Background:Gynecomastia, or male breast growth, has numerous causes. When occurring in very young males going through puberty the cause is a natural one over which one has not control. Fortunately, many puberty-induced gynecomastias are self-resolving. But when occurring in non-teenage males there is almost always a specific exogenous influence.
Gynecomastia is well known to be the result of certain drug uses. Precriptions drugs such as Prilosec, Tagamet, Zantac and Propecia are some recent examples. They exert their adverse effect by stimulating estrogen production. Anabolic steroids, which are generally used in non-prescription or illegal fashion in the body building industry, causes an equal if not greater number of gynecomastia cases through their aromatization effect and subsequent conversion to estradiol. Certain supplements in muscle building can also cause gynecomastia although which ones are a bit controversial.
Drug or supplement-induced gynecomastia almost always presents as firm glandular enlargement underneath the nipple-areolar complex. It makes the nipple protrude outward with a very discrete palpable mass. Because of the good muscular definition and lean body mass of most amateur and professional body builders, the protrusion caused by the breast lump is aesthetically obvious.
Case Study: This 22 year-old male from Bloomington Indiana had developed nipple protrusion over a one year period. He never had it before age 20 when he started to lift weights regularly. He purchased and took a muscle-building supplement purchased over the internet to help get bigger more quickly as part of his program. After a year, he had developed hard masses under his nipples. He stopped taking the supplement but the nipple lumps failed to go away. After six months of no improvement, he sought a surgical solution to his small ‘man boobs’.
Under general anesthesia, the breast lumps were approached through a lower areolar half-moon incision. A large amount of hard glandular breast tissue was cut out and removed. The removal was done until more normal soft chest fat was left. While getting every bit of abnormal gland tissue removed is important, some fat on the underside of the nipple and on the pectoralis fascia if possible should be preserved to prevent the risk of a sunken-in nipple later. Drains were placed and the incisions closed. A chest compression wrap was placed. This was performed as an outpatient procedure that took one hour to complete.
He wore a chest compression wrap for two weeks after surgery. By three weeks after surgery, all bruising and swelling had resolved. His chest was completely flat with a smooth nipple-areolar complex contour. He returned to exercise and weight lifting, without supplements, one month after surgery.
Most cases of steroid or supplement-induced gynecomastia in athletes and body builders present as discrete firm masses just under the nipple. The rest of the chest rarely has enlargement or needs contour reduction. This type of gynecomastia can usually be cured satisfactorily in a single procedure with a low risk of the need for revisional surgery. But it is important that no working out, specifically chest exercises, be done within the first month after surgery. Doing so will cause a fluid collection or seroma which will require drainage and may induce scar formation. Such scar formation may result in a mass that is just as big as the breast tissue that was removed.
Case Highlights:
1) Gynecomastia can be caused by any drug or supplement which has a stimulatory effect on breast tissue. This is a well known effect of numerous supplements used in body builders.
2) Supplement or drug-induced gynecomastia is glandular in nature and usually requires direct excision with or without contouring liposuction
3) Direct glandular breast excision is done through a lower areolar excision and must be done carefully to avoid a concave contour deformity. It is a completely curable gynecomastia problem.
Dr. Barry Eppley
Indianapolis, Indiana