A broad, flat chest is one of the hallmarks of masculinity. However, for some men, no matter how much they work out or eat right, they still have a full chest. This condition, called gynecomastia (also know as “man boobs”), is so common that it affects about 36% of young men and 57% of older men in the Boston area. Gynecomastia can make you feel self-conscious in some clothing such as polo shirts. It may prevent you from wanting to partake in certain activities like swimming or going to the beach. And it can definitely take a toll on your self-confidence.
Gynecomastia is defined as an enlargement of the chest caused by an excessive amount of breast tissue, and breast gland. It can manifest as a fullness of the breasts, in breast tenderness or pain or as nipple discharge. These symptoms may affect one or both breasts. The trigger for gynecomastia is a decrease in testosterone or an increase in estrogen. While certain drugs and medical conditions can bring about this imbalanoptioce, the underlying cause of gynecomastia is often unknown.
Board Certified Plastic surgeon Dr. Sean Doherty has extensive experience in treating gynecomastia. As a man himself, he is sensitive to how physically and emotionally traumatizing this condition can be. If you think that you may be suffering from gynecomastia, your first step is to schedule a consultation with Dr. Doherty at his Boston or Brookline office.
It is vital to get assessed in person. Just as there are different degrees of gynecomastia, there are different treatment options. Some patients may be able to get away with liposuction alone, but most are going to need a male breast reduction or gynecomastia surgery. It is a simple procedure in which Dr. Doherty removes the excess glandular tissue and fat from the breast area to deliver a firm, flat, masculine-looking chest.
*Each patient is unique and individual results may vary.
What Causes Gynecomastia?
Gynecomastia occurs when there is an imbalance in your testosterone and estrogen levels. All men have some estrogen. However, if these levels get too high, it can result in man boobs. There are three peak onset times for gynecomastia:
- Infancy: This typically resolves within 2-3 weeks of birth.
- Puberty: Hormonal imbalances during this time can result in swollen breast tissue, but it usually goes away on its own within 6 months to 2 years.
- Adult Age: Gynecomastia peaks in men between the ages of 50 – 69. As many as 1 in 4 men in this age group will be affected.
There are any number of factors that can cause your estrogen levels to rise or your testosterone levels to drop. These include alcohol and street drugs such as:
Prescription drugs such as:
- anti-androgens used to treat prostate enlargement
- ulcer medications
- heart medications
- diazepam and other anti-anxiety meds
- tricyclic antidepressants
There are also certain health conditions that can cause an imbalance in your hormone levels. These include:
- Klinefelter’s syndrome
- tumors involving the testes, adrenal glands or pituitary gland
- kidney failure
- cirrhosis or failure of the liver
*Each patient is unique and individual results may vary.
Pseudogynecomastia vs. Gynecomastia
There is a lot of confusing information on the internet about pseudogynecomastia versus gynecomastia. Both are caused by a hormone imbalance. Both result in a swelling of the breasts. The difference is really one of clarification. Pseudogynecomastia is the result of an excessive amount of stubborn fat in the pectoral region of the chest. While gynecomastia is the result of an excessive amount of breast tissue and fat.
Most men don’t realize that we have breast tissue just like women. When your hormones get out of whack, it can result in a feminization of this tissue or ‘moobs’. If you are suffering from pseudogynecomastia and you are overweight, Dr. Doherty’s first suggestion will be to take off the excess weight. This may cause the gynecomastia to resolve on its own. Even if it does not deliver your ideal chest, it is always a good idea to be within 10 pounds of a maintainable goal weight before getting any kind of aesthetic surgery.
As a 33 year-old male, it can be embarrassing to have a problem with enlarged breasts. This was my 2nd Gynecomastia surgery. The first was at age 30, and it was performed by a different doctor. After the first surgery, I was pleased with the results, however, the issue returned and I didn't totally feel at home with the doctor. The doctor that had performed surgery #1 was a nice guy, but I didn't always feel comfortable with his bedside manner and his responses to my questions. When the gynecomastia issue returned 2-3 years later (to the point where I was no longer comfortable going out unless I had a compression tee on), I knew I needed to address the situation. I was hesitant at first, because I didn't want to use the same doctor as before, so I decided to do a fair share of research. I came across Dr. Doherty's name. After carefully looking at his reviews, I decided to make an appointment to see him. No B/S, he made me feel 100% comfortable about my concerns in the first 5 minutes of meeting him. He noticed right away that there was a good amount of breast tissue in both of my pecs, and together we decided that surgery was the best option for the results I was looking for. I just wanted to have a normal looking chest again and be able to wear a tank top or a tight tee, and not have to worry that everyone under the sun was staring at my chest. Prior to surgery, we met to discuss the operation. Dr. Doherty couldn't have been any kinder. We exchanged emails & phone calls, and he was very quick to respond to any of my questions or concerns. On surgery day, the Doctor assured me that everything would be fine, and of course, it was. He kept in constant contact with me post-surgery to ensure I was healing okay, and we met every few weeks as well. It's been about 3 and 1/2 months since surgery and I feel amazing. I have no stress or anxiety about having my shirt off anymore. I've finally been able to get back to the gym and haven't had any issue from the procedure. The normal bruising and soreness didn't last very long. I had to wear a compression vest for a few weeks, but it was easy to get used to. If you're a guy and have similar concerns as I did, I highly recommend looking into this procedure. It costs nothing to make a consultation appointment, and I guarantee you won't regret it.
Gynecomastia Treatment Options
The right treatment option for you is going to depend on your anatomy, degree of gynecomastia and goals. Many men desire a completely flat chest. But as with all body contouring, the right chest for you is going to come down to proportion. Dr. Doherty will take the time during your consultation to really listen to your concerns and desired outcome. He will perform a physical exam to determine your level of gynecomastia, and then have an honest conversation with you about your best treatment options.
While there is no ‘natural’ do-it-yourself cure for gynecomastia, if it is the result of taking certain drugs or a medical condition, it should resolve once those drugs are stopped or the medical condition improves. If it is the result of excess weight, the gynecomastia should improve once you lose weight. In all other cases, however, the patient will require some type of gynecomastia surgery. In patients whose gynecomastia is solely the result of excess fat in the chest, Dr. Doherty will perform liposuction alone to decrease the size of your breasts. However, most men’s gynecomastia is the result of an excess of breast tissue and fat. For them, Dr. Doherty will perform a male breast reduction.
Male Breast Reduction Procedure
Depending on your type of gynecomastia, Boston plastic surgeon Dr. Sean Doherty will use one of two male breast reduction techniques. In patients whose gynecomastia is caused mostly by excess fat, Dr. Doherty will perform liposuction of the chest area. He will suction out the excess fat with a small tube or cannula through several tiny incisions. This surgery is performed in the operating room either under local or general anesthesia.
In patients whose breast enlargement is due to excess breast or glandular tissue and excess fat, Dr. Doherty will surgically remove the excess breast tissue through an incision made around the areola. The areola tissue may need to be reduced to accommodate to your new chest. This will be discussed with you in detail during your initial consultation. Once the extra tissue is excised, Dr. Doherty will use liposuction to remove the excess fat and further contour your new chest. This surgery is performed in the operating room under general anesthesia.
While both liposuction for gynecomastia and the male breast reduction are performed in the operating room, neither requires an overnight stay. You can expect to feel sore for about 4-7 days after surgery. Part of this will do the anesthesia. You can have some mild to moderate bruising and swelling following your procedure. The bruising typically resolves within a couple of weeks. Certain homeopathic drugs such as arnica may help to speed up the process. The majority of your swelling will resolve within 6 weeks, and this is when your final surgical results are typically visible. However, it can take anywhere from 3-6 months for all of the swelling to fully subside so be patient.
Dr. Doherty has all of his gynecomastia patients wear a compression vest 24/7 for the first three weeks following surgery, then for 12 hours a day for another two months. The vest reduces swelling and helps to ensure an exemplary result.
Whether you have chest liposuction or gynecomastia surgery, you will need to refrain from any kind of exercise for 7-10 days after surgery. Typically, at this point, Dr. Doherty allows his gynecomastia patients to return to light exercise such as cardio. Most patients can get back to their full work out regime, except for chest work, at 3 weeks post op, and all exercise at 6 weeks post-op.
To find out more about gynecomastia with Dr. Sean Doherty at his Boston or Brookline office, contact us today or call (617) 450-0070 to schedule a consultation.
Frequently Asked Questions
It depends. You will need to be examined in person by a board-certified plastic surgeon with a lot of experience in treating gynecomastia. If the swelling in your breasts is solely the result of an excess of fat in your chest that is resistant to diet and exercise then yes, liposuction alone is the treatment of choice. However, gynecomastia is typically due to an excess of both breast tissue and fat which require a surgical excision of the breast tissue in addition to liposuction
No. And frankly, it would look strange. All men have some degree of breast tissue. This can not be completely excised nor should it. The right chest for your anatomy is about proportion, but it will definitely have some degree of curve.
Any time that skin and tissue are surgically removed, there is going to be a scar. This is simply the trade-off for a surgical improvement. And though a scar on the breast sounds scary, they actually heal incredibly well. Most gynecomastia scars are placed around the nipple where they are camouflaged by the transition of the nipple to the breast skin. In certain extreme cases, the scar may be more severe. But for most of these men, the scar is a small price to pay for a flatter looking chest. There are also many extremely effective scar therapies such as silicone gels and laser treatments. Dr. Doherty is happy to discuss these options with you during your initial consultation.
Recovery from gynecomastia treatment is fairly easy. You may have some bruising, but this typically resolve in two weeks. You will be swollen, but the majority of the swelling resolves in about 6 weeks. This is when you can expect to see your final results. The biggest drag for most gynecomastia patients about their recovery is wearing the compression vest. However, it is a vital component of your healing process. You’ve taken the time away from your daily life or work and spent the money to finally improve the look of your chest. So, you need to apply the same time and care to your recovery. This means that you must wear your compression vest for the prescribed amount of time. It is worth it in the long run.
In the hands of an experienced plastic surgeon, the results of your male breast reduction should be permanent. However, if you wind up taking certain drugs or gain an extensive amount of weight post surgery, this could adversely affect your results. Most of the time, a recurrence of gynecomastia is due to an inadequate glandular excision during your initial surgery and/or liposuction alone when there should have also been an excision. This is why seeing a board certified plastic surgery with extensive gynecomastia experience is so important.