MD | Sep 18, 2015 | Quality
The University of British Columbia, Vancouver, Canada did a study of over 400,000 men from ages 15 to 25. The study was regarding the side effects for current users of the anti-psychotic drug, Risperdal or the generic equivalent, risperidone. The results of the study showed men were 5 times more likely to develop gynecomastia than those who did not take the drug. Additionally, a study was done on one million older men who took Risperdal, and the results showed they had 69% higher chance of developing male breasts.
In 2005, The FDA required a “black-box warning” on the packaging of Risperdal. A “black-box warning” is the most stringent warning required by the FDA, a warning reserved for serious or life-threatening drug side effects. To date, the warning is only concerning the substantial risk for elderly dementia patients who are at increased risk of death by taking the anti-psychotic drug.
It is hoped that in the future there will be additional warnings such as the increase of prolactin levels that may cause gynecomastia. In the meantime, even with lawsuits continuing to be filed, Risperdal has not been recalled by the FDA or Johnson and Johnson. Risperdal is still being prescribed by doctors to treat mental health issues in children and adults.
by Miguel Delgado, MD | Aug 30, 2015 | Quality
Risperdal is an antipsychotic drug manufactured by Janssen Pharmaceuticals Inc., a subsidiary of Johnson and Johnson. Of all medications on the market, Risperdal has one of the longest histories of legal disputes due to the side effects, mainly gynecomastia, that the drug causes. At one point, it was the most prescribed antipsychotic in the United States. What a travesty for boys and men suffering from mental illness to have the addition of developing male breasts.
The first case to go to trial regarding the consequences of the drug was in September of 2012. The trial ended in a settlement on the first day for an undisclosed amount. For more information on Risperdal and it side effects, see the blog for August 14, 2015.
Since the first court case, five more were settled in 2012, and Johnson and Johnson is now facing hundreds more lawsuits. It is believed that the drug raises prolactin levels and blocks dopamine, resulting in the possible development of gynecomastia.
If you Google Risperdal lawsuits, you will see multiple offers from different law firms offering to represent men who have had gynecomastia develop due to Risperdal. Some law firms claim there is a settlement in progress that may pay out large amounts per claimant.
Back in May of 2014, meetings were started to petition for Risperdal Multidistrict Litigation (MDL). An MDL is not a class action suit but is for individual claims.
In a class action suit, one lump sum would be awarded if a settlement is agreed upon. Then the award would be divided equally between all plaintiffs no matter what their degree of injury.
For multidistrict litigation (MDL) all of the pending claims are represented in one courtroom and heard by one judge. Then each plaintiff would be fighting his own claim and can negotiate an individual settlement with their Risperdal attorney.
Johnson and Johnson has already paid 2.2 billion dollars to the Department of Justice when, Janssen a subsidiary of J&J, pleaded guilty to misbranding the antipsychotic drug.
To date, there are more than 1300 cases pending in the Philadelphia Court of Common Pleas. So far there have been three bellwether trials. The purpose of bellwether trials is to help gauge how juries may respond to testimony that may influence future negotiations and settlements.
In February, the first bellwether case was all over the news as it settled for 2.5 million dollars. The plaintiff was a 20 year old man who started taking the drug when he was 8 years old for treatment of autism. The second case went in favor of the defendant as there was insufficient evidence that the plaintiff’s gynecomastia was caused by Risperdal. The third case just recently settled in favor of the plaintiff for an undisclosed amount.
The statute of limitations varies greatly from state to state. If you believe you have been a victim of this drug, it may be in your best interest to see a Board Certified Plastic Surgeon who specializes in gynecomastia, and perhaps a Risperdal attorney.
by Miguel Delgado, MD | Aug 26, 2015 | Pre-Surgery
It is a refreshing thing to be able to see people addressing gynecomastia on social platforms, especially influencers who reach a wide audience. Today, we will be spotlighting Aaron Marino.
About Aaron Marino
Aaron Marino, the creator of alpham, has built a successful business helping men achieve their full potential physically and emotionally, as a consultant for grooming, fashion, and fitness. He unabashedly addresses very personal issues that men have to deal with and uses compassion and humor to get much-needed information from men. Other than fashion, he covers topics including things such as hair loss, tattoo removal, and gynecomastia.
Aaron has appeared on many television programs such as; Fear Factor, Shark Tank, MTV, Ask Men, and many more and has also been featured in the Huffington Post, Forbes, GQ, and more. He has posted a video on YouTube titled “Man Boobs | How to Treat, Manage, and Eliminate Gynecomastia”. In this video, Aaron addresses the topic in a style of sensitivity and light humor. He explains some of the causes of gynecomastia. He has a very forthright way of talking directly to men giving them a sense that he understands the emotional havoc gynecomastia can cause. Additionally, he gives some very good suggestions to men on what they can do about it, from weight loss and exercise, avoiding steroid use, to buying t-shirts two sizes down, or compression vests such as Spanx. And of course, he discusses the possibility of surgery for some. Click here to view his gynecomastia YouTube video.
More About Gynecomastia
Gynecomastia is a condition that causes male breast tissue to become enlarged in one or both breasts. This excess breast tissue can understandably cause self-confidence issues and embarrassment for those living with it.
The main cause of gynecomastia is hormonal imbalance in testosterone production and estrogen levels in teenage boys, though it can also be caused by anabolic steroids, some recreational drugs, and certain medications (such as heart medications). Gynecomastia can affect males of any age including newborn babies, adolescent boys, and older men.
Common gynecomastia symptoms include:
- Breast tenderness
- Breast swelling
- Male breast enlargement
- Swollen breast tissue
- Puffy nipples
- Nipple discharge
- A firm lump of glandular tissue under the nipple
- And more
Gynecomastia is not to be confused with a condition called pseudogynecomastia, in which excess fatty tissue is the cause of enlarged breasts. While liposuction can help to reduce the size of the chest with pseudogynecomastia, weight loss and elimination of excess tissue is often the most effective treatment.
For some, gynecomastia will resolve on its own, usually during adolescence. However, others may not be so lucky. If gynecomastia follows a male into adulthood, surgery is the best way to treat gynecomastia.
About Gynecomastia Surgery
Gynecomastia surgery, also called male breast reduction, is a procedure that involves the surgical removal of glandular tissue, fatty tissue, and excess skin from the breasts. There are a variety of surgical techniques that can be used during this procedure including liposuction and excision.
Schedule a Consultation in San Francisco or Novato
If you are living with gynecomastia symptoms such as enlarged male breasts or male breast growth and are interested in learning more about this condition and if male breast reduction surgery is right for you, contact Dr. Delgado today. As a board-certified plastic surgeon with over 30 years of treating gynecomastia, Dr. Delgado has the ample skill and experience needed to correct gynecomastia.
Gynecomastia FAQs
Is breast cancer associated with gynecomastia?
The risk of male breast cancer is low in those with and without gynecomastia.
Is body fat the cause of my breast tissue growth?
If you are overweight and are experiencing breast enlargement, you may have pseudogynecomastia. In these cases, body fat is the cause for symptoms rather than breast gland tissue. Weight loss is often a solution. However, excess skin may be an issue following weight loss. This can be addressed with surgical intervention for a flatter chest.
What is asymptomatic gynecomastia?
This form of gynecomastia is gynecomastia that is not associated with any symptoms. It is actually quite common and can affect males of all ages.
How is gynecomastia diagnosed?
During a consultation appointment, Dr. Delgado will speak with you regarding your medical history and perform a physical exam. He may also ask you questions about your gynecomastia symptoms and how long you have been experiencing symptoms. Blood tests may also be ordered. A diagnosis may then be made and a plan for gynecomastia treatment created.
Can plastic surgeons address gynecomastia?
Yes, a board-certified plastic surgeon is a fantastic choice for performing your gynecomastia surgical procedure. When seeking out a surgeon, be sure to do your homework and consult with more than one to determine which surgeon is right for you.
When do males develop gynecomastia?
Males can develop gynecomastia at any age. However, it is most commonly developed during adolescence when hormone changes are occurring and hormone levels are fluctuating.
by Miguel Delgado, MD | Aug 14, 2015 | Causes
Gynecomastia, or the development of breasts in males, can be caused by a number of different things. Taking antipsychotics such as Risperdal can produce the condition. Male breasts can develop in both boys and men. Enlargement can vary from patient to patient, but generally men end up with breasts that look very close to that of a female.
Those who develop the condition from prescription medications can develop both fatty tissue in the chest area, and extra glandular tissue. While the medications that can produce the side effect of Gynecomastia are known as antipsychotics, they can trigger depression and anxiety in young boys, or men who develop breasts and become the targets of bullies. The FDA approved Risperdal also to treat anxiety and depression, but once becoming aware of the fact it’s the medication causing them to grow breasts, most won’t take it anymore, rendering it not only useless but harmful to them.
Risperdal, a pharmaceutical medication produced by Johnson and Johnson, is known for blocking dopamine while heightening prolactin levels. Prolactin is a hormone released by the pituitary gland. For women, prolactin stimulates breast growth and milk production. When the level of prolactin in males becomes too high, it can produce effects similar to those that are experienced by women, and result in gynecomastia. In some unfortunate and extreme cases, males who have taken Risperdal and developed gynecomastia because of its use have developed D-cup size breasts. Lactation has also been noted in some cases of gynecomastia.
Breast reduction is a term most generally applied to women. However, most males who develop noticeable female-like breasts (gynecomastia) choose to opt for a reduction. Patients with gynecomastia choose to get their chest reduced for a number of reasons, to feel better, to look ‘normal’ again, and if they’re younger (or even older) so they won’t be teased by bullies who don’t understand their condition. Gynecomastia is very serious and can cause damage not only physically, but mentally to whoever it affects.
Many times, breast reduction may only be necessary in extreme cases. In a lot of the milder cases, patients are able to discontinue the use of Risperdal, and swelling may start to dissipate. There are plenty of antipsychotics on the market that do not produce excess prolactin, and are much safer to use. The combination of ending the use of Risperdal and using a safer medication may be enough to treat the condition in milder cases. If however, chest size has not reduced within a year of stopping Risperdal’s use, patients with larger, unwanted breasts may want to contact a doctor and speak with them about the possibility of surgery (breast reduction.)
