What is Gynecomastia?
The term comes from the Greek words gyne meaning "woman" and mastos meaning "breast." In practical terms, this means abnormally large breasts on men.
The condition is relatively common in adolescent boys, and 90% of the time symptoms disappear in a matter of months, or, as adolescence wanes, a few years later. But the remaining 10% are burdened with a social handicap that causes a deep and complex shame, and puts one's relationship with one's body at risk.
There are several potential causes:
* steroid abuse (bitch tits)
* marijuana use (this is in question)
* genetic disorders
* chronic liver disease
* side effects of many medications
* Klinefelter Syndrome
* Gilbert's Syndrome
In cases of obesity, weight loss can alter the gynecomastic condition, but for many it will not eliminate it. For all other causes, surgery is the only known physical remedy. Once the physical encumbrance is lifted, psychological scars still need to be addressed. One must come to terms with one's body, accept it, and heal the wounds from the past.
Gynecomastia can be emotionally devastating. Feelings of shame, embarrassment and humiliation are common. One does not feel masculine in a society where masculinity is exalted. Self-hate threads itself through all aspects of the individual's life, creating an insidious web of powerlessness. A man or boy with gynecomastia struggles with anxiety over such simple acts as taking off his shirt at the beach.
For many men, the best solution is surgery. That accomplishes step one of the healing. Step two is psychological redress. From childhood taunting to a lifetime of hating his chest, the hurt feelings will not go away with the fact of breast reduction alone.
Men who have developed gynecomastia later in life from steroid abuse or some other cause may have little to no psychological distress. However, for some in this situation, it can leave them feeling out of control of their body or emasculated in some matter. Hopefully, corrective surgery will resolve these feelings, for some it will not and therapy will needed to relieve the distress.
It is important to recognize the scars on the inside. This is difficult work because it means coming to terms with one's body and past. Acknowledging the pain, moving into a new relationship with one's body and changing how he thinks the world sees him is the key to healing and freedom.
Men often have a very difficult time talking about their breasts to anyone, but it is the first step toward relief. Realizing that they are not alone is a powerful antidote for the shame and a beginning toward healing.
Drugs and Medications that may cause Gynecomastia (Male Breast Enlargement)
What is the best way to find a doctor?
The best way to find a plastic surgeon in your area is to contact the American Society of Plastic and Reconstructive Surgeons. They have a toll-free number for referrals-1-800-635-0635. Also, you can contact them on-line at www.plasticsurgery.org
. Also, check your potential surgeon's credentials your state's medical board. Other sources are your local medical society and hospitals in your area.
How can I tell if they really know what they are doing?
Your potential surgeon should have confidence in you discussion with you. Also, ask to see before and after photographs of former patients. Ask you surgeon to put you in contact of former gynecomastia patients. Another simple but important question is: How many of these procedures have you done in the past year?
How do I know if they have done this surgery a lot?
Hopefully, your potential surgeon will be honest with you.
Will insurance cover it?
Usually not. I have only had one insurance company cover a case and I'm still waiting to get paid.
What if they say no? Then what are my options? Do people ever win appeals?
If your insurance company turns you down, you can always appeal. People usually win appears, but I have never seen this for gynecomastia. It is usually considered a cosmetic procedure and medically necessary.
What is the best way to approach the insurance company?
Tell them that you have a congenital condition. Also, if you have breast tenderness to certain to mention this. Also, a potential patient who is close to their normal weight has a better chance than a patient who is overweight.
How much does the surgery cost?
There is a range. The surgeon's fee is anywhere from $2,500.00 to $3,200.00 and the operating room is about $900.00 to $1,500.00. Anesthesia from a board certified anesthesiologist is about $250.00 per hour. Other costs are compression vest, lab tests, pathology, and prescriptions.
What blood tests should be done before surgery?
A CBC-complete blood count and possibly a bleeding time if you have been using any type of aspirin-containing medications.
Who should do the test and evaluate them?
You can have your tests at any lab. Your results can be faxed to your surgeon and he should evaluate them. Also, we always have the anesthesiologist evaluate any lab tests before surgery.
Does it matter what causes gynecomastia?
Yes, if gynecomastia is drug induced-i.e., steroids, or excessive marijuana use it will re-occur. There, any drug use should be discontinued before surgery.
Is there an age that you have to be before you can have the surgery?
Usually 18 to 20 years.
Can you be too old to have gynecomastia surgery?
Not really. Only if you have certain medical conditions where it would not be advisable to have any type of surgery.
Are there any medical conditions that would prevent me from having surgery? I.c, diabetes, high blood pressure, etc.
Severe heart disease, malignant hyperthalemus or severe bleeding disorders. I have never seen a patient turned down for surgery due to a pre-existing medical condition. It's very rare.
Will there be any scarring?
Yes, a small peri-areolar (an incision around the nipple). Also, remember, that is time scars will fade. It takes at least 6 months to a year for a scar to fade in pigment.
What is the most normal procedure to remove the gynecomastia?
The approach is open removal of the glandular tissue and liposuction of the breast and the surrounding area.
I understand there are two types of liposuction. What is the difference? Is one better for this procedure?
Tumescent liposuction is the gold standard of this surgical procedure. Basically, the surgeon enlarges the area to be liposuctioned with a large amount of sterile fluid along with a vaso-constrictive agent such as epinephrine to reduce bleeding. Ultrasonic liposuction uses sound waves to break up the fat. In my opinion there is no advance to this technique.
I have large pendulous breasts. How do you remove then and how much scaring is there?
This is a very different problem. The skin has a tremendous ability to contract, especially if a patient is young. I usually do an aggressive sub-cutaneous mastectomy (breast removal) with liposuction. Also, I usually place drains so that fluids can drain for a few days following the surgery , foam padding and a compression garment. I have only had to make a full breast reduction incision in one male patient. I try to avoid this at all costs. My Philosophy: The goal of surgery is so that my patient can feel comfortable without a shirt or be comfortable in a light shirt. If a patient has noticeable scars after surgery he will never feel comfortable without a shirt. Therefore, if a patient is borderline, I try to avoid excessive scarring. If we need to do another surgical procedure due to excessive skin then we can use an incision around the areola only.
I am about 30 pounds overweight, how will that impact the surgery?
Gynecomastia hyperthrophy which does not react to either weight loss or gain. However, the gland can be stimulated with drugs. The breast is composed of breast glands and fatty tissue. If weight gain is general it can affect the size of the breast.
What do I need to do to prepare for the surgery?
No smoking, no aspirin-containing products and any other drugs that can affect bleeding. Such as Advil or ibuprofen. Also, herbal remedies such as St. John's Wort, Ginkgo Biloba and excessive amounts of Vitamin E can cause excessive bleeding. In my practice we send patient a compressive booklet a pre-operative instructions before surgery. Basically, the rule of thumb is to avoid all medicals such as these two weeks prior and after your surgery.
What is the recovery time?
Initial recovery time if from seven to 10 days. If drains are placed, they usually remain for about three days, then removed during a follow-up visit. Then, complete recovery time is from four to six weeks. This means no heavy exercise such as lifting weights, vigorous workouts at the gym, or any other strenuous activity. Also, I advise my patients to wear a compressive garment for least four weeks after their procedure. You have invested a lot of your time and money in this procedure; you have to also invest the time in yourself for optimum results.
What do I tell my work and friends?
Basically, any medical condition is confidential. In my practice we will gladly furnish any medical excuses that you need for work. Basically, it is none of your employer's business why you need to take time off for any medical procedures. It's up to you to tell whatever you want to your friends. Please remember, that gynecomastia is a very common condition and yet we have many patients that don't want to tell anyone they are having this procedure.
How long will I be in the hospital?
This is a same day surgery. The actual procedure takes about 2 ½ to 3 hours. After your surgery, you will be taken to the recovery room for at least two hours. Then, you are released to your home. You should not go home alone, rather with a friend to stay with you for at least 24 hours following surgery. If this is a problem for you, we can arrange for people to pick you up from the hospital and stay with you in your home.
How much pain will I be in post-surgery for how long?
The long-acting anesthesia will last at the surgical site for about 24 hours. The moderate discomfort for about another 24 hours. Then, after that only minimum discomfort. Most of my patients never really experience any severe pain, only "soreness." Also, I always prescribe pain medication after surgery.
Some doctors use drains and others do not, what is the difference?
I usually use drains in most of my cases. Drains help reduce swelling and promote better skin condition. Remember the function of a drain is simple-it allows the fluid underneath the skin to drain into a small bulb where it can easily be emptied by the patient.
What kind of stitches do you use externally? How long will they be there?
I use very thin 6-0 nylon suture that is removed from seven to 10 days.
What about exposure to sun post surgery? I have heard not to tan for a year, is that true?
Early exposure to incisions after surgery is not advisable, however, during the early healing stages you should use sun block for two to three months post-operatively. Also, I recommend silicone gel sheeting to be place directly on the incisions for two months after surgery. I find the silicone gel sheeting improves the appearance of the scars.
What if I don't like the results? Will it require more than one surgery?
After one year, a re-do or "touch-up" is covered by the patient's initial surgical fee. Remember, the one must have realistic expectations before undergoing any type of cosmetic surgery.
Do I need to wear a compression vest? What is it for? For how long?
Yes, for about six weeks. After the gland is excised and liposuction is performed a large open space exists. The compression garment helps the tissue come together and close. The placement of drains also helps. Another function of the garment is that it helps reduce the initial swelling and contract the skin over the surgical site.
When can I return to work?
Usually 5 to 7 days, depending on what type of work you do. If you do office work, 5 to 7 days, physical labor, 10 to 14 days.
Are there any postoperative things that I should be aware of? Painkillers, constipation, etc.?
Excessive fluid can accumulate underneath the skin. If a drain is not used, the fluid would have to be aspirated with a needle. Also, if you have pain after 24 to 48 hours, this could mean there is a problem. One potential complication is hemotoma-a collection of blood underneath the skin. If this happens, contact your surgeon immediately. Miguel A. Delgado, Jr., M.D.,FACS is a plastic surgeon with offices in the San Francisco Bay area. His Website is www.dr-delgado.com
CandyRoids05-19-2005, 07:03 PM
Not all surgeries are successful. In this space, I will list any stories that are sent to me. I do not take responsibility for the content. All information is submitted by the men themselves. For more information you would need to contact them or the doctors listed.
Excellent page of medical information about to do and not to do the surgery.
(This is not the first case that I have heard of where a doctor did a mastectomy instead of a gynecomastia reduction. Educate your self about the procedure and the doctor. It's your body, take care of it.)
I was operated in 95 by a butcher and now I cannot go out without a shirt. I have terrible scars and my nipples are completely recessed. I have big holes and my nipples are directly on my rib bones. I have terrible problems to try and carry loads as he cut several muscles. All the analysis show no trace of cancer, it was "normal" gynecomastia not caused by "they supposed" drugs to stabilized my blood pressure instability cause by my Porphyria.
I think it is necessary that people know that some doctors don't know anything about gynecomastia and must be avoided. Doctors Nassif is specialized in breast cancer operation for women and had never operated a man before me (I discovered that after the operation). He also known here for assepty problems and I was not the first case of Flesh Eating bacteria infection. The result is devastating physically and mentally.
Before the operation I was at the public swimming pool 2 to 3 times a week, since the operation it is no longer possible with the scars and the completely recessed nipples.
The name of the doctor is Doctor Edgar NASSIF, he is working at St Luc Hospital in Montreal, Canada.
I Have Found That The Higher The Dosages And The Longer The Cycles Of Anabolic Steroids The Better Your Chances For Getting "Bitch-Tits".
"Hey there, I'm a 21 year old male from NJ. First I'd like to say, to all those juice-heads out there who insist that they are only taking creatine and aminos, give it a rest!!! Creatine and aminos may be good supplements, but there is no way in HELL that they are gonna put the size on like anabolic steroids do! Don't get me wrong, I have nothing against the use of steroids, actually if taken properly they usually produce positive results. However, the "roids" are supposed to make your muscles bigger guys, not your ability to tell a lie. In other words, if you are man enough to take the juice, be man enough to admit it, so stop the Bullsh*t!
I have been around anabolic steroids for 6 years now, and I learn something new everyday. One of the best things that I have learned is that anti-estrogens such as Nolvadex and Proviron really do work, and are certainly worth taking. In my experience, Nolvadex is better than Proviron, but only cause it's stronger, so when you are already taking other pills, it can be a pain in the ass keeping up with all the Proviron. I have seen numerous differences when Anti-estrogens are taken with your regular cycle. Now I'm talking about over a dozen people over a period of a few years, not just one guy, one time.
What you have to realize is that when you take most anabolic steroids, they also have a Androgenic effect as well. To keep it simple, "your Testosterone level is gonna rise". In a way this is a good short term effect, because this is what will cause most of your strength gains, while the anabolic steroids will give you your size gains. But, your body will begin to produce Estrogen to balance the Testosterone levels. So, the more your Testosterone level increases through the amount of steroids you take, and the length of your cycle, the more your Estrogen level will increase as well. This irregular raise in Estrogen, can cause several side effects. The biggest is "gyno" better known as "bitch tits".
Basically, the male body begins to develope female breasts due to the level of estrogen in your body. This is not life threatening, but is very obvious and not too good for your self-esteem, not to mention that your talking thousands of dollars to have them removed, "which most insurance companys won't cover". I have several friends who went through it, and they were the ones who never listened. Of course everyone has a different tolerance to different steroids, but there is a good chance that most people will eventually go through it if they don't take an anti-estrogen.
Even if you have been taking steroids for years, and have never experienced "gyno", it doesn't mean that you won't get it from your next cycle. I have found that the higher the dosages, and the longer the cycles of anabolic steroids, the better your chances for getting "bitch-tits". So, if you have the money, instead of getting a second or a third anabolic steroid to stack during your cycle, take that money and invest in an anti-estrogen. I cannot guarantee that they will prevent "gyno", but it certainly cannot hurt. I have also noticed that when an anti-estrogen is taken, the gains seem to be bigger during a cycle, because you don't have the estrogen limiting the effects of the testosterone.
I found it best to slowly lower the dosage of the anti-estrogen after your cycle is over, so that your body can slowly bring your levels to a balance instead of sky-rocketing your Estrogen level to meet the Testosterone level. Also, I found it best to give a 6-8 week break between cycles to give your body a rest and a chance to get back to normal. As long as you keep lifting, you shouldn't lose too much of your gains, but don't get pissed if you can't bench what you did in the peak of your cycle. So, if you are gonna juice then consider taking an anti-estrogen, but the best way to prevent "gyno" is not to take steroids at all! If your gonna play, just be prepared to pay! Best of Luck, and be smart, no gain is worth a big loss!!!"
Editor's Note: Gynecomastia, also known as gyno and bitch tits, is female breast development in men. Gynecomastia is a common side effect of anabolic steroid use. Men naturally produces a small amount of estrogen, a female hormone. When anabolic steroids are used estrogen levels can rise and or dominate.
Some anabolic steroids are peripherally converted to estrogen. When these steroids are used both anabolic hormone and estrogen levels rise. High estrogen levels will sooner or later cause gynecomastia in most individuals.
Abruptly stopping steroid use greatly increases the odds of developing gynecomastia. Anabolic steroid use causes the testicles to atrophy, shrink in size, and become dormant. Normal testicular function usually resumes after steroid use is stopped, but it may take several months for the testicles return to pre-steroid use size and function. When steroid use is abruptly stopped a condition is created where very low levels of anabolic hormones are present. The testicles have not yet resumed normal testosterone production and exogenous anabolic hormones are no longer being taken. As a result, estrogen can now dominate. Gynecomastia is almost certain to occur.
Gynecomastia can usually be avoided by taking anti-estrogens like Nolvadex or using steroids that can not be peripherally converted to estrogen. A complete discussion of gynecomastia and a list of steroids that can not be peripherally converted to estrogen can be found in The Steroid Bible