Few things can be more embarrassing for a man than the shame and humiliation of bearing the dreaded man boobs, which in medical terms is referred to as gynecomastia. Having gynecomastia will almost certainly lead to ridicule from peers, especially if it is present in adolescents. This can cause the young boy shy away from social situations, especially those than involve removing the shirt such as going to the beach, and instead hide in isolation. Also, having gynecomastia can have a strong negative affect on a man’s self-confidence in regards to romantic encounters with women, due to the embarrassment and self-consciousness caused by the condition. Having the gynecomastia removed will have amazing psychological effects in improving confidence, self-esteem, and overall quality of life. Besides these psychological effects, there is even the risk of breast cancer in men if the condition is not treated.
How Does Gynecomastia Develop?
The two main causes of gynecomastia are either as a normal part of adolescent puberty, or through steroid abuse. As a young boy enters puberty, hormones are often out of balance, which can lead to abnormally high levels of female hormones such as estrogen and progesterone. When these female hormones reach high levels, gynecomastia can develop as a result. Young boys may develop gynecomastia in varying degrees during puberty, from none at all, to very mild, to extreme. In mild cases, it may go away on its own, or remain so small that it is not noticeable. However, in certain cases, the enlarged breasts experienced during puberty will persist on into adulthood.Also, one can get gynecomastia as a result of steroid abuse, as these substances also affect hormone levels.
Whatever the cause, once you have gynecomastia, the treatment that will work is surgery.
In certain cases, gynecomastia that comes on during a cycle of steroids can be reversed if anti-estrogens are used immediately, but in most cases, it is permanent.
True gynecomastia vs. pseudo-gynecomastia
Men who are extremely overweight will almost always have enlarged breasts or “man boobs”, but this is not always true gynecomastia. Pseudo-gynecomastia is when there are in fact large breasts, but it is just soft fat tissue, not hard breast tissue. If someone is very overweight with pseudo-gynecomastia consisting of just soft fat tissue in the chest region, it is possible to lose this with just regular weight loss via diet and exercise. However, hard breast tissue will not go away with normal weight loss, at least not completely. One way to tell if you have true gynecomastia or pseudo-gynecomastia is to massage your breasts firmly and feel for any hard lumps. Hard lumps underneath the nipples that feel like small ping-pong balls are a sign of hard breast tissue that can only be removed via surgery. If all you feel is soft fatty tissue, you may just have pseudo-gynecomastia, which will probably (although not always) go away with normal weight loss. If you are below 20% body fat and have significant fatty tissue around the breasts and protruding (pointy) nipples, you probably have true gynecomastia. If you are below 15% body fat and you have enlarged breasts and/or pointy nipples and protrude out more than normal, you almost certainly have gynecomastia. You can use this body fat estimator to get a quick estimate of what your body fat percentage is.
The Gynecomastia Surgery Procedure in Detail
If you are overweight, then before you get gynecomastia surgery, it is probably a good idea to first try to lose some weight naturally to see if the condition improves. If it does not improve, or you are not overweight to begin with, then you should meet with a plastic surgeon to discuss surgical treatment for your gynecomastia. There are two ways in which gynecomastia surgery is performed: Either direct excision of the breast tissue via surgery, liposuction, or both. Whichever type will work best for you will depend on your particular case, and only a board-certified plastic surgeon will be able to determine for sure which is the best method for your body. In most cases, however, liposuction is used to suck out the soft fatty tissue, in conjunction with directly cutting out (excising) the hard breast tissue.
If the breast tissue is to be directly excised (cut out) with surgery, the incision will usually follow the natural contour of the areola (nipple) and not be very noticeable. If liposuction is used, the cannula will usually be inserted under the armpit on the lateral region of the chest where the incision will not be very noticeable. Once the excess breast tissue is removed, you will be sutured up and often fixed with temporary drains to help remove any excess fluid. The procedure is performed under local anesthesia only in most cases, and the entire procedure only takes 45 minutes to an hour. It is an outpatient procedure, meaning you can return home the very same day. However, in very severe cases of gynecomastia, it may be performed under general anesthesia and require overnight hospital stay, but again, this is only for very severe cases.
An ideal candidate for the surgery is someone who has tight skin that will be able to conform to the new shape of the chest after surgery, and is a non-smoker (for optimal recovery). Also, it is recommended that you have had gynecomastia for some time before getting the surgery. If you get surgery while the gynecomastia is still growing, there is a chance it can grow back after surgery, although this is extremely rare, there is still the chance. Still, it is probably a good idea to wait at least a year after the onset of the gynecomastia to make sure it is not still growing before you get the surgery done.
Risks of Gynecomastia Surgery
Gynecomastia surgery is a touchy procedure. In a procedure such as liposuction, the goal is fairly straight forward, to remove as much fat as possible, although there some challenges to making the fat loss even and smooth. However, with gynecomastia surgery, the doctor must be careful to remove enough breast tissue to correct the condition, but not to remove too much as to create a “dish pan” deformity in which the nipples are actually indented. The most common complaints among patients who are dissatisfied with the results are that either too much or too little breast tissue was removed, more the commonly than too much was removed. If the doctor is not careful, he may remove too much breast tissue leaving you with a deformed chest and nipples that actually seem to “sink in”. This can, however, be fixed in most cases, with a soft tissue filler such as Radiesse or fat transfer, although these revisions are not cheap, they will help the appearance greatly. Because gynecomastia surgery can be so touchy and comes down to the individual expertise and skill of the surgeon, it is extremely important to research your plastic surgeon VERY thoroughly. Always ask to look at before and after photos of his work, and ask him how often he performs gynecomastia surgery in a given month. In addition to not being happy with the procedure, the usual risks that come with any plastic surgery procedure still apply – infection, bleeding, bruising, swelling, and pain, primarily.
Gynecomastia Surgery Recovery
Immediately following the gynecomastia treatment, you will be required to wear a compression bandage. This bandage must stay tightly wrapped around your body as much as possible for first few days, and it will eventually be replaced by a compression garment you will have to wear for up to six weeks. Most likely, you be fitted with drains for the first few days, although they will be removed a few days post-op. You will not experience much pain, but there will be a lot of bruising, swelling and numbness in the chest region. If you do experience pain, you can take some pain medication that your doctor will no doubt prescribe you.
For the first week of the recovery, you will want to take it as easy as possible and let your body heal. You may be able to return to work a week later, but be sure to take it very slowly. After about two weeks post-op, a lot of the soreness, bruising and swelling will have subsided, and you can return to very light physical activity, such as going on walks.
Over the next few months, you will likely experience some rather odd changes in your body as you heal. Immediately post op, your chest may appear to be flat, but as your body develops scar tissue, the nipples may puff back out, giving the illusion that not all the breast tissue was removed. Also, one side may heal quicker than the other, giving you an uneven look. However, be patient. It takes up to ten months for all the swelling to go away, and a year, possibly even two, for the scar tissue to break down fully. The doctor may be able to speed this process with kenalog injections, which will break down the scar tissue quicker, however, this must be done with caution. Kenalog injections can also break down fat cells and lead to a “dish pan” deformity, or indented nipples if too much is injected, so proceed with caution.
As far as the gynecomastia surgery scars go, they will not be very visible. Immediately following the surgery, they will be bright pink, but quickly fade. You doctor will most likely prescribe you some kind of skin cream to fade the scars quicker, and advise you stay out of the sun and not to smoke. If you follow these instructions, and the doctor did a good job on the surgery, the scars will fade very nicely. Also, because the scars will follow the natural contour of the areola (nipple), they will be extremely hard to detect, even before it has had a chance to fade. After a year of proper care, both the scars that follow the contour of the nipple and the liposuction scars under the armpit should fade to the point where they are practically invisible.
If you do contact sports such as wrestling or any type of martial arts, you will probably be out of training, at least out of full-contact sparring, for at least six months after the surgery. Any hard contact with the chest will be incredibly painful during the first six months. To be able to get the point where you can take pressure to your chest just as hard as you could pre-op with no pain can take a full six to twelve months, after all the scar tissue and swelling have a chance to heal.
Gynecomastia Surgery Cost
The average cost of gynecomastia surgery is $3,500. This is an all inclusive cost that takes into account the surgeon’s fee, cost of anesthesia, medications, etc. However, a post surgery compression garment will probably cost an extra $50 or so. It is important to realize that $3,500 is a lower end estimate for fairly mild gynecomastia. If you have a severe case of gynecomastia, or the surgeon anticipates a high degree of difficulty with the procedure for any reason, then the cost will go up. Also, the cost of the surgery will also depend on the experience and expertise of the doctor, as well as the location of his office. More experience and prestigious doctors will typically charge more, and the cost will also usually be higher in affluent areas, such as Beverly Hills, as opposed to smaller towns. However, always keep one thing in mind: Shopping around for lowest plastic surgery prices rather than looking at the skill and qualifications of the doctor is a terrible idea. Always make finding the best possible plastic surgeon who can provide with the best results you primary concern.