Monday, September 27, 2010

Gynecomastia: Diagnosis and Treatment, by Dr. Robert Brueck MD, Fort Myers

Another in the series of blog postings by Dr. Robert J. Brueck, MD FACS, Board Certified Plastic Surgeon practicing in Fort Myers and Cape Coral, Florida

I recently read an article in a national newspaper talking about the ramifications and the seemingly increasing incidence of gynecomastia or male breast tissue. Gynecomastia can be extremely large, tender and in some cases some men may suffer from breast cancer.

I feel the biggest issue with male breast tissue is the social embarrassment and psychological harm it can do to the individual. It can be truly devastating.

What causes gynecomastia: Usually gynecomastia is triggered by a hormonal imbalance which means less male testosterone compared with the female hormone, estrogen. This imbalance can be due to natural hormonal changes, certain medications and certain health conditions. About 25% of the time it is idiopathic i.e. there is no particular cause.

Male hormones control characteristics we associate with men, such as muscle mass, body hair, etc. Female hormones usually cause female characteristics i.e. breast growth and this hormone is estrogen. It’s important to know and realize that men also produce estrogen, the small quantities produced in men help to regulate bone density, affect their moods and also sperm production.

Gynecomastia in puberty is usually due to hormonal imbalance and usually goes away in a year or two. We often see gynecomastia in obesity and in that situation the abnormal breast tissue or collection of breast tissue, usually is atty tissue. As men age, there is another peak of gynecomastia occurring around the age of 45 to 50. It’s thought that about 25% of men suffer from it.

Certain medications such as AIDS medications or some meds used to treat prostate enlargement or cancer can cause gynecomastia. Some of the more common medications associated with gynecomastia include Digoxin and Furosemide or Lasix which is a very commonly used diuretic. Also the use of anabolic steroids (seen in gym rats) used to enhance athletic performance can cause gynecomastia as well.

On examination the gynecomastia may be fatty tissue and hence we call it psuedogynecomastia or lipomastia. There is very little breast tissue. When one examines this individual the abnormal breast tissue is soft and does not have any firm grittiness to it.

Most of the time the exam reveals a combination of fatty tissue and BREAST TISSUE. The breast tissue itself can be firm and nodular. In some cases the gynecomastia tissue is located underneath the nipple areolar complex. This can cause the nipple areolar complex to increase in size and be puffy. The gynecomastia also can be asymmetrical, that is one side can be larger than the other.

HOW TO TREAT IT: Treatment varies depending on what one finds on examination. Assuming there are no offending medicines, anabolic steroids, etc then one can either accept the condition or consider getting it surgically removed. Obviously, if there is a medication that may be the underlying culprit then stopping that medication may cause the gynecomastia to go away on its own.

If the underlying breast tissue is fatty tissue only then liposuction alone may be adequate. If it is a combination of breast tissue and underlying fatty tissue then I utilize suctioning and actually direct excision.

Usually, the incision I use is centered around the nipple areolar complex. Obviously we want to create as little scarring as possible. The biggest decision is, do we need to remove excess skin? We try to do the excess skin excision, if necessary with incisions around the nipple. This way the incision can be camouflaged and be limited to the area around the nipple areolar complex. There are some examples of this on my website.

The operation usually takes one to two hours and is done as an outpatient under sedation. What this basically means is there is no pain associated with it. There is minimal discomfort post-op as well and we certainly provide the patient with pain medication to control any discomfort they may have.

I think the most important thing to do post-op is to wear a compressive vest overlying the chest area night and day to minimize swelling and keep the skin from folding. I usually recommend that an individual wears his vest for a minimum of two weeks, sometimes up to four weeks depending on the degrees of skin laxity, swelling and edema.

Sometimes, but rarely, insurance will help pay for the procedure. I have to say that the results can be amazing and, oh so gratifying, when you can give an individual his life back as a result of suffering from gynecomastia.

If you would like to learn more about plastic surgery and how it may help you with facial or body concerns, visit Dr. Brueck's website at

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