Microsoft word - male breast reduction march 2012.doc
(Parkland Life/ Coconut Creek Life for March, 2012)
Often Overlooked: Male Breast Reduction
When the subject is breast reduction, the discussion is typical y about women, which we
discussed in last month’s issue. However, excess breast tissue in one or both breasts occurs in an
estimated 50% of the male population. Though the condition (gynecomastia) typical y does not cause
the physical discomfort produced in women, it often creates significant social trauma, especial y for
teens and younger men. Many wear heavy, loose-fitting shirts and steer clear of sports and the beach
Both excess fatty tissue and excess glandular tissue can be the culprits, creating a "female"
contour. Most commonly, gynecomastia is “idiopathic” (no known cause). However, it can be
familial, and there are known associations with rare endocrine conditions resulting in hormonal
imbalance. Of known causes, there are many popular exogenous “supplements” that can promote
gynecomastia. These include, classical y, anabolic steroids but less known are various over the
counter nutritional supplements. One of these is tribulus terrestris, a common herbal ingredient
purported to enhance muscle building but as a side effect can lead to gynecomastia. While diet and
exercise can help with generalized fat, as everywhere else, it cannot be directed to a specific area.
Neither wil help reduce excess glandular tissue. Indeed, as chest muscle is built with exercise, the
overlying fat and glandular tissue may be pushed further forward making the condition even more
noticeable. Common in early puberty, the condition often resolves spontaneously by age 17-18.
Surgical breast reduction should be delayed at least until age 15 or 16, or wel into puberty and after
several years of persistence of the condition. Before proceeding with treatment, the patient should be
relatively more mature, both physical y and emotional y. Although commonly treated in young men,
If the enlargement is being caused by excess fatty tissue, liposuction alone may resolve the
problem. If the problem is caused by excess glandular tissue, it may be necessary to directly remove
the excess tissue through a small incision at the lower edge of the areola typical y in combination with
liposuction. The area must be contoured careful y to create a smooth appearance. In rare cases with
excess skin, incisions are made around and beneath the areola, as with a female breast lift or
reduction, leaving longer scars. Results are permanent, although subsequent obesity or exposure to
anabolic steroids, for example can cause recurrence.
Patients typical y return to work in a few days unless the work is extremely strenuous.
Scarring around the nipple is minimal. There can be minor post-operative bruising, swel ing, and
occasional y fluid build-up. An elastic pressure garment is worn for 3 weeks and sun exposure is
avoided for several months. Temporary numbness may persist for up to one year. Infrequent
complications associated with any surgical procedure include bleeding, fluid col ection, infection,
unsatisfactory scarring or contour irregularities. Post-operative asymmetry, while rare, is possible
and may require a secondary procedure to remove additional tissue and create better balance.
Post-recovery, the patient enjoys a firmer, flatter, more contoured chest which fits the standard
“male profile”. Subsequent exercise to tone the chest muscles wil produce even greater
David J. Levens, MD, PA, FACS
, in practice in Coral Springs for 22 years, is a graduate of MIT and
Columbia University-Col ege of Physicians and Surgeons. Certified by the American Board of Plastic
Surgery, he has been named a Top Doctor in Castle Connol y's national ratings for 2010 and 2011.
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