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.

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.

Swelling is the body’s natural response to injury or surgery (we often refer to surgery as “controlled trauma”).  It is simply the movement of fluid and white blood cells to the surgical area and the body’s effort to heal.  Post-op swelling is different for every patient.  It can be diffuse and spread over a fairly wide area, or localized.  The swollen area can feel hard or soft.  Fluid can accumulate soon after surgery, or build up a few days later, and the swelling can be different on the two sides.  Maximum swelling usually occurs around 48 hours after surgery – but the body’s urge to swell can last for weeks.

The important thing to note is that moderate swelling is generally not a concern.  The body wants to swell for a few weeks after surgery, not just the first few days.  We tell our New York gynecomastia patients that it will almost always resolve itself over several weeks, as long as they follow instructions.  These normally include wearing a compression garment for at least four weeks.  We use compression vests and/or binders for most of our patients; other plastic surgeons use different types of compression garments.

Other measures our New York gynecomastia patients take to minimize swelling include:

• Taking it easy after surgery as directed
• Resting in an elevated position when possible
• Limiting arm movements and lifting for several days
• Avoiding all strenuous exercise for four weeks

Very rarely, a patient may develop a complication following gynecomastia surgery.  Excessive swelling may indicate the presence of a seroma, or fluid collection under the skin.  A simple procedure to drain the fluid may be performed.  Swelling can also indicate the presence of a hematoma, or pool of blood, within the breast.  A visit to the surgeon is then needed to determine whether immediate or delayed treatment is in order.

The risk of developing a seroma or hematoma is low, but we always suggest our male breast reduction patients call our New York office if they have any concerns.  Certainly, any patient should contact his plastic surgeon to report extreme pain, asymmetric chest enlargement, significant bruising, bleeding from incisions or any other post-op problems.

We’ve already discussed how gynecomastia causes extreme embarrassment, social withdrawal and can ruin a person’s self-image, making him feel worthless.

Truth be told, there is plenty of pain to go around!

On one website supporting a petition asking insurance companies to cover gynecomastia surgery, you can see lives being held back.

For instance, Bruce blogged:

“I opted out of a promising military career because I would not disrobe…I suffer from depression and often isolate myself. (Health) insurance will pay for tummy tuck and breast reduction in women but not for gynecomastia. Would somebody explain why?”

Mark B. wrote:

“The emotional impact can lead to feelings of hopelessness, depression and thoughts of suicide…there is pain and tenderness when jogging..gynecomastia plastic surgery has nothing to do with cosmetics. All we want to do is live normal and productive lives.”

Giovanni V. added:

“It is not normal to have breast tissue if you are a man!”

Louis P shared:

“Having gynecomastia as a teen, I put on a lot of weight because I thought I could hide it…I’m now 40 and trying to lose the 100 pounds I put on…An adolescent boy should not have to suffer through what I did!”

Porta S. wrote:

“At age 15, my son’s breasts are larger than mine; he can easily fill a size B bra. This otherwise healthy, athletic boy has to deal with kids gasping in horror when changing clothes in gym.”

Chase, 18, blogged:

“I have not led a full life due to my gynecomastia and it kills me! I try not being depressed but I can’t help it. Insurance coverage would give me the second chance I so desperately need.”

Jim, 48 said:

“In high school, my girl friend said ‘What the hell is this?’ while we were swimming. To this day, I won’t take my shirt off in public.”

Dedan L. wrote:

“I developed gynecomastia at 13. Whether I was 135 or 235, it made no difference. Even at my largest and leanest, 215 and 8 percent body fat, I still wore a rash guard (a spandex athletic shirt) to the beach.”

Karen added:

“My 13-year-old son has gynecomastia; it’s heartbreaking to see him worry so much about how much breast shows through his shirt.”

56-year-old Paul blogged:

“I have considered taking razor blades and performing surgery on my man boobs. My entire life has been affected by gynecomastia.”

Remember our recent post about gynecomastia and shirts off and shirts on guys?

Julian, a handsome 24-year-old black dude, is very much a shirts-on guy AND a jackets on guy, to boot.

Even on a hot day at the beach, he wears some kind of a jacket to hide his huge, sagging breasts.

His man boobs are so large, the areola (the brown skin surrounding the nipples) have been stretched out.

Moreover, it is verboten for his lovely girlfriend to touch his chest. So Julian, tired of hiding part of his anatomy, saves his money until he can afford the attention of a board-certified Newport Beach (California) plastic surgeon.

While the story is told on a YouTube segment, it was actually filmed for the old Plastic Surgery: Before & After, a program that aired on the Discovery Channel before its host, Dr. Jan Adams, ran into extremely serious trouble over the death of Donda West and a subsequent D.W.I.

(Later on, we will post a blog about why Ms. West’s death could have been prevented by a physical before plastic surgery.)

Dr. Adams’ show depicted actual surgery which starts with liposuctioning of as much of Julian’s breast fat as possible.

The  surgeon makes a small incision on the bottom side of Julian’s areola and then removes the actual breast tissue – yes, like woman have – which doesn’t yield to liposuction.

Julian receives a bonus on healing when he discovers his areolas are smaller.

And he may go back to the surgeon in three to four months to remove some excess, sagging skin on his now flatter chest.

The final frames hold a lesson for many plastic surgery procedures.

Julian is thrilled to take his shirt off in public — for the first time ever! — but  his chest is still a little swollen.

The lesson? Final results often take more months than patients like.

Plus, the lady in his life is thrilled that his chest is no longer off limits!

Watch the gynecomastia video – which may also remind you how much Plastic Surgery: Before & After is missed!