1. What is the difference between teenage and adult gynecomastia?
Gynecomastia, or male breast enlargement, can occur at any age. It is most commonly seen in teenage males after undergoing puberty. The breast tissue often responds by becoming larger and more noticeable. While many teen age gynecomastias do go away and the chest gets flatter again, this does not occur in all male teenagers. If the enlarged breast tissue has not gone down by age 15 or 16, it is not likely to go away. A parent should consult with their pediatrician first to be sure that there is not a treatable cause. (endocrine disorder)
Adult male gynecomastia is different in numerous ways. Breast masses, particularly if they are just on one side and painful, should be evaluated to rule breast cancer. (about 1% of all breast cancers do occur in men) Older men can develop gynecomastia as a result of the medications that they take for prostate enlargement and in the treatment of some cancers. Older men also develop chest sagging or drooping as well as some breast enlargement as their testosterone levels fall.
2. At what age should a teenager undergo surgery to correct their breast enlargement?
My personal approach is to treat the gynecomastia when it is psychologically disruptive to the teenager. I don’t think it is necessary to wait until they are 17 or 18 to see if it goes away. While age 12 or 13 is too young, if the breast enlargement has not changed by age 15 or 16, then a plastic surgery consultation is in order. If the breast enlargement is going to really go away on its own, a substantial change will be apparent by that age. From a psychological perspective, I have seen numerous teenage boys that have suffered too long and could have had surgical correction earlier.
3. Will my insurance cover the costs of gynecomastia surgery?
Insurance coverage for gynecomastia requires an insurance pre-determination process. After an initial consultation, your plastic surgeon will write a letter complete with photographs to them. They will use that information to either approve or deny coverage. My experience is that the success rate for insurance coverage is in less than half of the cases. Some insurance companies even specifically exclude gynecomastia surgery from their policies. Adolescent or teenage gynecomastia has a much better success rate than that of adult men.
4. What is the best method to treat gynecomastia, liposuction or open excision?
Liposuction and open excision are two methods to treat gynecomastia. Sometimes they are done alone and in others both are used in a single surgery. Which one is used will depend on the size of the gynecomastia and how firm or soft the breast tissue feels. For small breast tissue enlargement that is just around the nipple, a simple open approach with an incision around the lower half of the nipple is used to cut it out. If the gynecomastia is larger and soft, then liposuction alone may be sufficient. In gynecomastias that have sufficient size but have a harder feel under gthe nipple, then a combination of liposuction and excision is done.
In very large male breast enlargements (where an actual breast mound exists), another issue to consider is what to do with the extra skin. Some form of skin reduction needs to be done to lift the nipple, make it smaller, and tighten the chest skin as well. Because skin reduction causes scars, reduction of breast mound skin is usually done by keeping the incision and cut-out around the nipple. Older gynecomastia techniques used more traditional female breast reduction scars which should be avoided due to poor and very noticeable scarring.
5. When can I return to exercise and working out after surgery?
That will depend upon what type of gynecomastia surgery one has. If liposuction alone is used, one could return to working out within 10 to 14 days. If any form of open excision with or without skin reductio, is used, one should wait a full month after surgery before stressing the chest tissues. This will help prevent any build-up of fluids (seroma)that could occur.
6. What is the difference between gynecomastia and ‘man boobs’?
There is no difference. Man boobs is a slang or urban term for gynecomastia. It is used very unflatteringly across the internet with numerous so-named websites dedicated to mocking this unfortunate and embarrassing male condition.
7. Will I need drains after my surgery?
In cases where open excision is used, yes. The drains will stay in for 3 to 5 days after surgery. When liposuction alone is used, drains are not necessary.
Dr. Barry Eppley
Indianapolis, Indiana