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- May 20, 2005
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What is Gynecomastia?
The term comes from the Greek words gyne meaning "woman" and mastos meaning "breast." In practical terms, this means abnormally large breasts on men.
The condition is relatively common in adolescent boys, and 90% of the time symptoms disappear in a matter of months, or, as adolescence wanes, a few years later. But the remaining 10% are burdened with a social handicap that causes a deep and complex shame, and puts one's relationship with one's body at risk.
There are several potential causes:
* puberty
* steroid abuse (bitch tits)
* obesity
* marijuana use (this is in question)
* tumors
* genetic disorders
* chronic liver disease
* side effects of many medications
* castration
* Klinefelter Syndrome
* Gilbert's Syndrome
* aging
The Remedy
In cases of obesity, weight loss can alter the gynecomastic condition, but for many it will not eliminate it. For all other causes, surgery is the only known physical remedy. Once the physical encumbrance is lifted, psychological scars still need to be addressed. One must come to terms with one's body, accept it, and heal the wounds from the past.
Psychological Issues
Gynecomastia can be emotionally devastating. Feelings of shame, embarrassment and humiliation are common. One does not feel masculine in a society where masculinity is exalted. Self-hate threads itself through all aspects of the individual's life, creating an insidious web of powerlessness. A man or boy with gynecomastia struggles with anxiety over such simple acts as taking off his shirt at the beach.
For many men, the best solution is surgery. That accomplishes step one of the healing. Step two is psychological redress. From childhood taunting to a lifetime of hating his chest, the hurt feelings will not go away with the fact of breast reduction alone.
Men who have developed gynecomastia later in life from steroid abuse or some other cause may have little to no psychological distress. However, for some in this situation, it can leave them feeling out of control of their body or emasculated in some matter. Hopefully, corrective surgery will resolve these feelings, for some it will not and therapy will needed to relieve the distress.
It is important to recognize the scars on the inside. This is difficult work because it means coming to terms with one's body and past. Acknowledging the pain, moving into a new relationship with one's body and changing how he thinks the world sees him is the key to healing and freedom.
Men often have a very difficult time talking about their breasts to anyone, but it is the first step toward relief. Realizing that they are not alone is a powerful antidote for the shame and a beginning toward healing.
Drugs and Medications that may cause Gynecomastia (Male Breast Enlargement)
**broken link removed**
Gyno Gallery:
**broken link removed**
FAQ
What is the best way to find a doctor?
The best way to find a plastic surgeon in your area is to contact the American Society of Plastic and Reconstructive Surgeons. They have a toll-free number for referrals-1-800-635-0635. Also, you can contact them on-line at www.plasticsurgery.org. Also, check your potential surgeon's credentials your state's medical board. Other sources are your local medical society and hospitals in your area.
How can I tell if they really know what they are doing?
Your potential surgeon should have confidence in you discussion with you. Also, ask to see before and after photographs of former patients. Ask you surgeon to put you in contact of former gynecomastia patients. Another simple but important question is: How many of these procedures have you done in the past year?
How do I know if they have done this surgery a lot?
Hopefully, your potential surgeon will be honest with you.
Will insurance cover it?
Usually not. I have only had one insurance company cover a case and I'm still waiting to get paid.
What if they say no? Then what are my options? Do people ever win appeals?
If your insurance company turns you down, you can always appeal. People usually win appears, but I have never seen this for gynecomastia. It is usually considered a cosmetic procedure and medically necessary.
What is the best way to approach the insurance company?
Tell them that you have a congenital condition. Also, if you have breast tenderness to certain to mention this. Also, a potential patient who is close to their normal weight has a better chance than a patient who is overweight.
How much does the surgery cost?
There is a range. The surgeon's fee is anywhere from $2,500.00 to $3,200.00 and the operating room is about $900.00 to $1,500.00. Anesthesia from a board certified anesthesiologist is about $250.00 per hour. Other costs are compression vest, lab tests, pathology, and prescriptions.
What blood tests should be done before surgery?
A CBC-complete blood count and possibly a bleeding time if you have been using any type of aspirin-containing medications.
Who should do the test and evaluate them?
You can have your tests at any lab. Your results can be faxed to your surgeon and he should evaluate them. Also, we always have the anesthesiologist evaluate any lab tests before surgery.
Does it matter what causes gynecomastia?
Yes, if gynecomastia is drug induced-i.e., steroids, or excessive marijuana use it will re-occur. There, any drug use should be discontinued before surgery.
Is there an age that you have to be before you can have the surgery?
Usually 18 to 20 years.
Can you be too old to have gynecomastia surgery?
Not really. Only if you have certain medical conditions where it would not be advisable to have any type of surgery.
Are there any medical conditions that would prevent me from having surgery? I.c, diabetes, high blood pressure, etc.
Severe heart disease, malignant hyperthalemus or severe bleeding disorders. I have never seen a patient turned down for surgery due to a pre-existing medical condition. It's very rare.
Will there be any scarring?
Yes, a small peri-areolar (an incision around the nipple). Also, remember, that is time scars will fade. It takes at least 6 months to a year for a scar to fade in pigment.
What is the most normal procedure to remove the gynecomastia?
The approach is open removal of the glandular tissue and liposuction of the breast and the surrounding area.
I understand there are two types of liposuction. What is the difference? Is one better for this procedure?
Tumescent liposuction is the gold standard of this surgical procedure. Basically, the surgeon enlarges the area to be liposuctioned with a large amount of sterile fluid along with a vaso-constrictive agent such as epinephrine to reduce bleeding. Ultrasonic liposuction uses sound waves to break up the fat. In my opinion there is no advance to this technique.
I have large pendulous breasts. How do you remove then and how much scaring is there?
This is a very different problem. The skin has a tremendous ability to contract, especially if a patient is young. I usually do an aggressive sub-cutaneous mastectomy (breast removal) with liposuction. Also, I usually place drains so that fluids can drain for a few days following the surgery , foam padding and a compression garment. I have only had to make a full breast reduction incision in one male patient. I try to avoid this at all costs. My Philosophy: The goal of surgery is so that my patient can feel comfortable without a shirt or be comfortable in a light shirt. If a patient has noticeable scars after surgery he will never feel comfortable without a shirt. Therefore, if a patient is borderline, I try to avoid excessive scarring. If we need to do another surgical procedure due to excessive skin then we can use an incision around the areola only.
I am about 30 pounds overweight, how will that impact the surgery?
Gynecomastia hyperthrophy which does not react to either weight loss or gain. However, the gland can be stimulated with drugs. The breast is composed of breast glands and fatty tissue. If weight gain is general it can affect the size of the breast.
What do I need to do to prepare for the surgery?
No smoking, no aspirin-containing products and any other drugs that can affect bleeding. Such as Advil or ibuprofen. Also, herbal remedies such as St. John's Wort, Ginkgo Biloba and excessive amounts of Vitamin E can cause excessive bleeding. In my practice we send patient a compressive booklet a pre-operative instructions before surgery. Basically, the rule of thumb is to avoid all medicals such as these two weeks prior and after your surgery.
What is the recovery time?
Initial recovery time if from seven to 10 days. If drains are placed, they usually remain for about three days, then removed during a follow-up visit. Then, complete recovery time is from four to six weeks. This means no heavy exercise such as lifting weights, vigorous workouts at the gym, or any other strenuous activity. Also, I advise my patients to wear a compressive garment for least four weeks after their procedure. You have invested a lot of your time and money in this procedure; you have to also invest the time in yourself for optimum results.
What do I tell my work and friends?
Basically, any medical condition is confidential. In my practice we will gladly furnish any medical excuses that you need for work. Basically, it is none of your employer's business why you need to take time off for any medical procedures. It's up to you to tell whatever you want to your friends. Please remember, that gynecomastia is a very common condition and yet we have many patients that don't want to tell anyone they are having this procedure.
How long will I be in the hospital?
This is a same day surgery. The actual procedure takes about 2 ½ to 3 hours. After your surgery, you will be taken to the recovery room for at least two hours. Then, you are released to your home. You should not go home alone, rather with a friend to stay with you for at least 24 hours following surgery. If this is a problem for you, we can arrange for people to pick you up from the hospital and stay with you in your home.
How much pain will I be in post-surgery for how long?
The long-acting anesthesia will last at the surgical site for about 24 hours. The moderate discomfort for about another 24 hours. Then, after that only minimum discomfort. Most of my patients never really experience any severe pain, only "soreness." Also, I always prescribe pain medication after surgery.
Some doctors use drains and others do not, what is the difference?
I usually use drains in most of my cases. Drains help reduce swelling and promote better skin condition. Remember the function of a drain is simple-it allows the fluid underneath the skin to drain into a small bulb where it can easily be emptied by the patient.
What kind of stitches do you use externally? How long will they be there?
I use very thin 6-0 nylon suture that is removed from seven to 10 days.
What about exposure to sun post surgery? I have heard not to tan for a year, is that true?
Early exposure to incisions after surgery is not advisable, however, during the early healing stages you should use sun block for two to three months post-operatively. Also, I recommend silicone gel sheeting to be place directly on the incisions for two months after surgery. I find the silicone gel sheeting improves the appearance of the scars.
What if I don't like the results? Will it require more than one surgery?
After one year, a re-do or "touch-up" is covered by the patient's initial surgical fee. Remember, the one must have realistic expectations before undergoing any type of cosmetic surgery.
Do I need to wear a compression vest? What is it for? For how long?
Yes, for about six weeks. After the gland is excised and liposuction is performed a large open space exists. The compression garment helps the tissue come together and close. The placement of drains also helps. Another function of the garment is that it helps reduce the initial swelling and contract the skin over the surgical site.
When can I return to work?
Usually 5 to 7 days, depending on what type of work you do. If you do office work, 5 to 7 days, physical labor, 10 to 14 days.
Are there any postoperative things that I should be aware of? Painkillers, constipation, etc.?
Excessive fluid can accumulate underneath the skin. If a drain is not used, the fluid would have to be aspirated with a needle. Also, if you have pain after 24 to 48 hours, this could mean there is a problem. One potential complication is hemotoma-a collection of blood underneath the skin. If this happens, contact your surgeon immediately. Miguel A. Delgado, Jr., M.D.,FACS is a plastic surgeon with offices in the San Francisco Bay area. His Website is www.dr-delgado.com.
The term comes from the Greek words gyne meaning "woman" and mastos meaning "breast." In practical terms, this means abnormally large breasts on men.
The condition is relatively common in adolescent boys, and 90% of the time symptoms disappear in a matter of months, or, as adolescence wanes, a few years later. But the remaining 10% are burdened with a social handicap that causes a deep and complex shame, and puts one's relationship with one's body at risk.
There are several potential causes:
* puberty
* steroid abuse (bitch tits)
* obesity
* marijuana use (this is in question)
* tumors
* genetic disorders
* chronic liver disease
* side effects of many medications
* castration
* Klinefelter Syndrome
* Gilbert's Syndrome
* aging
The Remedy
In cases of obesity, weight loss can alter the gynecomastic condition, but for many it will not eliminate it. For all other causes, surgery is the only known physical remedy. Once the physical encumbrance is lifted, psychological scars still need to be addressed. One must come to terms with one's body, accept it, and heal the wounds from the past.
Psychological Issues
Gynecomastia can be emotionally devastating. Feelings of shame, embarrassment and humiliation are common. One does not feel masculine in a society where masculinity is exalted. Self-hate threads itself through all aspects of the individual's life, creating an insidious web of powerlessness. A man or boy with gynecomastia struggles with anxiety over such simple acts as taking off his shirt at the beach.
For many men, the best solution is surgery. That accomplishes step one of the healing. Step two is psychological redress. From childhood taunting to a lifetime of hating his chest, the hurt feelings will not go away with the fact of breast reduction alone.
Men who have developed gynecomastia later in life from steroid abuse or some other cause may have little to no psychological distress. However, for some in this situation, it can leave them feeling out of control of their body or emasculated in some matter. Hopefully, corrective surgery will resolve these feelings, for some it will not and therapy will needed to relieve the distress.
It is important to recognize the scars on the inside. This is difficult work because it means coming to terms with one's body and past. Acknowledging the pain, moving into a new relationship with one's body and changing how he thinks the world sees him is the key to healing and freedom.
Men often have a very difficult time talking about their breasts to anyone, but it is the first step toward relief. Realizing that they are not alone is a powerful antidote for the shame and a beginning toward healing.
Drugs and Medications that may cause Gynecomastia (Male Breast Enlargement)
**broken link removed**
Gyno Gallery:
**broken link removed**
FAQ
What is the best way to find a doctor?
The best way to find a plastic surgeon in your area is to contact the American Society of Plastic and Reconstructive Surgeons. They have a toll-free number for referrals-1-800-635-0635. Also, you can contact them on-line at www.plasticsurgery.org. Also, check your potential surgeon's credentials your state's medical board. Other sources are your local medical society and hospitals in your area.
How can I tell if they really know what they are doing?
Your potential surgeon should have confidence in you discussion with you. Also, ask to see before and after photographs of former patients. Ask you surgeon to put you in contact of former gynecomastia patients. Another simple but important question is: How many of these procedures have you done in the past year?
How do I know if they have done this surgery a lot?
Hopefully, your potential surgeon will be honest with you.
Will insurance cover it?
Usually not. I have only had one insurance company cover a case and I'm still waiting to get paid.
What if they say no? Then what are my options? Do people ever win appeals?
If your insurance company turns you down, you can always appeal. People usually win appears, but I have never seen this for gynecomastia. It is usually considered a cosmetic procedure and medically necessary.
What is the best way to approach the insurance company?
Tell them that you have a congenital condition. Also, if you have breast tenderness to certain to mention this. Also, a potential patient who is close to their normal weight has a better chance than a patient who is overweight.
How much does the surgery cost?
There is a range. The surgeon's fee is anywhere from $2,500.00 to $3,200.00 and the operating room is about $900.00 to $1,500.00. Anesthesia from a board certified anesthesiologist is about $250.00 per hour. Other costs are compression vest, lab tests, pathology, and prescriptions.
What blood tests should be done before surgery?
A CBC-complete blood count and possibly a bleeding time if you have been using any type of aspirin-containing medications.
Who should do the test and evaluate them?
You can have your tests at any lab. Your results can be faxed to your surgeon and he should evaluate them. Also, we always have the anesthesiologist evaluate any lab tests before surgery.
Does it matter what causes gynecomastia?
Yes, if gynecomastia is drug induced-i.e., steroids, or excessive marijuana use it will re-occur. There, any drug use should be discontinued before surgery.
Is there an age that you have to be before you can have the surgery?
Usually 18 to 20 years.
Can you be too old to have gynecomastia surgery?
Not really. Only if you have certain medical conditions where it would not be advisable to have any type of surgery.
Are there any medical conditions that would prevent me from having surgery? I.c, diabetes, high blood pressure, etc.
Severe heart disease, malignant hyperthalemus or severe bleeding disorders. I have never seen a patient turned down for surgery due to a pre-existing medical condition. It's very rare.
Will there be any scarring?
Yes, a small peri-areolar (an incision around the nipple). Also, remember, that is time scars will fade. It takes at least 6 months to a year for a scar to fade in pigment.
What is the most normal procedure to remove the gynecomastia?
The approach is open removal of the glandular tissue and liposuction of the breast and the surrounding area.
I understand there are two types of liposuction. What is the difference? Is one better for this procedure?
Tumescent liposuction is the gold standard of this surgical procedure. Basically, the surgeon enlarges the area to be liposuctioned with a large amount of sterile fluid along with a vaso-constrictive agent such as epinephrine to reduce bleeding. Ultrasonic liposuction uses sound waves to break up the fat. In my opinion there is no advance to this technique.
I have large pendulous breasts. How do you remove then and how much scaring is there?
This is a very different problem. The skin has a tremendous ability to contract, especially if a patient is young. I usually do an aggressive sub-cutaneous mastectomy (breast removal) with liposuction. Also, I usually place drains so that fluids can drain for a few days following the surgery , foam padding and a compression garment. I have only had to make a full breast reduction incision in one male patient. I try to avoid this at all costs. My Philosophy: The goal of surgery is so that my patient can feel comfortable without a shirt or be comfortable in a light shirt. If a patient has noticeable scars after surgery he will never feel comfortable without a shirt. Therefore, if a patient is borderline, I try to avoid excessive scarring. If we need to do another surgical procedure due to excessive skin then we can use an incision around the areola only.
I am about 30 pounds overweight, how will that impact the surgery?
Gynecomastia hyperthrophy which does not react to either weight loss or gain. However, the gland can be stimulated with drugs. The breast is composed of breast glands and fatty tissue. If weight gain is general it can affect the size of the breast.
What do I need to do to prepare for the surgery?
No smoking, no aspirin-containing products and any other drugs that can affect bleeding. Such as Advil or ibuprofen. Also, herbal remedies such as St. John's Wort, Ginkgo Biloba and excessive amounts of Vitamin E can cause excessive bleeding. In my practice we send patient a compressive booklet a pre-operative instructions before surgery. Basically, the rule of thumb is to avoid all medicals such as these two weeks prior and after your surgery.
What is the recovery time?
Initial recovery time if from seven to 10 days. If drains are placed, they usually remain for about three days, then removed during a follow-up visit. Then, complete recovery time is from four to six weeks. This means no heavy exercise such as lifting weights, vigorous workouts at the gym, or any other strenuous activity. Also, I advise my patients to wear a compressive garment for least four weeks after their procedure. You have invested a lot of your time and money in this procedure; you have to also invest the time in yourself for optimum results.
What do I tell my work and friends?
Basically, any medical condition is confidential. In my practice we will gladly furnish any medical excuses that you need for work. Basically, it is none of your employer's business why you need to take time off for any medical procedures. It's up to you to tell whatever you want to your friends. Please remember, that gynecomastia is a very common condition and yet we have many patients that don't want to tell anyone they are having this procedure.
How long will I be in the hospital?
This is a same day surgery. The actual procedure takes about 2 ½ to 3 hours. After your surgery, you will be taken to the recovery room for at least two hours. Then, you are released to your home. You should not go home alone, rather with a friend to stay with you for at least 24 hours following surgery. If this is a problem for you, we can arrange for people to pick you up from the hospital and stay with you in your home.
How much pain will I be in post-surgery for how long?
The long-acting anesthesia will last at the surgical site for about 24 hours. The moderate discomfort for about another 24 hours. Then, after that only minimum discomfort. Most of my patients never really experience any severe pain, only "soreness." Also, I always prescribe pain medication after surgery.
Some doctors use drains and others do not, what is the difference?
I usually use drains in most of my cases. Drains help reduce swelling and promote better skin condition. Remember the function of a drain is simple-it allows the fluid underneath the skin to drain into a small bulb where it can easily be emptied by the patient.
What kind of stitches do you use externally? How long will they be there?
I use very thin 6-0 nylon suture that is removed from seven to 10 days.
What about exposure to sun post surgery? I have heard not to tan for a year, is that true?
Early exposure to incisions after surgery is not advisable, however, during the early healing stages you should use sun block for two to three months post-operatively. Also, I recommend silicone gel sheeting to be place directly on the incisions for two months after surgery. I find the silicone gel sheeting improves the appearance of the scars.
What if I don't like the results? Will it require more than one surgery?
After one year, a re-do or "touch-up" is covered by the patient's initial surgical fee. Remember, the one must have realistic expectations before undergoing any type of cosmetic surgery.
Do I need to wear a compression vest? What is it for? For how long?
Yes, for about six weeks. After the gland is excised and liposuction is performed a large open space exists. The compression garment helps the tissue come together and close. The placement of drains also helps. Another function of the garment is that it helps reduce the initial swelling and contract the skin over the surgical site.
When can I return to work?
Usually 5 to 7 days, depending on what type of work you do. If you do office work, 5 to 7 days, physical labor, 10 to 14 days.
Are there any postoperative things that I should be aware of? Painkillers, constipation, etc.?
Excessive fluid can accumulate underneath the skin. If a drain is not used, the fluid would have to be aspirated with a needle. Also, if you have pain after 24 to 48 hours, this could mean there is a problem. One potential complication is hemotoma-a collection of blood underneath the skin. If this happens, contact your surgeon immediately. Miguel A. Delgado, Jr., M.D.,FACS is a plastic surgeon with offices in the San Francisco Bay area. His Website is www.dr-delgado.com.
