BEFORE AND AFTER PHOTOS
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We tend to think of breast reduction as a female procedure, but many men also opt to have their breasts reduced. “Gynecomastia” is the term for enlargement of male breasts. It is a common condition, affecting about one-third of males overall, and an even larger percentage of adolescent boys and men over 65.
What Causes Breast Enlargement 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, resolving on its own in most cases, or develop in older men as the balance of circulating testosterone and estrogen shifts toward the latter.
Sometimes gynecomastia may be caused by a specific drug or medical problem. Chronic alcoholics and men who use anabolic steroids as part of a bodybuilding program are more likely to develop this condition. Certain hormonal abnormalities, inherited or acquired, usually involving either a deficiency of testosterone or excess of estrogen, can cause breast enlargement. Hyperthyroidism can cause it too. Marijuana and cancer chemotherapeutic agents can bring it on. Gynecomastia can also be a side effect of a number of heart and blood pressure medications. In rare cases it may be associated with an estrogen-producing testicular tumor. If one of these medical conditions is suspected, the patient is referred to another specialist for investigation. Usually insurance companies regard this condition as cosmetic.
Most commonly, there is no underlying hormonal imbalance and no medical cause. Gynecomastia is seen predominantly in two age groups: (1) young men, whose pubertal breast bud development did not go away, and (2) men aged 50 and over, when breast development can occur due to hormonal changes. Excess breast tissue is unresponsive to diet and exercise. Although cosmetic, the problem is not trivial. Men have told me, “This makes me feel like I’m a woman,” even one memorable heavily-tattooed patient of mine who competes as an ultimate fighter. Another patient, a successful trial attorney in his early 60s, 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 young man 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 in high school. Another told me no one had seen him without his shirt off since he was 15, including his fiancée. The psychological implications of this eminently correctable problem can be profound.