Before Gynecomastia Surgery

Patients sometimes ask about exercising before male breast reduction surgery to build chest muscles. We do encourage our patients to pursue good health and we applaud those who work out—but it’s not a necessary step in preparing for the procedure.

You also don’t need to stop working out before you come in for male breast reduction. We would suggest you don’t exhaust yourself the night before surgery so you have plenty of energy in reserve for recovery, but a mild to moderate workout is fine.

After Gynecomastia Surgery

Gynecomastia surgery is less invasive than many other surgical procedures. Even so, the recovery process must still be gradual. You can expect to be able to drive after a few days and return to sedentary work and light activities in a few days as well. You can go to restaurants, see movies and enjoy other non-strenuous pursuits.

Workouts should not be resumed for at least four weeks. As you return to the gym, the pool or your jogging route, take it easy at first. The key is to take care not to raise your blood pressure too high too soon. Elevated blood pressure can cause increased swelling, and it can open a blood vessel that was sealed in surgery, leading to post-surgical bleeding or a hematoma even several days down the road.

Avoiding Common Mistakes

One of the most common mistakes men make when recovering from gynecomastia surgery is misunderstanding the reason for avoiding strenuous exercise for a few weeks. Occasionally one of our New York City gynecomastia patients will think, “I’m more fit than the average guy, I can take it,” and grab the free weights too soon. Others go back to their regular exercise circuit the first day back at the gym, without resuming the routine a little at a time.

Make sure you understand that maintaining low blood pressure the first few weeks after surgery will be of tremendous help in reducing swelling and guarding against bleeding. No matter how strong and eager for a workout you may feel, the inevitable rise in blood pressure is not worth the risk.

After all, shrinking those man boobs as fast as possible is what it’s all about, right?

Find more information about recovering from gynecomastia surgery and other aspects of enlarged male breasts in the list of frequently asked questions on our website devoted to gynecomastia surgery.

Photo by Spirit-Fire, available under a Creative Commons attribution license.

In an article in World Psychiatry several years ago, Katharine A. Phillips of Brown Medical School described BDD as a relatively common, severe mental disorder that can dramatically impact a person’s quality of life. She said, “Patients with BDD believe they look ugly or deformed (thinking, for example, that they have a large and ‘repulsive’ nose, or severely scarred skin), when in reality they look normal.” Unhappy sufferers obsess about one or more body features, spending hours worrying and looking in the mirror instead of socializing, working or pursuing other everyday activities.

When you think about it, it makes sense that some men who suffer with the disorder end up in a plastic surgeon’s consultation room to discuss male breast reduction. Many who are obsessed with their physique spend hours in the gym pumping iron, and some turn to anabolic steroids—known to cause gynecomastia—for increased muscle development. Even those with only a hint of moobs or no man boobs at all may perceive that their chest is unsatisfactory and seek plastic surgery.

Ms. Phillips joined forces with two other authors, Harrison G. Pope and Roberto Olivardia, both of Harvard University, to publish a book on BDD in men titled The Adonis Complex: How to Identify, Treat and Prevent Body Obsession in Men and Boys. The researchers point out that men are impacted by media images of bodies that are next to impossible to attain—think Chippendale dancers and the male models plastered around Times Square—just like women are. The difference is, men can’t really talk about it. They tend to suffer in silence, assert the authors, and develop dietary rituals, seek hair transplants and yes, consider plastic surgery whether or not it’s appropriate.

When we meet prospective patients to discuss gynecomastia in Manhattan, we probe motivations and stay on the alert for possible BDD. When we encounter someone we believe has an inaccurate view of his physique, our first suggestion is counseling. Unfortunately, even if the patient has an obvious case of gynecomastia, we might very well decline to operate. Not because we might not deliver a good result, but because we know it’s likely the patient would not be satisfied.

Ironically, all those hours in the gym can actually contribute to noticeable moobs, or “bitch tits” as they’re often called in the world of bodybuilding. Since these patients often have well-developed muscle structure and little fat, any excess breast tissue tends to be prominent on the chest wall. The tissue is usually concentrated in the center of the breast and often causes puffy nipples (though we have seen large amounts of breast tissue in body builders as well).

Another common contributing factor for body builders with man boobs is the use of anabolic steroids. Gynecomastia is a well-known side effect of these substances. The body converts the testosterone they contain into estrogen, which can trigger the growth of breast tissue.

Fortunately, for body builders who will refrain from taking illicit drugs in the future, male breast reduction surgery can provide a permanent solution. For our patients in New York with gynecomastia, we simply make a very small incision around the edge of the areola and remove the breast tissue. We often perform light liposuction to assist in re-draping the skin. Sometimes we use drains to help channel away post-surgical fluid and avoid build up. After healing, scars are most often nearly invisible.

Body builders are a unique group of gynecomastia patients in that they are most often in excellent physical and nutritional health. They pay attention to their well-being, and they don’t smoke. Therefore, body builders can generally anticipate a positive outcome from male breast reduction surgery.

If you’re a body builder with gynecomastia, we encourage you to visit a board certified plastic surgeon who’s experienced in working with patients like you and has dozens of before and after gynecomastia photos to prove it. If you’d like to consult us, just call the office at 212-570-6080 or use our contact form.

Photo by roonb, 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.

• Go back to work
• Return to their weight lifting routines

Most guys can return to sedentary work after about a week while still wearing compression vests which are  easily hidden under clothing.

Our patients wear a compression garment for four weeks 24/7 after surgery. For another two weeks, they wear the garments just at night.

We encourage you to slowly walk around the day after your gynecomastia surgery.  For the remainder of the first month, do nothing to increase your blood pressure or heart rate. Don’t do any lifting, aerobic exercise  or anything else that breaks a sweat.

Think all your conditioning and training is going down the drain while you heal? Not so — you’ll soon be back to your pre-surgery workout level.

Just wear the compression garments, avoid strenuous exercise for one month and you will have a nice looking chest for the rest of your life.  That’s a good bargain!

When you return to the gym four weeks after surgery, go easy on your chest.  It will feel tight and have a pulling sensation.  Gradually stretch your chest; within a few days it will feel normal.  If  swelling occurs after the gym, wear the compression garments overnight.

Oh, be sure to tell your plastic surgeon you’re getting back into the gym.

Gynecomastia surgeon – and body builder – Richard Silverman, M.D. was once asked for a safe routine after gynecomastia surgery.

He said, in part:

Basic rule: if a lift hurts, forget about it for another week.

At first,  lift light weights or use the machines and forgo any pec training.

By the sixth week, you can ease back into full body training, gradually increasing weights and reps.

If something just doesn’t seem right,  listen to your instincts. It probably isn’t right!

Just stop if you notice any pain, watch out for swelling, signs of infection or other problems around the surgical site(s).

Call your surgeon if you are really worried. We would much rather hear about a little thing that turned out to be nothing rather than deal late with a genuine problem that turned into a big thing.

(Read more about the advice of a body builder/gynecomastia surgeon.)

As you can imagine, the attitude in gyms among weight lifters is often overly masculine so male bodybuilders often refer to gynecomastia as having “bitch tits.”

You may also hear one or two complain about “man boobs” or the abbreviated phrase, “moobs.”

One New York City plastic surgeon had to constantly tell his answering service that callers asking about “bitch tits” were not being crude or impolite, but just using the language of the gym.

Because the mirror is the measuring tape of body building, many want absolute perfection in their bodies.

Consequently, they will go to extreme lengths to make sure those “ripped pecs, abs and lats” (Translation: highly developed chest, stomach and lateral muscles) show well through the skin.

But many often take a misstep and see a surgeon for only liposuction of chest fat.

In reality, many have cases of gynecomastia, quite often caused by the steroids they take to build larger muscles.

Usually, weight lifters have a very low body fat percentage, with some very dense breast tissue around and under the nipple.

But not always. We’ve seen some guys come in with solid white breast tissue as big as a softball.

What’s all this mean? A couple of things:

• Breast tissue is too dense to liposuction
• Breast tissue requires an incision in the brown area around the nipples
• But we do liposuction around the areola

That extra liposuction helps make the buffed up muscles shine through the skin more.

In a very few cases, some overweight body builders lost a lot of weight but were left with loose, hanging skin.

In those cases, we perform skin tightening and nipple relocation procedures.

Which can result in a perfect chest!

This bodybuilder had loose skin removed and his areoli lifted to a higher position.

(See more bodybuilder before and after Gynecomastia pictures.)