Male Breast Reduction

Q:  I am a 40 year old male who has had unusually large breasts since my teens. Recently I began working out with a Nordic Track and this has seemed to make the condition even worse. What are my options for cosmetic surgery? What would the cost, risks and extent of this type of surgery be?

A:  Gynecomastia is the medical term for enlargement of the male breast. It is a normal transient occurrence in about 70% of boys going through puberty, but is present in only about 1% of adult men. True enlargement of the breast glands needs to be distinguished from excess fat in the breast area that occurs with weight gain. In your case regular workouts may have caused your breasts to appear more prominent because of increased bulk in the pectoral muscles underneath the breasts.

Before you consider surgery, it would be important to exclude possible reversible causes of your breast enlargement. The commonest causes in adults are alcohol-related liver disease and medications such as cimetidine (anti-ulcer), spironolactone (diuretic for high blood pressure), digoxin (heart drug), and marijuana. Of course any hormone-related disease or ingestion of hormones such as estrogen would need to be ruled out. I read a report of a 70-year-old Tennessee man who developed large breasts which was eventually traced to absorption of his wife's vaginal estrogen cream during intercourse.

I should also mention the very remote possibility of breast cancer that does occur in men. Particularly if just one breast is enlarged, a mammogram should be obtained. Sometimes the breasts are painful. In such cases, tamoxifen, an anti-estrogen drug which is used for breast cancer, has been used experimentally with men to reduce breast size and pain.

In the majority of cases, there is no identifiable cause of breast enlargement, and the next step is to see a plastic surgeon. According to Dr. David Larson, head of Plastic and Reconstructive Surgery at the Medical College of Wisconsin Physicians and Clinics, the operation is done as an outpatient, usually under local anesthesia, which means that you are not put to sleep.

The type of surgery will depend on whether the enlargement is primarily fat or breast gland tissue. Usually the physician can tell by carefully examining and feeling the breasts. Dr. Larson will use liposuction if the breasts are mostly fat, but firm breast tissue requires direct excision and removal. An incision is made around the areola (the darker skin surrounding the nipple) in a semi-circle from the three o'clock to the nine o'clock position, so the scar is essentially invisible. All work is done through that small cut. Some tissue is left under the nipple; otherwise the person will end up with indented nipples. A drain may be left in for a few days, and it may take two or three weeks before the patient can resume exercising and activities that require lots of arm movement.

As with any surgery, there are risks of bleeding and infection, which are not common. A unique side effect that I wasn't aware of is a possible alteration in nipple sensation if the nerve gets damaged. This could result in either decreased feeling or hypersensitivity. Dr. Larson has seen patients in which the nerve presumably gets "caught" in scar tissue, and their nipples become so sensitive that they have to wear bandaids to avoid rubbing against their shirt. (This probably told you more than you wanted to know.)

Dr. Larson has performed the operation on many young men who have been self-conscious about baring their chest in public places like pools, and he has seen a transformation in their personality and self-confidence. The issues might be different for an adult like you who has lived with this for many years. Now, after hearing the scoop on breast reduction, it's up to you to decide how important this operation is to your well-being.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.