Gynecomastia is the term given for excessive breast development in males. It has an incidence that is much higher than most people think. An estimated 30 to 40% of all males (and 60-70% in adolescent boys) have varying degrees of excessive breast development. Teenagers will often have a temporary course of enlargement that resolves spontaneously over a 2 to 3 year period. Adult males often exhibit permanent enlargement.
Fortunately, there have been many advancements in the treatment of gynecomastia over the past 10-15 years. All breast tissue generally develops as a response to circulating hormones, especially estrogen. The balance between estrogen and testosterone helps determine whether breast development will occur or not. Men and women both have circulating testosterone and estrogen – just at different ratios. Males like females, have a “bud” from which the breast develops. Females have high levels of estrogen that throughout adolescence will cause breast maturation. Males generally exhibit low levels of estrogen and higher levels of testosterone, thus the relative lack of breast development. If males have low testosterone, or high estrogen, the breast “bud” can over-develop. Other causes of gynecomastia include marijuana or heroin use, medications (often used for depression, hypertension, or seizures), and adrenal/testicular tumors.
When making a decision regarding treatment, the duration and severity of the breast development are important considerations. Plastic surgeons will allow most adolescents at least 2 to 3 years for possible self-correction prior to any treatment. A thorough work-up is necessary prior to treatment to evaluate for any medications or diseases that may be causing the problem. If so, treatment is generally directed at the underlying cause. However for any gynecomastia lasting greater than 1 to 2 years, generally some, if not most, of the breast hypertrophy becomes permanent.
Medicines are generally not effective in the treatment; surgery is the primary mode of correction. Surgical options in the past were primarily “Excisional”- meaning that extensive scars were often necessary to remove the excess breast tissue. Breast reduction surgery in women often leave lengthy scars, but they are generally well hidden in the natural contours of the female breast. The cosmetic goal in male breasts is essentially to remove most, if not all, of it – in this situation, scars cannot be well hidden. Since the 1980’s, plastic surgeons have been utilizing Liposuction to contour the male breast – with excellent results. However, it was still difficult to remove some of the tissue, especially the hard lump generally found just beneath the nipple. Also, it was difficult to treat the excess skin that was often found in severe cases. In the mid to late 1990’s, a new technique of liposuction, called Ultrasound-Assisted Liposuction, helped even further advance treatments and outcomes. The ultrasound technology helps emulsify fat and works particular well in denser tissues (which are often found in male breasts). The thermal effects of ultrasound may even help contract some of the loose skin. This has become the state-of-the-art treatment for gynecomastia today.
In both cases, liposuction has allowed greater than 80% of patients with gynecomastia avoid extensive scars on the chest – and with good results. Surgery lasts approximately 1 to 2 hours, and a compressive vest is worn for 4 to 6 weeks after surgery. Swelling should subside between 6 and 9 months to arrive at the final contour.