A prolactinoma is a benign growth—or adenoma—of the pituitary gland. According to the Mayo Clinic, the growth produces excess amounts of a hormone called prolactin, which serves to decrease testosterone in men. Symptoms vary from patient to patient, and can include erectile dysfunction, loss of sexual desire, decreased body hair, a milk-like secretion from the breasts and gynecomastia.

The Mayo Clinic notes that women tend to notice prolactinoma symptoms earlier than men do, possibly because missed periods are common for women. Men often don’t notice anything unusual until the adenoma is much larger and causes headaches and/or vision problems.

If you believe you have the symptoms of a prolactinoma, a visit to your doctor is in order. He or she may refer you to an endocrinologist who will test your blood to see if you have elevated levels of prolactin. You may also undergo imaging, such as a CAT scan or an MRI, to help confirm the diagnosis and see how large the growth is.

Oral medications are available to suppress prolactin production, and some are effective in shrinking the prolactinoma in some patients. If treating the growth with medication is not effective, or if your vision is impaired, surgery may be the right course of action. Some patients do best with a combination of medication and surgery.

If enlarged male breasts persist after treatment, patients may be candidates for plastic surgery. For our New York gynecomastia patients with prolactinoma, we make every effort to coordinate care with other physicians to ensure the best possible outcome.

We have been performing male breast reduction for many years and have worked with 2,000 gynecomastia patients. When it comes to man boobs, we’ve seen about every shape and size you can imagine, and we’re experienced in the various causes of enlarged male breasts, including prolactinoma.

If you would like to hear our evaluation of your case, we would be happy to work with you. Just fill out our short contact form to request a consultation.

Photo by Will Foster, available under a Creative Commons attribution license.

The truth is, there are many foods that contain what are known as phytoestrogens. According to the Tulane/Xavier Center for Bioenvironmental Research at Tulane University, phytoestrogens are part of a larger class of plant-produced chemicals called phytohormones that “mimic or interact with hormone signals in animals.” You can read Tulane’s comprehensive overview of phytoestrogens here.

Since soy products are consumed in quantity by infants (in soy-based formula) and in Asian cultures, soy products are some of the leading phytoestrogen-rich substances under study. Still, there’s no clear answer as to whether soy can cause gynecomastia or not.

A 2008 article on “An Unusual Case of Gynecomastia Associated with Soy Product Consumption” by two endocrinologists suggests there may be a link between moobs and soymilk. The physicians describe the case of a 60-year-old man with elevated female hormone levels, gynecomastia and impaired sexual function. The patient reported consuming three quarts of soymilk daily, and when he discontinued the practice, his enlarged breasts and sexual symptoms disappeared and his hormone levels returned to normal.

But many other physicians remain unconvinced about the possible link between soy products and gynecomastia. Dr. Steve, the host of Weird Medicine on Sirius XM Radio, gives one fan some fairly typical input on the topic via the Men’s Fitness website. He says the notion that soy products stimulate breast growth “appears to be a myth, or at least is not supported by the medical literature.”

So what’s an average guy struggling with gynecomastia to think of all this? One important thing to know is that phytoestrogens are not rare. Read through the information on the Tulane website and you’ll find that foods that contain these mild estrogen-like chemicals include apples, cherries, garlic, parsley, wheat, rice, beans, carrots, potatoes and coffee. Most of us enjoy many of these foods in average amounts on a daily basis. So, we reassure our New York male breast reduction patients that their diet is most likely not the source of their problem.

On the other hand, if you happen to consume a large quantity of a food containing phytoestrogens, like soymilk, it certainly doesn’t hurt to discontinue the practice and see what happens.

Fortunately or unfortunately, depending on your point of view, most cases of gynecomastia cannot be influenced for the better by changes in diet. We urge you to contact a board certified plastic surgeon who specializes in male breast reduction to find out more about your specific case. If you’d like to contact us, give our offices a call at 212-570-6080 or fill out our short contact form.

Photo by Drab Makyo, available under a Creative Commons attribution license.

We find that, for most men we work with—whether we talk online, by phone or in person in our offices in Manhattan—the gynecomastia-steroid connection is well understood.  But there are other drugs, prescription medications, which are also linked to the development of man boobs. Propecia, a drug marketed to help stop and even reverse male pattern baldness, is one of those.

Propecia, also known by the generic name finasteride, has been demonstrated to be effective in increasing hair count for men suffering early hair loss.  Speaking very generally, treatment is most effective in younger men who have not yet experienced advanced balding.

Unfortunately, Propecia has also been shown to trigger gynecomastia in a small percentage of patients.  There are no formal studies yet, but there’s enough anecdotal evidence to suggest a link between Propecia and breast tissue growth for some men.  Equally distressing, there’s no way to predict who might suffer this unwanted side effect.

In working with our Manhattan gynecomastia patients and by studying the available literature, we’ve noted the following apparent patterns that impact surgical decision-making:

1. Men who developed gynecomastia early in life, then took Propecia with no apparent additional breast tissue growth, are usually good candidates for male breast reduction surgery. For this group of patients, we’ve observed no breast tissue regrowth after gynecomastia surgery even when the patient continued to take Propecia.
2. Men who developed gynecomastia after taking the medication can also be candidates for surgery.  In these cases, we recommend the patient discontinue the use of the drug to prevent reoccurrence.

If you’re taking Propecia and you have not noticed this particular side effect, don’t be overly concerned.  At this point it appears that the percentage of men who develop man boobs while taking the medication is small.  On the other hand, if you’ve noticed your breasts swelling, a visit to your primary care physician is probably in order and you may need to make a decision about continuing to take Propecia.

We’ve noted that once unwanted breast tissue develops in Propecia patients, it rarely disappears by itself.  If you would like to consult us about this or any other gynecomastia-related topic, call our offices at 212-570-6080 or fill out our short contact form.

Photo by e-Magine Art, 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.

When we counsel overweight patients with gynecomastia in New York, we advise them to try their best to lose weight before considering male breast reduction. We tell them that as the pounds come off, their man boobs shrink. For most patients they don’t disappear completely, but they do become smaller. And there’s the bigger bonus of being healthier and feeling happier overall.

We sometimes agree to perform male breast reduction for the right overweight patient. Often it’s someone whose appearance holds him back from physical activity, including regular workouts, so he has a difficult time losing weight. We refer to male breast reduction for these New York patients as “compromise surgery.”

In consultation, we advise these men to lose as much weight as they can before their procedure. We also ensure they understand that they will see improvement after surgery, but not “perfection.” They can expect their moobs to be smaller, but they should not anticipate a trim, tightly contoured chest. In fact, most retain some amount of inframammary fold, or crease beneath the breast.

Patient reactions to the results from compromise surgery run the gamut:

• Many feel that modest improvement is enough and they are content
• Others use surgery as inspiration to hit the gym for further improvement
• A few are disappointed, not having heard us about realistic expectations

In our practice, we do not perform gynecomastia surgery when patients are obese. There’s not enough improvement to be gained in the chest area when someone is that far from a healthy weight.

To determine the right course of action for you, the first step is to know your BMI, or Body Mass Index. There’s an easy-to-use calculator on the National Institutes of Health website. You can find some sound weight control suggestions there as well. When you’re ready, arrange a consultation with an experienced gynecomastia surgeon and listen carefully to what they have to say about the amount of improvement you might see after surgery.

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.

The answer to this question from our perspective is, “It’s not yet clear.”  There is some evidence that lavender and tea tree oil may contribute to gynecomastia, particularly in young males, but the proof is far from conclusive.  Here’s the story.

It all started early in 2007 when the New England Journal of Medicine published a study by a University of Colorado pediatric endocrinologist.  The physician found enlarged breasts in three of his male prepubescent patients and discovered that each had used personal products like lotion containing lavender, tea tree oil or a combination.  In addition, after the boys discontinued the use of such products, the gynecomastia disappeared.

A researcher at the National Institute of Environmental Health Services, or NIEHS, then tested the essential oils.  He found that the substances mimic the action of estrogen, which stimulates breast tissue growth, and/or inhibit androgen, which governs male attributes and limits breast development.  The NIEHS researcher said that the combination of effects made the essential oils “somewhat unique as endocrine disruptors” (see http://www.nih.gov/news/pr/jan2007/niehs-31.htm).

All this may sound convincing, and if you’re concerned about enlarged male breasts in adolescents it is something to consider—to a point.  There are several factors to weigh when deciding how worried to be about lavender and tea tree oils.  First is the small size of the study—just three boys.  Much larger groups would have to be studied, including control groups, for the findings to be notable.

Also, the boys used different personal care products, most not identified in the study, containing unknown concentrations of these essential oils.  In addition, there are many other endocrine disruptors the boys may have also been exposed to, such as ingredients found in pesticides.

Scientists have spoken up since 2007 to point out the shortcomings of the lavender and tea tree oil study.  And even while stating that the case histories of the boys and the tests on the oils showed “an association” between the substances and gynecomastia, the NIEHS itself said the strength of the association remained unknown and called for further research.

To our knowledge no further studies have yet been published.   So here we stay for the time being: there may be a link between the use of lavender and tea tree oil and gynecomastia in boys.  When our New York gynecomastia patients ask what they should do, we point out that when it comes to shampoos and lotions, there are plenty of choices these days.  The best answer we can give now is “better safe than sorry.”

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

Gynecomastia results from excess fat, overdeveloped breast tissue or a combination of the two.  When the culprit is too much breast tissue, the underlying condition is typically decreased testosterone levels.  With testosterone levels low, estrogen levels can climb and breast tissue may form.  Low testosterone levels can be the result of a number of factors including alcohol consumption.

Heavy drinking can also contribute to gynecomastia by affecting liver function.  Men with liver problems, including cirrhosis, may experience hormone changes that allow breast tissue to grow.  In addition, certain medications for liver disease can trigger the appearance of enlarged male breasts by affecting hormone levels.

Finally, there’s the simple matter of calories.  Many people do not realize how many extra calories they add to their diets each month by consuming beer, wine and cocktails.  Courtesy of the Task Force on College Drinking, a project undertaken by university presidents, researchers and students across the nation in partnership with the National Institute on Alcohol Abuse and Alcoholism, here are some sample calorie counts (per one serving):

• Regular beer:  149
• Light beer:  110
• Liqueurs: 188
• Red wine:  80
• Martini:  140
• Margarita:  168

You can see how quickly calories add up, even for a social drinker.  Since the typical male stores extra fat in his abdomen and chest, the implication is clear: overconsumption of alcohol can trigger the development of fatty man boobs.

If you have enlarged male breasts, the best way to understand the underlying cause or causes is to consult a board certified plastic surgeon with substantial experience in treating gynecomastia.  New York area residents and men across the country suffering from “moobs” can contact our office with questions or for a consultation.  We have a special interest in this area of plastic surgery and enjoy helping men from all corners of the nation look better, enjoy more activities and gain confidence.

Photo by T. Narik, available under a Creative Commons attribution license.

What Causes This Gyno?

While asking about the possibility of male breast reduction, many men want to know what caused their gynecomastia. (Read our last post about Kleinfelter’s Syndrome, a not-too-common  gynecomastia cause.)

The easiest answer is also the most common: Nature.

After birth, an infant may have larger breasts because he is reacting to his mother’s hormones which are still in his system from being in the womb. (Nature has arranged for both boys and girls to have some estrogen.)

During puberty, a boy can either have too much female hormone in his system or his breast tissue reacts too vigorously to whatever amounts of estrogen are present.

Some affected teens will see their chests return to a flatter, more masculine state. But, in our experience, if a boy’s “man boobs” last more than two years, the enlarged tissues will most likely remain into adulthood.

At other end of life’s spectrum, normal aging and declining male hormones may cause men to again grow larger breasts.

Between those milestones, other factors can come into play, including:

• Drug side effects

Antibiotics, antidepressants, amphetamines, and high blood pressure medications can cause male breast growth.

• Steroids

Body builders often take anabolic steroids to build larger muscles. But the substances reduce male hormones while chemically morphing into estrogen which create what weight lifters call “bitch tits.”

• Alcoholism

Problem drinking leading to liver disease may change the way the liver uses hormones, allowing a buildup of estrogen which then triggers larger breasts in men.

• Diseases

Malnutrition, kidney failure, thyroid disorders, cancer and other hormone reducing conditions can lead to male breast growth.

• Overweight

Obesity usually places extra fat on the chest anyhow. But too much fat ramps up the body’s production of estrogen which again, leads to…., well, I think you’ve got the picture by now. Paradoxically, some men with gynecomastia gain large amounts of weight on purpose to try and hide their prominent breasts.

• Puberty

Pre-teen and teen years can be especially cruel if a youngster  must complete junior high and high school with large breasts. Cruel remarks, teasing, taunting and downright bullying are almost guaranteed. Thus, we often recommend, instead of “watchful waiting” – recommended by many doctors – that the actual breast tissue be surgically removed early, as young as 14 or 15.

I have never had a case of gynecomastia recurrence after male breast reduction surgery on a teen boy.

(View some male breast reduction pictures.)