Male breasts are not inconsequential

It seems that gynecomastia is more common than I thought.  

It is, simply put, male breast tissue.  It can affect young adolescents to senior citizens. It’s effects on the younger generation are huge.  

I recently read a study that compared two similar age groups from 12-21.  One group had gynecomastia.  Those individuals with gynecomastia had consistently lower ratings of general health, lower self esteem, social functioning and mental health.  Some young teens had eating disorders and it did not seem to correlate with the degree of gynecomastia.  As a plastic surgeon in Florida, I have witnessed the severe depression that many of these patients feel. It's a shame. But not irreversible.

GYNECOMASTIA ON THE RISE

You might ask “what is gynecomastia?” Simply put it is male breast tissue.

It is on the rise and can be a very difficult surgical challenge. I happen to enjoy that challenge, because the solution is so gratifying to a patient..

The amount of excess breast tissue can be significant where the person may be a “C” cup. This is a constant source of embarrassment and low self esteem.

Living here in Florida, these men are afraid to bare their chests because of their excessive breast tissue. This tissue can be firm, gritty, regular breast tissue or merely excess fatty tissue. In most cases it is a combination of both.

Often times body builders who take steroids will exhibit varying degrees of gynecomastia. It also is common among men who are obese. Treatment consists of surgery, ie. via liposuction or direct excision.

These are procedures I perform right here as a Fort Myers plastic surgeon.

More men choosing plastic surgery - Dr. Brueck comments.

Once again, Fort Myers Board Certified plastic surgeon, Dr. Robert Brueck, reports on the state plastic surgery. You can read more from Dr. Brueck at his web site., Beauty-by-Brueck.com

THE RACE IS TIGHTENING

Men are mounting a great race. For so long, cosmetic surgery was primarily something women would inquire about and ultimately do, but men are staging a valiant challenge.

Recently released figures by the American Society of Plastic Surgery (ASPA) shows that more and more men are choosing the knife. Overall, cosmetic plastic procedures were up 2% in 2010 over 2009 BUT certain procedures really jumped. Facelifts were up 14% in 2010 over 2009 and Liposuction was up 7%. There was a 6% increase in gynecomastia resection (male breast tissue). I can’t help but wonder if their search for the fountain of youth is to help put their best foot forward in the job market.

I had liposuction to my “love” handles 25 years ago because they never went away. So frustration probably is also a big part. Obviously demand for cosmetic procedures is also distracted by the economy. In 2010 the top 5 male cosmetic procedures in terms of shear numbers were:

1. Rhinoplasty -64,000

2. Eyelid Surgery-31,000

3. Liposuction- 24,000

4. Breast reduction (gynecomastia)-18,000

5. Hair transplantation-13,000

When there is something about the way you look that you are not happy with, it can affect your self-confidence and well-being. There is nothing wrong with fixing it.

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 http://www.Beauty-by-Brueck.com