A Discussion about Gynecomastia (Male Breast Enlargement)

What is Gynecomastia?

Adolescent male breast enlargement (gynecomastia) is actually a very common problem.  It often develops in a boy who is approaching puberty and has an otherwise normal body build.  Most of the time, this will resolve spontaneously within a year or two.  If it does not, the child and the family may choose to intervene surgically if it is very noticeable, tender or makes the boy self-conscious. This surgery involves either suctioning with a liposuction technique tailored to male breast enlargement or a short incision at the junction of the areola and the breast skin.  Unfortunately, although this is a true congenital deformity, insurance will not cover this surgery unless the patient has “Klinefelter’s Syndrome,” which is a pre-malignant condition and would be diagnosed by your pediatrician.

Gynecomastia may also be a result of generalized obesity.  The obesity should be addressed first if this is the cause, unless the enlarged breast is extremely noticeable.  In this case, there is usually skin excess as well as fullness, and the breast may be droopy as well as large.  The breast or fatty tissue will be addressed in the same manner as before, but some skin will have to be removed as well to restore the normal shape.  The pattern for skin removal which I prefer is around the areola in a circle because when the scar fades, it will not be obvious that surgery was done.  If there is a lot of skin, the choice is to put a more extensive and noticeable scar on the chest or to re-excise the circle in a few months under local anesthesia.  This may need to be repeated.  In both cases, the same amount of skin is ultimately removed, but the staged procedure provides a smaller scar.

There are some medications that can cause gynecomastia.  These include anabolic steroids used by body builders, Aldomet, Androgel, Cardiezem, Celexa, Lupron, Norvasc, Pepcid, Premarin, Lanoxin, Lunesta, marijuana, Motrin, Prozac, Wellbutrin, Xanax, Zocar and many others.  A complete list can be obtained on the internet.

Smokers heal poorly in terms of infection and wound breakdown, and you are advised not to smoke for at least 1 month before and after the surgery.  Nicotine screening may be necessary the day of your surgery.  IF THE TEST IS POSITIVE, YOUR SURGERY WILL BE CANCELLED.

The risks of this surgery include bruising and numbness which are usually temporary, swelling and very rarely bleeding or infection.  The patient will need to refrain from contact sports or aerobic exercise for about two weeks and may wear a compression garment around the chest for a week or two.  He can then switch to a Spanx for Men or Hanes Classics Power Slim undershirt for a few more weeks.

In general, this is a straightforward operation with few complications, minimal pain and a reasonably quick recovery, although some swelling will persist for up to several months.

It will be a pleasure to discuss gynecomastia with you.  Please do not hesitate to contact me if I can be of further assistance (804-320-8545).