Men with “MOOBS”… it’s a Real Problem
Double Board-Certified Plastic Surgeon, Dr. Babak Dadvand Dives into the Taboo Topic of Gynecomastia
WHAT IS GYNECOMASTIA?
All males have breast tissue. However, in men with gynecomastia there will be an increase in the amount of glandular tissue. Patients usually feel embarrassed and often avoid situations where they will need to expose their chest in public. Dr. Dadvand has dedicated a large part of his time ever since he started his private Los Angeles practice to deeply understand gynecomastia and develop techniques to surgically correct his patients’ chests.
There are many things that can lead to an increase in gland tissue. The broad categories of causes include physiologic (puberty, old age), pharmacologic (due to medications), and pathologic (due to hormone disorders, breast cancer). Puberty is a common cause due to hormonal surges and imbalances. Many medications such as anabolic steroids, some anti-depressants, anti-psychotic, anti-seizure, and heart medications may also cause disturbances to the delicate testosterone pathways.
This will alter the testosterone:estrogen ratio and can lead to production of secondary estrogens. An elevated estrogen level can then stimulate the glandular tissue to grow, leading to the features typical in gynecomastia: puffy nipple, cone shaped chest, and fullness on the outer and lower part of the chest.
Types of Gynecomastia:
Teenage , Bodybuilders , Overweight Men & Old Age.
What is Gynecomastia?
Gynecomastia comes from the Greek words Gyne, meaning feminine, and Mastia, meaning breast. It is a condition where a male has a feminine shaped breast and can be due to excess fatty tissue, breast tissue, or both.
What causes Gynecomastia?
There are many causes of gynecomastia, including medications (steroids, heart medications, anti-depressants), hormone imbalances and endocrine disorders, genetic component, and physiologic (e.g. puberty, or middle-age). There is a portion of males where the cause is not known, and this is referred to as physiologic.
Of all the patients that come into your practice, what would you say are the 2 most common causes based on what your patients tell you about their history?
The two most common causes are physiologic (developed during puberty) and steroid use.
What are the symptoms of Gynecomastia?
The physical symptoms can range from no symptoms at all to significant pain in the breast. Psychological symptoms may include low self-esteem, embarrassment, and depression.
Does exercise and diet improve or cure this condition?
For true gynecomastia where there is an excess of breast tissue, diet and exercise will not help. If due to having excess fatty tissue, there may be improvement with diet and exercise.
Are there certain medications that treat Gynecomastia?
There is no medication that definitively and predictably treats gynecomastia. Some medications, including tamoxifen and clomiphene, have been shown to reduce the gynecomastia but typically it is not full correction, and patients have to be on the medications long term.
What is the emotional toll that this condition takes on these men?
Many men with gynecomastia are embarrassed and have low self-esteem. It affects the clothing they wear, their personal relationships, their ability to be active, and even their posture, often slouching to hide the gynecomastia.
What emotional changes do you see in your patients from before the surgery to after?
I see an immediate return of self-confidence. This is the most gratifying aspect of what I do. I have had teen patients who were bullied due to their chests and their self- esteem and ability to re-incorporate into high-school is very satisfying for me to see.
How does Gynecomastia affect their daily life?
Even when there are no physical symptoms, gynecomastia affects mens’ lives by limiting their personal interactions, the wardrobe they wear, and even their sitting or standing posture.
What measures do these men take to “hide” or “camouflage” their condition?
Males with gynecomastia are masters of camouflage. Most wear multiple layers, or dark shirts, shirts with busy patterns, or shirts with pockets. Many of them admit to slouching because sitting up straight would, in their minds, bring attention to their chest.
What surgical procedures treat Gynecomastia?
There is no one procedure that will treat every form of gynecomastia. Most surgeries will incorporate removal of the breast tissue and may include liposuction to address any fatty excess.
What is involved with Gynecomastia Surgery?
The surgery is an outpatient procedure that takes a couple hours and patients go home the same day. Some types of gynecomastia surgeries may be performed under local anesthesia, but most are performed under general anesthesia.
What are the most common complaints following the surgery regarding recovery?
The most common complaint patients have is not being able to exercise for the first few weeks after surgery.
What is the recovery protocol following this surgery?
In my practice I have patients wear a compression vest for the first 4-6 weeks and restrict their exercise for that same period of time. This is to limit the amount of swelling that may develop after surgery.
Why is it important for men to not engage in strenuous activity for up to 6 weeks?
It is important to restrict strenuous activity for 2 reasons; 1) To limit the amount of swelling that may occur, and 2) To reduce the chance of bleeding or fluid collections right after surgery.
How painful is the surgery?
The surgery is not very painful at all. Most patients are off of the pain medicine after 2 days, and are able to return to a desk job in 4 days.
What are some important life style changes or preventative measures you suggest to your patients so they may maintain the results you give them?
One word of advice I give patients is to watch that they do not gain a significant amount of weight as this will result in fatty tissue build up in the chest and may look as if the gynecomastia had returned. I also advise my patients to be very careful about which work out supplements they are taking. They need to read the labels carefully and if they have any questions about a certain ingredient I tell them to call or email me so I am able to guide them.
Does gynecomastia ever return once it is treated?
Gynecomastia surgery has very long lasting, if not permanent, results. The only times the chest can start looking more feminine is if the patient gains excessive weight or starts taking steroids or any other medication that may stimulate any residual breast tissue that is left in the chest.
Since this is your area of expertise, do you ever see patients who have had the surgery with other doctors that are unhappy with their results?
As a gynecomastia specialist, approximately 20% of my practice is evaluating and treating revision gynecomastia cases. It is very important to have a very tailored surgical plan because each patient is different.
Also, revision patients come from a different emotional place because they have already gone through the surgery and have been disappointed by the results so it is very important to make sure their next surgery is their last.
What does revision Gynecomastia Surgery entail?
Generally speaking, most gynecomastia revisions are due to over resection or under resection. The surgery for under-resection entails removal of the excess tissue. This may be fatty tissue, breast tissue, or scar tissue. For patients who are over-resected, they usually present with craters, or dents in their chest. This can be corrected by taking fat from other areas of their chest and rotating it in to fill the dent. Another option is to harvest fat from a different part of their body and inject it into the chest.
How often do you perform Revision Gynecomastia Surgery?
Revision gynecomastia surgery encompasses 20% of my practice.
When can patients expect to be fully recovered/healed from their surgery and resume their normal life?
I usually tell patients that their final results are around 6 months. However, they will notice a big difference even at 1 week. They resume their normal lives, with the exception of exercise, in a few days to a week. They resume exercise between 4-6 weeks after surgery.
Will other people notice that they had surgery on their chest?
I tell my patients that their incisions will heal exceptionally well. I have ever revised one of my own incisions. This is because my technique is very good, but also because the placement f the incision is in a camouflaged area at the border of the areola and normal skin.
What happens when a patients scars do not heal well and how do you treat the scaring?
If a patient has a scar that does not heal well, it is very straightforward to perform a scar revision. This can be done under local anesthesia in the office.
What are your recommendations to people who are searching for a surgeon to treat this condition if they are unable to be treated by you?
I recommend that they seek out a board-certified plastic surgeon who has experience in evaluating and performing gynecomasita surgery. It is not unusual for patients to travel to find the right doctor if they do not have one in their local community.
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