We tend to think of breast reduction as a female procedure, but the truth is, many men also opt to have this surgery. "Gynecomastia" is the term for enlargement of male breasts. It is a common condition, affecting about 50% of men, particularly men over 50.

What Causes Breast Development in Men?

Most of the time, there is no known cause. The problem is cosmetic. Men feel self-conscious without a shirt, and in severe cases, even with a shirt on. Gynecomastia can start with puberty, or develop in middle age.

Sometimes the cause is a specific drug or medical problem. Alcohol abuse and anabolic steroids can cause gynecomastia. Certain hormonal imbalances (usually a relative excess of estrogen over testosterone) and medications, including several heart medications, can cause unwanted breast development. In rare cases it may be associated with testicular tumors or liver dysfunction. If a medical problem is suspected, the patient is referred to another specialist for investigation. Usually the condition is regarded as cosmetic by insurance companies.

Most of the time there is no underlying hormonal imbalance and no medical cause is responsible. Gynecomastia is seen frequently in two age groups - young men, whose pubertal breast bud development did not go away, and in middle-aged men, over age 50, when breast development can occur due to hormonal changes and is unresponsive to diet and exercise.

Men have told me "This makes me feel like I'm a woman," even one memorable tattooed patient who competed as an ultimate fighter and did not look like the kind of guy one would want to meet in a dark alley. One successful attorney in his early sixties told me after surgery, "For the first time in my life, I feel normal." He said he thought his breast problem had made him try to overcompensate by being aggressive professionally. One patient told me he faked hydrophobia as a teenager, even to the point of seeing a psychiatrist, so he would not have to take off his shirt for swimming classes. Another told me no one had seen him without his shirt off since he was 15, including his fiancé. The psychological implications cannot be ignored.