Gynecomastia

Gynecomastia is a combination of excess male chest fat and an enlarged mammary gland (breast tissue) in adult men. The enlarged mammary gland is often the main reason for the breast-like appearance associated with gynecomastia. Understandably, the appearance of full breasts can have a significant impact on a man’s self esteem. This enlargement of male breast tissue is categorized as either True Gynecomastia or Pseudo-Gynecomastia.

True gynecomastia is caused by hormonal changes and involves the glandular tissues.
Pseudo-Gynecomastia is the presence of excess fatty tissue around the breast.

The causes of gynecomastia are diverse, but always involve the endocrine (hormone) system. Sex hormone imbalances are the most common direct cause of gynecomastia. Low levels of androgens, such as testosterone, combined with elevated estrogen levels (female hormones) can produce an enlargement of the breast tissues. Many adolescents experience gynecomastia during the pubertal hormonal shifts. Some medical conditions lead to the production of antiandrogens (testosterone inhibitors), causing low testosterone levels. These may include thyroid imbalances (hyperthyroidism), liver disease (cirrhosis) and kidney disease or kidney failure. There may also be issues with testosterone production. This may be the case in certain genetic disorders (Klinefelter syndrome) which can result in hypogonadism (small testicles). Older men may also experience a decline in testosterone production as they experience loss of testicular mass. Pituitary tumors can result in lowered stimulation of the testes, resulting in a lower output of testosterone and adrenal gland tumors can produce excess estrogen. Both of these conditions may cause excess breast tissue growth. Some tumors also produce human chorionic gonadotropin (hcg). This hormone is produced during a normal pregnancy, however in a healthy adult male it should be almost undetectable.

Many drugs or medications can cause cases of gynecomastia. Obviously, hormones like anabolic steroids can directly cause an enlargement in the breast tissue. Less obviously, many other prescription medications, like those used to treat prostate cancer (flutamide), can cause gynecomastia. Calcium channel blockers and spironolactone, both used to treat blood pressure, can stimulate breast enlargement. Combined with the lowered testosterone production in older men, this can lead to the less than ideal side effect. Cimetidine, an over the counter acid reducer, can induce enlargement of the breast tissue. Many psychiatric drugs can also cause gyno. Tricyclic antidepressants such as sertraline and anti anxiety medications like valium (diazepam) can be culprits, as can amphetamines used to treat ADHD. Methadone, used to treat pain medication dependence, can cause enlarged breasts in men.

Popular essential oils, like tea tree oil, should be used with caution in young boys. Although most consumers consider herbal treatments like essential oils to be safe, they can also have the effect of causing gynecomastia.

Recreational drugs like marijuana, heroin or amphetamines can also lead to excess breast tissue.

No matter how well you eat or how many hours you spend in the gym, stubborn fatty tissue around the pecs can be almost impossible to eliminate, and no diet or chest exercise can change an enlarged gland or excess glandular tissue, these are related to your endocrinology, not your diet.

True Gynecomastia involves more than just male breast fat. The enlargement of the mammary gland is a principle element of true gynecomastia. No amount of push-ups, bench press or weight loss will result in the resolution of true gynecomastia, it is a men’s health issue.

Pseudo-gynecomastia is a condition which mimics true gynecomastia. In pseudo-gynecomastia, an excess of body fat leads to the appearance of male breasts. This condition is most common in patients who struggle with obesity. To improve psuedo-gynecomastia, a combination of strength training and cardio along with whole body weight loss, will lead to an improvement in the appearance of your chest. Often with pseudo-gynecomastia, as patients experience fat loss, they also notice some looseness in the skin of the chest. This can be corrected with a male breast lift or through less invasive procedures such as liposuction with Renuvion (J Plasma).

Because of the possibility of medical causes for your gynecomastia, you should always be evaluated by your primary healthcare provider to ensure there are no reversible causes for your enlarged breast tissue. They will perform a physical examination to determine if you have true gynaecomastia or pseudo-gynaecomastia. They will also look for nipple discharge and ask you about breast pain.

The work up for gynecomastia may involve checking hormone levels (blood tests) such as testosterone and estrogen levels as well as hCG. A breast exam can help determine the possible need for imaging studies such as mammogram to rule out breast cancer as as possible cause, particularly when the ”extra fat” is one sided. Biopsy may be required to rule out some conditions.

If a medical condition is found for your gynecomastia, your doctor may recommend medications such as tamoxifen, which helps to lower your estrogen levels.

If you have a medical condition that is not corrected first, gynecomastia surgery will be futile (as will any chest exercises or weight loss) as the medical condition will likely cause the gyno to recur. Furthermore, treatment of the medical condition may also result in treatment of gynecomastia.

You should also be aware that recreational drugs are a common cause of modern gynecomastia. Marijuana acts as an estrogen stimulator and also leads to decreased testosterone levels. This results in the growth of your mammary glands (breast tissue). If you continue to smoke weed after your gynecomastia surgery, your enlarged glands will likely return.

Many of the gyno patients we see at Imagen are avid body builders. Many of the supplements used by those trying to build muscle can not only lead to an increase in your chest muscles but can also lead to an increase in your breast tissue.

Once all medical causes have been ruled out or addressed, you may consider gynecomastia reduction surgery.

Gynecomastia surgery at Imagen is a unique procedure that involves more than just fat removal. All of our gynecomastia surgeries are performed as an outpatient under local anesthesia with oral sedation. During the procedure, the doctor also removes a portion of the mammary gland. This enlarged gland behind the areola, combined with chest fat, causes the breast-like appearance associated with gynecomastia.

For those concerned about loose or sagging skin after their gynecomastia procedure, Imagen uses Renuvion for skin-tightening in conjunction with all liposuction procedures. Renuvion uses a combination of radio-frequency (RF) with helium gas to tighten your skin so that your chest looks contoured, firm, and more defined. For severe cases of skin laxity, you may need a skin excision. Unfortunately, this procedure is only performed under general anesthesia and will leave a rather large scar. The skin excision procedure should be done by a reconstructive plastic surgeon.

This cosmetic surgery helps to improve not only physical health but mental health with the confidence your post-op results can provide your overall well-being and self-confidence.

Male Breast Reduction surgery at Imagen is a unique procedure that involves more than just excess fat removal. During the procedure (which is done entirely under local anesthesia), the surgeon will perform liposuction to remove excess fat and help reveal the pectoral muscles underneath. He will also remove a portion of the mammary gland from behind the nipple. This enlarged gland behind the areola, in addition to excess chest fat tissue, is what causes the breast-like appearance associated with gynecomastia (aka male breasts).

4D Hi Def Liposculpting of the chest is used to help define the muscle mass of the chest contour. Your upper body will look lean and toned. If you need help in building up your pectoral muscles, fat transfer can be used for augmentation of the upper poles of the pecs while lipo removes fat from the lower poles and behind the nipple, giving a more ripped and masculine appearance to your chest area without the reps. Hi Def Lipo can also be used to reduce belly fat and give you the appearance of six pack abs.

In cases where gynecomastia is primarily the result of excess fatty tissue, liposuction may be used alone. This requires the insertion of a cannula, through several small incisions. The cannula is moved back and forth in a controlled motion to loosen the excess fat, which is then removed from the body. There are various liposuction techniques that may be used; the technique most appropriate for your body type will be determined in your initial consultation with your cosmetic surgeon.

In the past, the only reliable method of skin tightening was to perform invasive plastic surgery (a male breast reduction where a plastic surgeon removes some of the excess skin leaving an ”anchor” scar). Through advancements in technology and cosmetic procedures, there is now a state-of-the-art treatment available that smooths and tightens unwanted skin: Renuvion or JPlasma.

Renuvion is a minimally-invasive, skin tightening treatment that restores elasticity and firmness to the skin. Renuvion is available in Omaha only at the surgery center at Imagen Body Sculpting.

Good candidates for the male breast reduction procedure are close to their ideal body weight and have exhausted all measures such as diet and exercise to reduce excess fat. They have often worked with nutritional experts and personal trainers to reduce excess body fat. Additionally, medical causes of any breast gland development such as medications, drug use, and hormone-secreting tumors must be excluded and/or corrected. Good candidates lead a healthy lifestyle, exercise regularly, and are non-smokers.

Male breasts are typically not caused by a serious medical condition, although the doctor will take a full medical history during your consultation.

During your initial consultation, your physician will go over medical history, side effects and possible complications, recommendations for weight gain/weight loss around the time of your surgery, and realistic expectations and your goals for your surgical procedure.

It is generally recommended to hold off on a gynecomastia surgery until you are fully through puberty and development. Most surgeons recommend waiting until at least age 18, at which point your hormone fluctuations have decreased.

A common question is “Is gynecomastia a risky surgery?” While there are risks associated with any medical procedure, overall gynecomastia surgery is low risk. You will have bruising and swelling (these are normal and expected). It is possible to develop hematomas or seromas as a result of the procedure. You should always discuss possible complications and how you can reduce them with your surgeon.

Gynecomastia patients will notice immediate improvement, but optimal results appear 3-6 months after surgery. You will notice a reduction in the general volume of the chest, in particular the glandular volume behind the nipple.

Most patients will notice a significant improvement in their chest contour with a single treatment. Unfortunately, if the factors that caused the initial increase in breast tissue remain, it is possible to redevelop the gynecomastia. If this occurs, you may need another procedure.

It is imperative that you follow all of your post-op guidelines including wearing the compression garment at all times except during bathing. Bruising and swelling may occur but usually subside within a week of surgery and most patients can return to normal physical activity after a day or two unless otherwise suggested by your doctor. You will need to reduce your high impact exercise (such as running and some cardiovascular exercises) and decrease your resistance when weight training for a few weeks after your procedure.

If you have a skin excision procedure (similar to a breast lift in women), you will have a large scar. There are treatments that you can do to help minimize the scar, but it will always be there. One of the biggest benefits of a less invasive treatment (like those that we offer at Imagen) is the lack of scarring. Dr Frank generally hides the glandular reduction scar along the edge of the nipple, so even shirtless it’s hard to see. Just take a look at our before and after photos.

We are commonly asked “Does gyno surgery last forever?” Gynecomastia surgery at Imagen is a unique procedure that involves more than just excess fat removal. During the procedure, the doctor also removes a portion of the mammary gland, which can be a major cause of the breast-like appearance associated with gynecomastia. This gland responds to a variety of triggers which lead to gynecomastia. These triggers can include the use of anabolic steroids, certain prescription medications, and marijuana (pot). Because a portion of the gland is still intact, it is possible to grow again if the patient chooses to use the substances that may have led to the original enlargement.

The average cost of gynecomastia surgery varies between patients but typically the gynecomastia procedure falls somewhere between $5,000-$7,000. Imagen’s prices are always all-inclusive, with no hidden fees. Your surgical fee will include:

• The Gynecomastia Surgery Procedure (Surgeon’s Fee)
• All Pre Op and Follow-Up Visits with our Expert Patient Care Team
• SmartLipo and Renuvion Technology
• 2 Compression Garments
• All Anesthesia and Facility Fees

We want gynecomastia surgery to be accessible to all budgets. We offer several financing options, including some that are interest free and others that have longer financing terms.

Depending on the causes and severity of your gynecomastia case, it may be possible that your health insurance could cover your Gynecomastia Surgery. You should talk with your health insurance provider for any questions related to your coverage.

Gynecomastia reduction surgery boasts a 96% Worth It rating on RealSelf. We find that our patients have a renewed sense of confidence and self esteem after their procedures. Many of them describe the procedure as “life changing.”