This can be a difficult topic to discuss. Young men are often reluctant to share their anguish due to the level of embarrassment they feel about their man boobs. Moms and dads usually have trouble figuring out how to broach the subject. Trust us, it’s worthwhile to face discomfort and talk with your son; he needs your support.

One great way to get started is to begin a conversation about how challenging—and sometimes funny—adolescence can be. This approach works especially well if you can relate an experience from your teen years that you laugh about now. This gives you the opportunity to talk about the role hormones play in physical changes, and how they can come on too strong and cause unwelcome effects like sudden voice changes, extremely oily skin and gynecomastia.

You can reassure your son that as hormone levels even out over time, body changes settle into place too. This means that for some young men, moobs disappear eventually. It may be helpful to print out information from qualified sources for your son. Feel free to make use of our website devoted to the condition: www.gynecomastianewyork.com.

If you’re thinking of making an appointment with your family doctor, you might want to have a conversation with the physician first. Be advised that some doctors may not be as sensitive as they could be in dealing with a teen with gynecomastia. Many tell a young man to wait and the problem will resolve itself. For some teens this is not the case, especially if moobs have been present for several months or longer. And if your son is lucky enough to see his enlarged breasts shrink over time, gynecomastia can take quite a toll on self esteem in the meantime.

If, like many teens and parents, you find it difficult to be as open as you’d like to be about body changes, here are some signs you can watch for—indications that your son may be really suffering:

• He gains weight suddenly, possibly to try to disguise his chest
• He walks hunched over and seems to be “hiding”
• He wears many layers of shirts at once, even in warm weather
• He becomes reclusive, especially avoiding activities that reveal his physique

One other consideration for you: gynecomastia can result from the use of illegal drugs like marijuana and anabolic steroids. It’s a good idea to acquaint yourself with all the triggers of man boobs in order to be armed with full information. The Mayo Clinic offers a comprehensive list here.

If you’re starting to think that plastic surgery might be an option for your son, you’re not alone. According to the American Society for Aesthetic Plastic Surgery, more than 18,000 men and young men had male breast reduction in 2010. And the number grows each year. Generally speaking, the procedure is straightforward, safe and effective.

If your son’s condition is persistent, if you want to learn more about gynecomastia surgery or you simply need help discussing the condition and your options with your young man, we can help. Make an appointment to consult us about gynecomastia in New York if you live nearby or can travel to the area. Male breast reduction is one of our specialties, and we have worked with many teens and their parents.

Give us a call at 212-570-6080 or contact us online.

Photo by Brandon Giesbrecht, available under a Creative Commons attribution license.

Of course, there are a number of patients who sign up for male breast reduction surgery eagerly and want to get into the operating suite right away! These are men referred to us by someone they know. After seeing a friend or loved one get a new lease on life when they lose their moobs, our referral patients are inevitably enthusiastic about achieving the same results.

Generally speaking, though, the patients we see for gynecomastia in New York seem to become more comfortable with the idea of male breast reduction as they do some research and discover:

• Gynecomastia surgery is not very invasive and is low in risk
• The procedure is satisfying and permanent for almost all men
• The sooner you have surgery, the more likely your skin will bounce back

For some who don’t want others to know they’ve had gynecomastia surgery, a question may remain as they approach a decision. What will it be like when I return to work in a compression garment with restricted movement?

The answer depends on you and the kind of work you do. For instance, if you have a job that requires you to dress rather formally in a tailored shirt or a uniform and you do very little lifting, it’s unlikely anyone will notice anything is different.

Similarly, if you work outdoors in cool weather and you wear a sweatshirt, jacket or similar clothing, it’s likely that your compression garment will not be noticed. But if lifting and carrying is part of the job, you may find it necessary to explain to some people why you need to take it easy for a while.

If your job setting is more informal and you typically wear a shirt that may reveal a compression vest to those you work with closely, you may also want to be prepared to explain the temporary change to your colleagues. Some patients decide to tell others they’ve cracked some ribs or hurt their back and need extra support. Some find it important to be as truthful as possible and say they’ve had minor surgery or even a growth removed and need a temporary bandage.

This is an ideal topic to discuss with patients who have been through male breast reduction surgery and recovery. You can ask other men—in a forum like the one on gynecomastia.org, for example—what it was like when they went back to work. This can help you think about how to prepare. The bottom line is, however, that just like any other medical concern, gynecomastia is no one’s business but your own.

Photo by Brent D. Payne, available under a Creative Commons attribution license.

One article brought to our attention recently actually perpetuates an old myth: exercise can rid you of moobs. In fact, the piece boldly proclaimed that you can now “free yourself” from gynecomastia by working out and went on to list the “best exercises” to get rid of the condition.

Unfortunately, it’s just not true. Exercise cannot cure gynecomastia.

The article in question made two incorrect assumptions. First, the author stated that gynecomastia, even when caused by a hormonal imbalance, is the result of excess fat. While patients who consult us about gynecomastia in New York often do have fat that contributes, unwanted breast tissue is almost always present as well.

The fact is that when men suffer hormonal swings—whether they’re temporary peaks and valleys which adolescents experience or an imbalance that triggers a more lasting condition—breast tissue often grows. We have seen very few cases of man boobs in which fat alone is the culprit.

The other major flaw in the article is an idea that was common decades ago: the notion of “spot reducing.” If you’re old enough, you may remember sets of exercises promoted to rid certain areas of the body of flab, and even strange devices marketed to stimulate, jiggle or otherwise prod certain parts of the body to shed fat.

Today, health professionals recognize that there’s no such thing as “spot reducing.” In order to lose love handles, beer bellies and, yes, excess fat in your chest area, you need to lose weight overall. But even when you’re successful in dropping the pounds, you can’t instruct your body about where to lose inches and where to retain them.  In truth, the only way to “spot reduce” is to have targeted liposuction on a particular area.  Toning chest muscles is a great idea, one we promote in our practice. But bench presses, push-ups and time on the rowing machine will not actually have an impact on your moobs.  In fact, it may make them worse by pushing them further outward from your chest.

In fairness to the author, there’s nothing wrong with recommending a workout like the one described in the article we’re referencing. In fact, we applaud any of our patients who decide to pursue a combination of weight training, interval training and cardiovascular exercises. We just hope most gynecomastia patients know by now that their man boobs cannot, as the author maintains, be “controlled with adequate exercise and a proper diet.”

If you have gynecomastia, the best advice we can give is to seek the counsel of a board certified plastic surgeon who’s a gynecomastia specialist. Failing that, start by visiting a website like gynecomastia.org, where you can ask questions of qualified physicians.

Photo by Dave Murr, available under a Creative Commons attribution license.

Men can have tuberous breasts just like some women do, and the condition is equally frustrating for both sexes. Some people learn to make peace with boobs that protrude a little like tubers—hence the name—while others seek cosmetic breast surgery to correct the condition.

To get a sense of what tuberous breasts in men look like, and the kind of surgical result that’s possible, take a look at our before and after gynecomastia photos. Pay close attention to patients 68, 71 and 77. Each one had a clear case of tuberous breasts, and all three patients were very satisfied with their surgical outcome.

Another frustrating aspect of tuberous breasts—sometimes called tubular breasts, zucchini breasts, Snoopy breasts (referring to the famous beagle’s nose) and other unflattering names—is that no one knows exactly why they occur. We do know that in patients with tuberous breasts the base diameter of the breast is somewhat constricted, causing growth in a narrow corridor instead of in a pleasing, rounded shape.

In women, breasts are usually smallish as well as misshapen and sometimes droopy, nipples and areolas can be large and puffy. It’s also not unusual for a marked degree of asymmetry to be present. When men have tuberous breasts, the growth of the breast gland is generally restricted to an area beneath the nipples. The result is usually the hated “puffy nipples” and often some sideways spread as well.

Treating a male patient involves making a small incision around the rim of the areola to enable the gynecomastia surgeon to remove the excess breast gland. Liposuction is almost always needed as well, not just to help remove gland and fat but to loosen and redistribute skin so the breast gains a normal contour. For the majority of patients, the formerly large, puffy nipples and areolas shrink to an average size after the procedure.

When a man decides to explore the idea of cosmetic surgery for tuberous breasts, the most important move he can make is to find an experienced gynecomastia surgeon. Not every plastic surgeon treats dozens of patients with man boobs each year, and even fewer see many male patients with tuberous breasts.

If you have this condition, do plenty of homework on the Internet first. Identify board certified plastic surgeons who specialize in gynecomastia surgery and have demonstrated experience with tuberous breasts. View the before and after gynecomastia photos to ensure this is indeed an area of specialty for a prospective surgeon.

Then arrange consultations with at least two, even if you have to send photos and have a discussion long distance. You may need to be prepared to have male breast reduction in New York or another large city to ensure you’re working with someone who can deliver the outcome you’re seeking.

We understand that having one man boob that’s bigger than the other can be extra distressing. That’s why we hasten to tell our New York gynecomastia patients that one-sided gynecomastia is not that rare. We see many cases of lopsided male breasts every year, and it’s a safe bet that every other gynecomastia specialist from Manhattan to Manhattan Beach does too.

The next thing to know is that it’s very likely you really don’t have gynecomastia on just one side. The truth is that many patients with man boobs are somewhat to extremely lopsided. Chances are, even if it seems like you only have one moob, you have at least a little excess gland or fat on each side.

Believe it or not, this is actually good news. Any experienced male breast reduction surgeon will tell you that it’s easier to achieve a near symmetrical outcome from gynecomastia surgery when you operate on both man boobs. Achieving a perfect match by reducing just one side can be a challenge.

Gynecomastia surgery takes skill and experience to get right, especially when a patient presents with one side dramatically larger than the other. If you believe you are one of the few men with gynecomastia on just one side, it’s all the more reason to ensure you choose a gynecomastia specialist with hundreds of surgeries under his or her belt.

One last consideration: there’s a small but real possibility that an underlying condition such as male breast cancer is behind the problem. When you have a consultation with an experienced plastic surgeon, you can feel confident that they will know if you need to see another specialist.

If you’re lopsided or one-sided and interested in our input, please contact us in Manhattan. Gynecomastia is one of our key specialties, as you can see if you browse our before and after gynecomastia photos. We find helping men like you most rewarding. If you live outside greater New York and New Jersey and don’t care to travel, do see an experienced male breast reduction surgeon.

Although we specialize in helping men feel content with their physiques with procedures like gynecomastia surgery, liposuction, torsoplasty and even nipple reduction, we don’t do areola reduction. Let me explain.

One reason we don’t perform areola reduction is that it’s too risky. If you cut a doughnut shape from around the edge of the areola, you’re essentially disconnecting an important part of the blood supply. This means there’s a very real possibility of loss of sensation. If you need to remove some tissue from beneath the nipple/areola complex as well, as most gynecomastia patients require, you will cut off most of the rest of the blood supply. In this case, the entire nipple can easily die.

If you do decide to remove a doughnut of skin from the areola to reduce its size, you then have to suture a larger diameter circle to a circle that’s much smaller. This results in a series of small pleats or puckers of skin that take time to iron out, and may not ever lie fully flat. This kind of wound is under tension as it heals, so some plastic surgeons use a permanent circular stitch to hold the incision together and prevent wide scars. Patients often complain that they can feel these sutures and find them annoying.

But the primary reason we don’t perform areola reduction is that our New York gynecomastia patients don’t need it. We often use a balloon analogy to explain. If you inflate a balloon and draw a dark circle on it, then let the air out, the circle shrinks. Right? That’s a good way to visualize what gynecomastia surgery does for areola size. As you remove the tissue that caused the man boobs and re-contour the chest, the areolas shrink. In fact, in all our years performing gynecomastia surgery in New York, we have never seen overly large areolas on a man without gynecomastia.

After male breast reduction, our patients are usually quite satisfied with the look of their chest—including the areolas. Still think you need areola reduction? Make an appointment with a highly experienced male breast reduction surgeon and see what he or she thinks.

These are questions every man who’s considering male breast surgery asks at some point, whether he’s online doing research at gynecomastia.org or chatting with us in the consultation room in New York.  Gynecomastia patients are actually luckier than patients seeking some other plastic surgery procedures in this regard.  Here’s why.

Every surgical procedure leaves a scar as the body heals with tissue that’s more fibrous.  In the case of relatively extensive plastic surgery where skin is delicate and there is tension on the wound —such as abdominoplasty, for instance—scars tend to be quite noticeable.  In a less invasive procedure, especially in an area where scars can be disguised, the traces of surgery can be almost unnoticeable after healing.

This is the case for most male breast reduction patients.  Our own New York gynecomastia surgeries usually involve a 1/8 inch “nick” in the skin on the side of the chest near the armpit where post-op scars are unlikely to be noticed. These heal to look like blemishes.

Sometimes we also make incisions around the areolas.  As these small incisions are made along the border of chest skin and the darker skin of the areola, the eventual scars are almost invisible.  Take a look at some of our before and after gynecomastia photos to see if you agree (scroll down to the bottom of the photo gallery).

Of course every patient is different, and scars are inherently unpredictable.  As you consider surgery, talk with your plastic surgeon about this.  Share any worries about scarring you may have, especially if you or a close member of your family has a history of unfavorable scarring.  And take note of what you can do to ensure your incisions heal properly, including wearing your post-op compression vest or bandages and limiting strenuous activities that can pull at scars and cause them to widen.

Good news about scars:  If a wound heals poorly, plastic surgeons have lots of tricks to improve the resultant scars – so all is not lost.

In any decision about plastic surgery, there are tradeoffs to be considered.  One of those tradeoffs is whether the scars that are likely to result are worth the aesthetic and/or functional improvement.   Most men suffering the embarrassment of man boobs decide that the scarring they can expect as a result of gynecomastia surgery is well worth the improvement in contour.

It’s understandable that men want to know the makeup of their man boobs.  Some think that if their problem is largely fat, they can embark on a strict diet or choose a liposuction-only solution for male breast reduction.  Others simply seem horrified at the thought of having female-like breast tissue under their nipples and just have to know what’s inside.

If you frequently poke and prod your chest in an effort to identify what’s beneath the skin, we have a suggestion: stop. We’d like you to consider that it really doesn’t matter all that much what’s inside those moobs.  Here’s why.

First, it can be a real challenge to determine from the outside exactly what kind of tissue you’re feeling with your fingers.  Fat can sometimes feel dense and lumpy–just as you might imagine glandular tissue to feel.  Even if you could determine that most of your excess breast tissue is fat, know that it can be very hard to reduce the size of your man boobs through dieting.  Men tend to put on weight most readily in their bellies and chests, and unfortunately those pounds can be quite stubborn to banish.

Actual breast tissue, which all men have to some extent, can also feel like fat to the touch.  It takes an experienced gynecomastia surgeon to get a sense of what’s behind a man’s moobs, and even experts can be wrong.  A patient can’t be expected to figure this out.  Moreover, in our practice we find that nearly every one of our New York gynecomastia patients has at least some measure of breast tissue that needs to be excised during their procedure.  That’s why we would never suggest a patient choose liposuction-only male breast reduction in the consultation room.  If the plastic surgeon is not ready to address whatever he or she finds after using the scalpel, the patient is likely to be dissatisfied with the results.

Let’s face it–when it comes to the male chest, what matters is contour.  You want to look masculine and sleek whether your arms are raised or at your sides, whether you’re pumping iron or at rest and whether it’s hot or cold.  The exact ratio of fat to glandular tissue is not something others will poke you to find out, and it’s not a vital factor in your overall look.

If you do find yourself preoccupied and unhappy with your chest, what we do suggest is a consultation with an experienced male breast reduction specialist.  Even if you’re not thinking of surgery but simply wanting some answers, it’s a good investment to seek expert input.

Photo by JoelK75, available under a Creative Commons attribution license.

After Gynecomastia Surgery

So many patients ask what happens after a male breast reduction procedure, I prepared a handout listing virtually all the questions that are most frequently asked. (FAQs.)

(I also have a handout instructing patients what to do before surgery.)

After any cosmetic plastic surgery procedure, the main concerns are:

• Infections
• Bleeding
• Fluid collections

The chest is usually – temporarily – swollen and slightly bruised at the surgery site. So you won’t be able to see the results of the surgery right away.

You may also be aware of some numbness, tingling, itching or mild burning that goes away after a few weeks.

Usually, I tell patients their chests will feel like they’ve done a very heavy chest workout like 300 push-ups.

A tight fitting compression vest is vital to stop fluid or pools of blood building up under the skin. Rarely, you may have some surgical drains under the vest.

And here’s where you have to be your own plastic surgeon and make yourself do what’s in your own best interest: wear the compression vest 24 hours daily, seven days a week except for showering.

And we’re talking three to four weeks after surgery. Not to worry; a compression vest fits nicely under your street clothes.

Here are some rare, but possible, post surgery symptoms for which you should get back to me or my staff immediately:

• Severe discharge, redness, tenderness or pain at the surgical site
• One side much more swollen
• Muscle aches beyond soreness
• Nausea
• An overall ill feeling with fever

Most guys are able to go back to sitting activities like desk work in two to three days.

More hardy exercise or sports can usually be resumed after about three to four weeks. But you’ll have to wait three to six months to see the full results of surgery on your chest.

Another rare, possible but totally unpredictable side effect is scar development on the chest or directly under the nipple any time after surgery. I’ll treat those at no extra charge for up to a year after your surgery.

Looking at the long term, the bulging, female-like breast tissue that was causing you so much embarrassment will not return. However, if you gain a lot of weight, some fat will appear on your chest.

But look on the bright side: if you protect your surgical investment, consume a sensible low-fat diet and continue with a reasonable exercise plan, you will only enhance the results of gynecomastia surgery!

Oh, I am SO ugly!

Just about anybody who is interested in plastic surgery has read and wondered about Heidi Montag’s many plastic surgical procedures.

Many are up in arms about Heidi having ten cosmetic plastic procedures in one day and wonder why somebody so obviously addicted to cosmetic plastic surgery is allowed to go under the knife.

But there’s a bit more here than meets the eye.

Heidi works in a highly competitive industry where appearance is not the only thing, it’s everything. Moreover, she has managed to keep herself in the public eye with all the comments about her procedures, including:

·         Liposuction

·         Rhinoplasty revision

·         Buttocks augmentation

·         Chin reduction

·         Breast augmentation revision

To the casual eye,  Heidi is young and strong.

Bear in mind I have not examined her but, off hand, I would agree that 10 surgeries in one day are a bit much but probably safe, providing that she has followed California law and had the required blood work, physical exam and medical clearance done before surgery.

But addicted to plastic surgery?

Probably not.

The official name of plastic surgery addiction is known as Body Dysmorphic Disorder, or BDD.

The hallmark of the disorder is dissatisfaction with one’s own body. Oftentimes, the perceived flaws are seen only by the patient and not by anyone else.

No amount of plastic surgery can correct what the victims sees as terrible flaws because it is a disorder of perception. The victim looks in the mirror and sees only ugliness – and is off to see yet another cosmetic plastic surgeon about correcting it

But plastic surgeons are trained to spot BDD. They must be –  the “victims” are famous for suing cosmetic plastic surgeons, claiming the outcome is shoddy, when, in fact, any rejuvenation surgery on a BBD patient is often found to be disappointing (at least to the patient).

Given Ms. Montag’s many appearances in skimpy bathing suits, I would venture to say that the young starlet could not be said to hate her appearance or her body. Just the opposite!

In a certain way, she is revelling in her new appearance and attention and is probably sifting with relish through the new offers of work she has received.