Gynecomastia (overdevelopment of male breasts) is a common condition characterized by an excess of localized glandular tissue in the breast.  Pseudo-gynecomastia has a similar look, but the excess is of fat alone, and not breast tissue.

Gynecomastia occurs in approximately 50% of teenagers and resolves in 90% of those individuals leaving about 5% of males with true breast development.

For teenagers, the right answer is generally to wait as for most it resolves.  However, by adulthood, surgery will make all the difference.

It can be caused by hormonal disturbances (hypogonadism), certain medications including anabolic steroids, and certain drugs, notably marijuana.    It can occur in one or both breasts, and can affect babies, preteens, teenagers and older men due to natural hormonal changes.

Symptoms of gynecomastia include enlarged breasts, breasts that feel rubbery or firm and, in young boys, nickel- or quarter-sized breast “buds.” Breast buds are common in adolescents, and tend to go away on their own.

Treatment of Gynecomastia

Once growth has stabilized and other causes, such as disease or medication are excluded surgical treatment becomes an option.  Generally waiting until at least the age of 17 or 18 is necessary to ensure that natural hormonal involution is not going to occur.

Liposuction or resection will be planned based on the extent of the gynecomastia and whether or not there is significant skin excess.

For a more diffuse and mild gynecomastia liposuction may be all that is needed.  More commonly a direct excision through an incision along the lower half of the areola is used to remove the firm “puck” of tissue beneath the nipple along with liposuction around the periphery.

In those with skin excess, the nipple may be moved upwards and a large incision along the fold under the breast is used to remove skin and leave a normal appearing male chest.

Nearly all surgeries are performed in the operating room under anesthesia, though some mild cases can be treated in the office.

Recovery After Surgery

With resections, drains area placed and stay in position for 5-10 days.  A compression wrap is worn continuously after surgery and transitioned to a compression Vest that can be worn under clothing at about a week.  This vest is worn for 4 to 6 weeks.  Generally 1 to 2 weeks off work, 4 weeks before exercise.

While scars are present they generally hide pretty well.  If there is significant hair growth, scars are often tough to see.  For others they can be noticeable, but the contour improvement and ability to wear clothing comfortably, including tight T shirts is a huge improvement.

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