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Many adolescent boys presenting to my Walnut Creek Plastic Surgery office for Gynecomastia Reduction have had hormonal testing, and in the vast majority of cases, the numbers are perfectly normal.

Chest Reduction Before and After Pictures (Men)

Gynecomastia Reduction provides a more masculine contour both in and out of tight shirts.

ASPS Recommendation

A study by the American Society of Plastic Surgeons (ASPS) concludes that routine measurement of hormone levels and an assessment by an endocrinologist isn’t needed for most adolescent boys with gynecomastia (male breast enlargement). The study was published in Plastic and Reconstructive Surgery®, one of the most respected, peer reviewed medical journals dedicated to the field of plastic surgery. So, what did they find?

Who Did the Researchers Study?

Liposuction can be used for male gynecomastia reduction in selected cases. If the fullness beneath the nipple is fat, liposuction can help. If it is glandular tissue, direct excision of the gland is needed.

If the fullness beneath the nipple is fat, liposuction can be used for gynecomastia reduction. If glandular tissue is causing the breast enlargement, direct excision is the optimal treatment.

According to the study. “The researchers analyzed 197 adolescents with gynecomastia seen at British Columbia Children’s Hospital from 1990 through 2015. Although adolescent gynecomastia is a common issue that usually resolves with time, it has been standard practice to send these teens for evaluation by an endocrinologist: a specialist in diseases of the glands and hormones.”

Causes of Adolescent Gynecomastia

Most patients had known risk factors for gynecomastia, with the number one cause being obesity, present in about half the patients. Another 15% had a family history suggesting an increased risk of gynecomastia, such as the father having breast enlargement as an adolescent. Only 8% of patients had a “secondary” cause of gynecomastia. Most of these involved drugs linked to male breast enlargement (marijuana, the antidepressant drug fluoxetine, or anti-seizure drugs used to treat epilepsy). Some patients had medical causes of breast enlargement – most commonly (three patients) the inherited chromosomal disorder Klinefelter syndrome. Testicular cancer is a rare cause for gynecomastia, so self examination of the testicles is especially important in adolescents with gynecomastia.

Why No Lab Testing?

According to the study, endocrinological investigations did not yield new clinical information in 99.4 percent of cases. These evaluations carried considerable costs. Based on ASPS data on breast reduction surgery for adolescent gynecomastia, the cost was almost $5 million in 2016 alone

Watchful Waiting

About 70 percent of patients had psychological distress due to their breast enlargement, so how where they treated? Overall, 51% of patients received no medical treatment, other than “watchful waiting” or diet and exercise to lose weight. In this group, gynecomastia resolved over time (median age 14.6 years). About 44% underwent plastic surgery to treat their gynecomastia. In this Canadian study, the median age at surgery was 16.5 years.

When to Operate on Gynecomastia?

Gynecomastia Reduction after Massive Weight Loss is a different operation than the typical gynecomastia reduction. The large amount of excess skin and extremely low nipple position need special treatment. This patient had chest skin reduction (a male breast lift), reduction and repositioning of his nipples and a tummy tuck to clean up after his impressive weight loss.

After massive weight loss, even male breasts can sag. This type of reduction also involves nipple grafts and skin reduction, thus the incisions beneath the breasts. He also had a Tummy Tuck to tighten the abdominal skin.

Gynecomastia Reduction Surgery should be considered if gynecomastia has persisted for two years or beyond the age of 16, or for patients who are severely distressed. Of course, this is elective surgery, so if the appearance is not bothersome, surgery is not necessary.

Male Breast Reduction Consultations

The best way to learn how Male Breast Reduction can be tailored to your specific needs is with a private consultation appointment. If you are considering Gynecomastia Reduction, consult an experienced and Board Certified Plastic Surgeon. In the San Francisco Bay Area call (925) 943-6353 to schedule your private consultation appointment.

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