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.)

Gynecomastia patient has one breast larger than the other

Occasionally, a patient comes into my office with one breast larger than the other and, to appear normal, wants gynecomastia surgery on just that one breast.

It’s a condition known in medicine as unilateral (meaning, one side only) gynecomastia which requires a unilateral mastectomy.

First, we make sure nothing else is happening — like a tumor.

But here’s the fly in the ointment: it is very difficult to operate on one breast and make it identical to the other. About the only way to accomplish the task is to perform surgery on both.

Otherwise, the outcome can be one breast that looks normal (the operated breast) but now the untouched breast may look odd — or even bigger in comparison.  And usually some excess tissue on the other breast also exists, but obviously not as much as the larger side.

So, most plastic surgeons want to perform surgery on both sides as well.

I usually recommend that both sides be done to provide the best and most optimal results possible.

While virtually all gynecomastia patients report being unhappy with their large, female-like breasts, having one breast that is far larger than the other only makes the problem worse.

Some body builders are extremely frustrated when they devote endless hours to weight lifting and then discover the large chest muscles they have developed only make the breast fat and tissue – known as “bitch tits” to them — stick out farther.

The one larger breast problem also occurs in teens and non-bodybuilding men.

Overall, you may be wondering how many men have – or will develop – any form of gynecomastia. If you look at the articles that have been written about the topic, it often depends on who counts.
Four M.D.s writing in a 1961 issue of the Journal of the American Medical Association (JAMA) reported that 65 percent of boys may have the problem but that it “typically resolves on its own.” (Also, typically, many do not!)

A military doctor, counting Navy patients on active duty in 1944 found eight percent had enlarged male breasts, or “man boobs.”

Other researchers, counting hospitalized men and  those in pathology labs, found about 40 percent have the condition with almost 60 percent of men over 70 having it.

One of the statistics I like the best is by Merl Yost, a psychoanalyst, gynecomastia patient, author of a book on gynecomastia and operator of the excellent website, Gynecomastia.org.

Yost wrote in a 2006 article for Men’s Health that about 91 percent of gynecomastia surgery patients were happy and would recommend the procedure to a friend.

All of which brings us to our next post: of the nine percent who were not happy, some had revision gynecomastia surgery.

Same patient as above after gynecomastia surgery

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!