It's not going to surprise anyone to hear that thousands of patients a year are going to plastic surgeons' offices looking for correction of their uneven, unsightly, and sagging breasts.  But is it surprising to hear that these are male patients?  In 2003 the American Society of Plastic Surgeons (ASPS) reported that 14,611 men had breast reduction surgery to correct gynecomastia, the medical term for female-like breasts in men. 

Symptoms and Side Effects

As many as 40-50% of men suffer from this condition that can range in severity, and can include the appearance of excess fat tissue, excess breast tissue, or the development of female glands.  Gynecomastia can occur in either one or both breasts, and the symptoms can vary greatly.  For some, the disease is no more than an excess of fat and tissue that causes no pain aside from social embarrassment.  In other cases, what is called true gynecomastia, men develop female glands in their breasts.  In some cases men experience a hard lump under their nipple with some associated pain or discomfort, and can also encounter nipple excretion.

Causes

Gynecomastia can develop in adolescents as early as age twelve as a result of hormonal changes.  Other chemical shifts caused by aspirin, marijuana, alcohol, cigarette smoke, Valium, and other drugs and medication can increase the chances of gynecomastia.  Men taking anabolic steroids often suffer from gynecomastia as testosterone levels in the body rise dramatically, causing the body to respond by producing enzymes that turn excess testosterone into estrogen.  Other factors including being obese or overweight and aging can cause the development of excess tissue.

Treating Gynecomastia

In some instances, simply changing eating habits or drug usage can reverse the development of gynecomastia.  For teens, signs of breast development regress within a few months or toward the end of adolescence about 90% of the time.  In these cases it is best to wait and let nature take its course.

In other instances, however, gynecomastia is permanent and can only be treated with surgery.  Dr. Mordcai Blau, chief of plastic surgery at the Westchester Ambulatory Center in New York says that the necessity of surgical intervention is dependant upon the boy's body type.  "If he is trim and fit [gynecomastia] will not go away, and surgery can be performed as early as 15 or 16."  Patients who are overweight, says Dr. Blau, will usually have regression of breast development, and it is best to wait until they are 18 before surgery is considered.

Of course surgery can be an option for men at any age.  Some of Dr. Blau's patients are in their 60's, and many are athletes and body builders in early middle age or younger.  Men of all ages have breast surgery for the same reasons as women: to feel more self-confident and attractive.

The Surgical Cure

Just like any other elective surgery, men choosing to go under the knife should be aware of the pre-operative qualifications, surgical and non-surgical options, and should be familiar with the doctor and staff.  With a total price tag that can be as high as $6,000, usually not covered by medical insurance, not to mention the associated risks that accompany every surgery, the decision to have surgery should not be taken lightly.  Dr. Blau, as he does with all surgical procedures, provides patients with a 25-page personalized booklet that explains to patients the procedure, risks, and possible complications.  He says that men are becoming better informed and more open about surgery, this makes them better patients and can lead to better results.

Performing the surgery, that can last about an hour and a half and is usually performed as an outpatient procedure, can be done using surgical excision, liposuction, or a combination of the two.  For the majority of Dr. Blau's patients a combination of both techniques is necessary. After making a small incision at the lower part of the areola, Dr. Blau surgically removes excess tissue, and then uses liposuction to remove any remaining fat.

Recovery

After surgery doctors use compression garments or ace bandages (Dr. Blau's preferred method) to offer support while the area heals.  Because the operation is an outpatient procedure and can often be performed with the use of a local anesthetic and an intravenous sedative, many patients feel comfortable returning home within an hour of surgery, but may not be able to return to normal activity until a few weeks later.  Dr. Blau tells his patients on training regimens not to return to them for 2-3 weeks, and even then says that they should take it easy and gradually build toward their normal routine.  It is essential not to over do it at first, says Dr. Blau, as the most common surgical complications, especially hematoma, stem from patients trying to do too much after surgery.

Choosing a Surgeon

Gynecomastia can cause men social and emotional stress, and having to undergo multiple surgeries or suffer complications and side effects will only add to the problem.  To ensure you will receive adequate care, Dr. Blau believes it is important to choose a board certified plastic surgeon affiliated with a respectable local hospital.  Most importantly, he says that the patient "should interview the doctor and choose one that makes him comfortable, and a staff that makes him comfortable."