Board certified Plastic Surgeon Gregory A. Buford, MD, FACS, PCEO wants the world to start talking about gynecomastia, often referred to as “man boobs.” Instead of perpetuating shame and silence, he wants to shine a light on the condition and let men know they have options. We recently sat down with Dr. Buford to discuss this condition and the underlying medical issues that may be causing it.
What is gynecomastia?
Dr. Buford: Gynecomastia is the abnormal development of breast tissue in a male. We all have breast tissue underneath the nipple and the areola. For women, the normal event is that, through puberty, this breast tissue is acted upon by hormones that effectively allow for breast development.
Gynecomastia can have a staggering effect on self-esteem and confidence. While the cause of this condition may be hereditary or hormonal, it may also be the side effect of certain medications or associated with the loss of testosterone that takes place during aging.
In males, gynecomastia can develop as a result of several things, the most frequent being estrogen dominance. For the majority of my patients, breast tissue develops either in their teens or their 20s and they never really realize that there is a way to treat it. This is very unfortunate because treating gynecomastia is really pretty straightforward. My patients that have undergone the procedure are incredibly happy with the results.
Why do you advocate so strongly for gynecomastia awareness?
Dr. Buford: A lot of these men either, number one, don’t recognize the fact they have gynecomastia, or two, they don’t realize that there’s an effective treatment for it. They think that it’s something that they just have to live with. They think they just have to ‘suck it up,’ so to speak. I think this is very sad because there are techniques that are very effective, affordable, and literally life-changing that can really alter the appearance of gynecomastia and improve quality of life.
While gynecomastia is often seen as a cosmetic issue, the effect it has on emotional and psychological well-being can be great. Studies have shown that adolescent males with gynecomastia are found to have significantly lower self-esteem and higher incidences of eating disorders than other boys of the same age. For those suffering from the condition, access to more information could make a world of difference and help to eradicate the stigma associated with it.
Many of the men I work with don’t go swimming. They don’t take their shirts off in the locker room. It is a huge social stigma for these men, so I think more education is needed, both in terms of diagnosis and how to effectively treat it.
How does testosterone affect gynecomastia?
Dr. Buford: When a patient comes in suffering from enlarged breast tissue, I always check their testosterone levels. The reason I check is that I’ve found over the years that we were taught as Plastic Surgeons to offer technology to patients, to perform that technology, and then, effectively, wish them on their merry way, with no reflection on how they actually got there.
Not addressing the underlying issues is a major concern of mine and the main reason why I approach gynecomastia in the unique way I do. Hormonal imbalances and the resulting breast enlargement that occurs can indicate some serious health issues. These can range from mood changes and emotional side effects to elevated blood cell mass and high hemoglobin levels, which can increase your risk for strokes.
In many ways, only performing surgery is an irresponsible way of treating gynecomastia because, while this condition can develop from a number of different things, it’s been shown that many patients that have gynecomastia have an imbalance between their levels of testosterone and estrogen.
What is estrogen dominance and how does it contribute to male breast development?
Dr. Buford: When a male patient shows either very high levels of estrogen and normal testosterone or, as is often the case, relatively normal levels of estrogen but extremely low levels of testosterone, this effectively tilts the balance toward being estrogen-dominant. When estrogen dominance occurs, it tends to stimulate hormone accumulation and, subsequently, breast development.
In patients where testosterone levels are very low, additional surgery will not create an optimal result. The underlying issue must be addressed, otherwise the patient will not only see substandard results, they can experience potentially dangerous health effects.
For example, a surgeon may operate on a young man to remove excess breast tissue. The procedure may go smoothly, with results indicating successful treatment. However, what if the patient returns a few months later with residual breast tissue that shouldn’t be appearing? For me, this is a red flag that something else could be wrong with the patient and a prime example of why testing testosterone levels is critical to treating a patient appropriately.
How do you treat gynecomastia?
Dr. Buford: The main treatments that I know of are surgical, because by the time patients seek my help, the breast tissue is already developed and I don’t know of any way to reverse the development of breast tissue without mechanically removing it. Gynecomastia is usually composed of a few different tissues. You have to look at the fatty tissue, you have to evaluate the presence of glandular tissue, and you have to evaluate the quality of the overlying skin.
True gynecomastia is the development of the gland itself. The underlying fat will actually intensify this and make it more prominent. After performing initial tests, we generally begin by performing liposuction of some form. I typically perform ultrasonic or some type of power-assisted liposuction to remove the fat. Once this is removed, then you get a better, clearer picture of how much breast tissue there really is left. And we call that a subareolar disk.
The subareolar disk is the breast tissue that has developed as a result of lack of testosterone or excess estrogen. There are a few ways to remove it, depending on the amount of tissue, but some surgeons do not address it at all. I think this is a huge mistake.
Is this treatment for gynecomastia permanent?
Dr. Buford: Once the hormonal imbalance has been corrected, the results can absolutely be permanent. They may never have a need to do any other permanent surgery in life. Now, does that mean if they gain a fair amount of weight that they are going to gain back a gynecomastia-like appearance? They absolutely could. I tell my patients that this is an investment, not a quick fix.This is a jump start that allows someone to achieve something that they could not achieve on their own, but could only be achieved through surgery.
After the initial recovery period, I am continually stressing the importance of staying on top of physical health and maintaining an exercise regime to help keep results permanent.
Any final thoughts?
Dr. Buford: Striving to educate both my patients and the public about this often misunderstood condition, I ideally want everyone to know that they don’t have to suffer in silence. Many men are unaware of their options, or that breast growth may be indicating a larger medical problem. I want to change this.