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Gynecomastia is a well known condition of breast enlargement in men. It can occur in any male body shape from a thin teenager to an older male. The size of the gynecomastia  and the extent of chest deformity can vary considerably. But the one feature that all gynecomastia patients have is the very firm lump of breast tissue that lies under and around the nipples.

One very unique form of gynecomastia is that seen in male body builders. Even though they have little body fat and are long past puberty, gynecomastia can occur most often due to the use of anabolic steroids or other high dose supplements. While their gynecomastias are small in size compared to many other forms, it is disturbing to them due to their high aesthetic standards and its easy visibility as a stand out feature on their chest which is highly scrutinized if they participate in competitions.

In the February 2015 issue of the journal Plastic and Reconstructive Surgery, a paper was published entitled ‘Correction of Gynecomastia in Body Builders and Patients with good Physique’. Over a 33 year period, over 1500 body builders underwent gynecomastia reduction. Subtotal excision of most of the firm breast tissue was removed through an open approach using an inferior areolar incision in all cases. Liposuction was minimally used in 2% of the cases. Good aesthetic results was obtained in 98% of the cases. Hematoma rates averaged 6% over the study period. The authors has no infections, contour deformities or redevelopment of breast tissue.

This paper highlights that successful gynecomastia reduction in male body builders requires essentially a near complete subcutaneous mastectomy. The tissue needs to be thinned out under the nipple-areolar complex to just a few millimeters so that it will lay flat on top of the pectoralis fascial/muscle layer. This will also prevent recurrence of the breast tissue since these patients may likely continue taking steroids and supplements that caused the problem initially. Attention to the smallest chest contour detail is important since these patients are by nature of their body types perfectionists.

One very important element of this type of gynecomastia reduction is the postoperative activity level. Male body builders are very religious about their workout routinues and it can be hard to keep the out of the gym for any extended period of time. Exercises of the chest need to be restricted for at least two weeks after surgery with three weeks preferred. Noncompliance is associated with higher rates of hematoma and seroma formation.

Dr. Barry Eppley

Indianapolis, Indiana

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