After so much hard work to lose weight, a guy wants to look his best. He shouldn’t have to deal with a problem like fleshy, feminine-looking breasts. But often, with great weight loss, the body doesn’t just shrink to perfect proportions, and the upper torso may reveal more than sculpted pectoral muscles.

For adolescents, there can be the puberty issue—boys who may develop excessive breast tissue. Usually this practical joke on nature’s part resolves itself fairly quickly.

Sometimes though, significant weight loss or hormonal imbalances that create male breasts require more than the tincture of time to go away.

The medical term for enlarged breasts in males is gynecomastia (guy-nuh-ko-MASS-tee-uh). True gynecomastia affects only a small number of men. David J. Wainwright, MD, associate professor of surgery at The University of Texas School of Medicine at Houston, explains that gynecomastia may be a temporary condition for up to 80 percent of prepubal males, when hormones are out of balance. Within two to three years, the problem will go away on its own for most young men. For those other teenagers with extreme cases, the agony of dressing for gym class, the embarrassment of summer sports, and ridicule by peers may become their lot.

Wainwright says that surgery is an option, whether it appears that breasts are a result of weight loss or a hormonal problem that doesn’t resolve on its own. Because the source of the problem is different with these two types of patients, the treatments are not the same.

Cause and effect of gynecomastia

“When we see a patient for gynecomastia, we look at two things to determine how to treat the problem,” Wainwright explains. “One element is the amount of breast tissue that is present, whether it be harder glandular tissue or soft, fatty tissue. The other is the amount of excess skin.”

He explains that this may make active sports uncomfortable or painful and may cause psychological problems. A young man with enlarged breasts would first see his primary care physician, and then he should be referred to an endocrinologist. “Anything that triggers feminization will cause it,” Wainwright says.

Some of these conditions are

• Klinefelter’s syndrome: a chromosomal abnormality where a male is born with an extra X sex chromosome
• Undescended testicles: when one or both testicles fail to descend into the scrotal sac before birth
• Hormonal birth defects or conditions that may trigger feminine characteristics

For men beyond adolescence, gynecomastia is sometimes caused by certain prescription drugs. Marijuana and alcohol often have been implicated as well.

For adolescents with gynecomastia in which glandular tissue and/or fat have accumulated, surgery to reduce the tissue may not involve skin removal. In most cases, this surgery is outpatient. For some adolescents, hormonal therapy such as the use of tamoxifin will resolve the problem.

Liposuction can be a solution if only fatty tissue is involved. For those who also have glandular—harder—masses, scalpel surgery is generally necessary.

Male Breast Reduction

When men become obese, fat accumulates throughout the body, in the belly, hips and in the breasts, Wainwright explains. “With patients who have lost significant amounts of weight, fatty tissue and excessive skin will need to be surgically removed. It’s a progression of the same technique used for female breast reduction surgery.”

The plastic surgeon takes into account the amount of fatty and glandular tissue and how much skin must be removed, as well as the age of the patient. In younger patients, skin is more elastic and more likely to tighten to the contours of the body, so skin removal may not be necessary.

Insurance may cover either type of surgery, if medical or psychological problems are documented:

• For true gynecomastia, if the breasts are substantial and easily identified in photographs
• If breasts are secondary to an underlying hormonal imbalance
• If the excess skin is a result of weight loss and creates irritation beneath the overlapped skin

Wainwright suggests that documentation of problems with work or in performing certain activities, as well as reports from psychologists or psychiatrists also might be helpful in applying for insurance coverage.

Rule out medications

Medications cause 10-20 percent of cases of gynecomastia in post-adolescent adults. These include

• cimetidine, stomach acid inhibitor
• omeprazole, marketed as Prilosec, for gastrointestinal conditions
• spironolactone a synthetic steroid used for many conditions
• finasteride, also marketed as Propecia, used to treat prostate enlargement and male pattern baldness
• certain antipsychotics, a large category of drugs that treats a range of mood disorders and other neurological conditions
• Androstenedione, produced in the adrenal glands and the gonads, used in another form as a performance-enhancing food supplement
• Medications used in the treatment of prostate cancer, such as antiandrogens and GnRH analogs

Do not discontinue any medications that you suspect might be contributing to gynecomastia without first consulting your physician. Most medications have alternatives in the same family that may not carry this same side effect.

If you have an adolescent son, check with his pediatrician if pubescent gynecomastia is affecting his self esteem or keeping him from certain physical activities.

Last Updated: 4-04-2007

 

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