Causes of Gynecomastia
Gynecomastia is a medical condition that causes swelling of the glandular breast tissue in males. This leads to enlarged breasts which make many men self-conscious about their appearance. When fat deposits are the sole reason for the appearance of male breasts, it is called pseudogynecomastia. Plastic surgery can correct both true gynecomastia and pseudogynecomastia, although these conditions have very different causes.
True gynecomastia is the result of a hormonal imbalance. Male and female hormones are present in individuals of both sexes. These hormones regulate the development of secondary sex characteristics such as facial hair or breast tissue. Men with standard hormone levels have a larger amount of testosterone and a lower concentration of the hormone estrogen. A drop in testosterone levels paired with increased estrogen levels is the main cause for gynecomastia.
There are certain times in a male’s life where these hormone fluctuations and resulting breast tissue are relatively normal. Boys going through puberty may notice growth of male breasts. This will normally go away on its own six months to two years after puberty begins. Although some adolescents do benefit from surgery to correct gynecomastia, it’s important to discuss this with your doctor if you or your child are considering the surgery as a teenager. Gynecomastia is also common among older men as testosterone levels begin to naturally drop.
If you notice you have enlarged male breasts, you should consult with a medical professional. The condition may result from natural hormone fluctuations, but it can also be an indication of serious medical conditions, especially when paired with nipple discharge, lymph node swelling, or other symptoms. Plastic surgery can remove the breast tissue that causes the appearance of male breasts, but you may need medication or other medical intervention to treat underlying issues. Otherwise, the enlarged breasts may return after surgical removal.
Drugs and Herbal Remedies
There are a number of prescription drugs and herbal remedies that can lead to the development of male breast tissue. These substances alter your hormone levels which, in some cases, promotes the development of breast tissue.
- Spironolactone (Aldactone) and other calcium channel blockers used to treat high blood pressure
- Diazepam (Valium) and other anti-anxiety medications
- Anabolic steroids
- Protein pump inhibitors for heartburn
- Certain antibiotics and antifungals
- Tea tree oil
- Dong quai
If you believe any of these substances are contributing to your gynecomastia, make sure to discuss this with your doctor. Do not stop taking any prescribed medication without consulting with a medical professional. You should also always tell your doctor when you are taking herbal supplements or alternative medicine remedies, as these can interact with other medications to produce unwanted side effects.
Pseudogynecomastia is when fat tissue (rather than glandular tissue) contributes to the growth of male breasts. If you are overweight or obese, fat deposits can build up in the chest area and take on the appearance of breasts. In some cases, obesity can also increase estrogen levels, leading to true gynecomastia.
If your gynecomastia is a result of obesity, you may still be a candidate for surgery. Liposuction can remove these fat deposits. However, this is only true if the male breasts linger after weight loss. You must be at or close to your ideal weight at the time of surgery. If you gain weight after surgery, your pseudogynecomastia will return and you may need another procedure to remove the fat deposits.
If you have already treated underlying conditions and still have enlarged breasts, surgery for gynecomastia may help you. Men with gynecomastia can suffer from reduced self-confidence and feeling less masculine. Surgery removes fat and glandular tissue deposits to restore a flat chest. Many men feel more confident and have a greater libido following the surgery.
If you have pseudogynecomastia or if the breast enlargement is mostly due to fat deposits, the procedure will likely involve liposuction only. Your plastic surgeon will insert a cannula (a thin, hollow tube) into your chest through multiple incisions. They will then use vacuum suction to remove fat from the area.
Excision surgery is also an option. This is best suited to patients who have more glandular tissue or who have noticed a change in nipple size and shape. This type of procedure also removes excess skin, whereas liposuction does not. Your surgeon will make an incision around your nipple and will move it upwards while removing tissue from the chest.
In some cases, the surgeon will use a combination of liposuction and excision surgery. This will depend on your specific condition and on your desired appearance after surgery.
Recovery and Results
Dr. Hess and Dr. Sandeen will give you specific instructions for after your surgery. These will take into account your unique medical situation and any special considerations. In general, you will likely need elastic bandages around your incisions during the healing process. You should also reduce activity to avoid stretching or tearing the incisions.
You will have scars from the procedure, but these may be hidden by natural contours in your chest. Most men who undergo gynecomastia surgery feel more confident in their body, even with any resulting scars. It is important for you to have reasonable expectations. Dr. Hess and Dr. Sandeen can help answer any questions about how your chest will look after surgery. You should also keep in mind that, if the underlying cause of the gynecomastia isn’t corrected, your male breasts may return after surgery. We recommend discussing this with your primary care doctor, especially if you need to switch any medications.
Gynecomastia is primarily a cosmetic procedure, so most insurance plans do not cover it. However, you should talk to your provider as coverage does vary. Many of our patients finance their surgeries through Care Credit, which can help make it easier to pay for your procedure over time. You can always ask Dr. Hess and Dr. Sandeen about our financing options.