Affecting at least 60% of all men at some time in their life is the development of female-type breasts, which is caused by a condition known as gynecomastia. The most prevalent time this occurs is the adolescent years as young men pass through puberty and experience hormonal changes. As their hormones are changing and the estrogen level is temporarily high, they may have what is referred to as “puffy nipples.” Fortunately for most, their gynecomastia will resolve on its own without any intervention. However, for some, if their chest is not back to normal after two years, it may be permanent, with gynecomastia surgery as the only effective option.
Gynecomastia Causes
Overall, there are many different factors that can cause gynecomastia or breast enlargement in males. The most common cause is a hormonal imbalance with estrogen levels being higher than testosterone levels, while certain medications may also lead to male breast enlargement. Anabolic steroids can also lead to gynecomastia, which is common among the bodybuilding community.
True Gynecomastia and Pseudo-Gynecomastia
True gynecomastia occurs when there is excess glandular tissue in the male breasts along with excess male breast tissue resulting in enlarged male breasts. Surgical treatment is often the best solution for true gynecomastia.
It is important to note that true gynecomastia should not be confused with false gynecomastia, or pseudo gynecomastia, which results in enlargement of the male breasts due to weight gain, excess fat, and fatty tissue on the body. The main cure for pseudo-gynecomastia is often weight loss.
Gynecomastia Grades
Gynecomastia can be divided into different grades to determine severity. These grades include:
Grade I: severity is mild with enlargement centered around the areola. At this grade, gynecomastia is usually not noticeable with clothing.
• Grade II: enlargement is moderate without excess skin past the areola. At this stage, gynecomastia can still be concealed with loose clothing.
• Grade III: enlargement is moderate with excess skin. At this point, the swelling of the breast tissue is moderate to severe, and is highly visible.
• Grade IV: significant enlargement with feminine-type breasts and excess skin. This is the most severe stage of gynecomastia.
The severity of the gynecomastia will determine how the male breast reduction surgery is to be performed. It is imperative to select a board-certified plastic surgeon that has extensive experience with gynecomastia.
For patients with mild to moderate gynecomastia, the less invasive “pull-through technique” procedure may be an option. For those with more severe gynecomastia, a “Two Stage Procedure” may be necessary in order to reduce the excess skin.
Schedule a Consultation
If you are tired of living with the symptoms of gynecomastia and are ready to make a change, contact Dr. Delgado in San Francisco today! Your first step will be to schedule a one on one consultation appointment to discuss your concerns and gynecomastia treatment options.
Gynecomastia in San Francisco FAQs
What is the most severe grade of gynecomastia?
The most severe grade of gynecomastia is grade 4, which involves severe levels of excess breast tissue and glandular tissue. This excess tissue will create a noticeable condition regardless of whether the patient is wearing a shirt.
What is the best treatment for Gynecomastia?
Gynecomastia surgery is often the best way to treat gynecomastia. This surgical procedure is performed to correct moderate breast enlargement through the removal of excess glandular and fatty tissues.
Do all adolescent males experience gynecomastia?
No, not all adolescents will experience gynecomastia symptoms. However, most males do experience gynecomastia during their teen years as this is when their hormones are fluctuating.
Does gynecomastia cause breast pain?
For some males, gynecomastia can cause the breasts to be tender or painful to the touch.
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.
You may have heard of gynecomastia. You may even know it from personal experience. It is the enlargement of breasts in men and boys—also referred to as “man boobs.” Although most think of it as abnormal, it actually occurs in about two thirds of puberty-aged boys—usually about 13 or 14 years old, according to endocrinologist Glenn Braunstein. It also occurs frequently in older males, usually after the age of 50.
Gynecomastia can cause physical pain, such as extreme tenderness of the nipple when things such as shirts or towels rub against it. Moreover, it can cause serious emotional stress and anxiety. Teenage boys with gynecomastia may live in fear, taunted or shamed by peers, and constantly comparing themselves to “normal” males.
Gynecomastia is most frequently caused by a hormonal imbalance. Although all men have some amount of estrogen—the hormone that plays a key role in female development—gynecomastia occurs when a male’s body produces too much estrogen. Obesity can also play a role in causing gynecomastia, as it can and often does lead to fat being stored behind the breast. Although gynecomastia can be a symptom of certain cancers or other more serious problems, Braunstein says it should only be a cause for real concern if it develops early, such as in a five-, six-, or seven-year-old.
While most cases show that gynecomastia goes away on in three to six months, there are several treatment options for men and boys who suffer from it. Gynecomastia.org is a vast source of information about the various treatments available. There are medications that help to reduce the pain, and if the condition persists past puberty, then male breast reduction surgery is an option, in which a plastic surgeon can remove the extra tissue.
Braunstein suggests waiting at least a year and a half after the issue manifests before considering surgery. After that point, he says, the breasts may contain scar tissue, in which case the extra tissue would be less likely to go away on its own or respond to available medications. It is important to be sure boys are finished with puberty before undergoing surgery; if the breast tissue is removed before a boy’s body has finished developing, then it is possible that the gynecomastia will return.
If you currently struggle or at any time in the past struggled with gynecomastia, look no farther than gynecomstia.org for a place to give and receive the support that everyone with this condition deserves.
Gynecomastia.org is the world’s best forum and source of information and current news on this common but rarely discussed condition.
One major cause for gynecomastia revision surgery is when too much of the male breast tissue has been removed leaving what is known as a “crater deformity”. A crater deformity is as it sounds a crater or depression under the nipple/areola complex with the inadequate blending of surrounding tissue for a firm smooth contour.
How to Correct a Crater Deformity
Fortunately, there are procedures that can correct the crater deformity. First, the patient must wait until he has completely healed from the original surgery. In general, the fat flap is the best choice and has become the most predictable; this is where the skin is elevated and the fat that surrounds the crater is sewn together filling in the depression. Sometimes the use of fat injections also known as fat transfer or fat grafting can take place but it all depends on the architecture of the defect.
Find a Board Certified Plastic Surgeon
It is important for the gynecomastia patient to find an experienced Board Certified Plastic Surgeon. A secondary procedure is much more difficult due to scar tissue that has formed which makes the dissection more difficult and healing less predictable. In addition to the complication of scar tissue, the skin usually does not contract as well as the first time around. I would say that 35% to 40% of my gynecomastia procedures are revision surgeries.
See video of “post-surgery” in a blog dated April 2, 2012.
BREAST CANCER INCIDENCE IN ADOLESCENT MALES UNDERGOING SUBCUTANEOUS MASTECTOMY FOR GYNECOMASTIA.
IS PATHOLOGICAL EXAMINATION JUSTIFIED?
AUTHUR: John Koshy, M.D. from the location of plastic surgery, Baylor College of Medicine and the Department of Pathology.
REVIEW OF ARTICLE:
This is a question that every surgeon asks himself when removing tissue from the human body. This tissue such as fat from liposuction or excised skin from a face-lift or tummy tuck is not at issue but any abnormal tissue becomes a question. Is it justified to send gynecomastia tissue pathology in men under 21 years old is this the question asked by this article?
John Koshy, M.D., at Baylor performed a retrospective or three major hospitals in Texas from 1999 to 2010 looking at the tissue pathology of patients less than 21 years old. They also performed a literature review from 1965 to 2010 of men less than 21 years old who underwent male breast reduction for gynecomastia. In addition, they did an informal survey of 61 major children’s hospitals across the country if gynecomastia tissue was routinely sent to pathology.
Gynecomastia Pathology results:
The ten-year review of 81 patients of men less than 21 years old revealed no cases of breast cancer. The quota cost for the pathology was $1,260.00 as the out-of-pocket cost.
LITERATURE REVIEW
2,000 articles were reviewed. There were only 36 articles to discuss cases of adolescent Gynecomastia. Over a 35-year period, 615 cases were examined. The average age of the patient being 17 years old. The pathology revealed six cases of cancer.
INFORMAL SURVEY
22 of 61 hospitals gave responses in 18 states either routinely performed or required histological exam of gynecomastia of breast tissue excised from men with gynecomastia.
CONCLUSION FROM THE STUDY:
The incidence of abnormal pathology in adolescent men is rare. There seems to be little benefit in the routine histological exams, and the current policy and procedures should be reviewed.
Based on this study, routine microscopic exams of men 21 years of age or less should not be routinely done or required. This can be performed when desired by the patient, patient’s family, or managing physician.
gynecomastia.psstage.com does not give advice or options to try to produce educational and permission for its readers.
Reviewed by,
Miguel Delgado, M.D.
www.gynecomastiaspecialist.com
