Understanding Gynecomastia Symptoms & Causes

What Causes Enlarged Male Breasts?

The term gynecomastia has Greek origins and means "woman-like breasts." The condition can affect one or both breasts, and it's far more common than most men realize. The problem is that most men never do anything about it or even know they have a diagnosable problem. However, gynecomastia is a legitimate medical condition.

Gynecomastia is even more common in teenage boys, affecting three out of four. For teens, enlarged breasts are usually due to the high levels of estrogen and testosterone coursing through their bodies during puberty. But like acne, in most cases, their enlarged breasts will pass with the end of puberty as hormones stabilize. For adult men, however, the condition typically doesn't resolve on its own and requires surgical intervention for correction.

True gynecomastia is usually caused by hormone fluctuations, particularly an imbalance between testosterone and estrogen. In adults, gynecomastia usually occurs in middle age and above. Just like during puberty, this is a time of fluctuating hormones as testosterone levels naturally decline with age.

Beyond hormones, certain medications are linked to enlarged breasts, including steroids, antibiotics, tricyclic antidepressants, heartburn treatment drugs, THC, anti-anxiety medications, and AIDS treatment drugs. Lifestyle factors can also contribute: heavy drinking, frequent marijuana usage, and weight gain are all risk factors for developing gynecomastia.

It's important to understand that not all male breast enlargement is true gynecomastia. Sometimes, excess fat from weight gain can create the appearance of enlarged breasts without the presence of excess glandular tissue. This condition, sometimes called pseudogynecomastia, may respond to diet and exercise alone.

Dr. Schiesel can diagnose true gynecomastia by feeling for a firm, rubbery mass beneath the nipple. This mass is usually less than 2 inches in diameter and is often sensitive to applied pressure. This glandular tissue is what needs to be surgically removed to achieve lasting correction.

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Am I a Good Candidate for Gynecomastia Surgery?

In some cases, a man's enlarged breasts can be simply the result of weight gain rather than true gynecomastia, so Dr. Schiesel may first recommend that patients lose weight first to see if the condition persists once excess fat is reduced. This helps determine whether you're dealing with true gynecomastia (excess glandular tissue) or pseudogynecomastia (excess fat).

Additionally, heavy drinkers, marijuana users, and those who use steroids are not ideal candidates for immediate surgery, as their breast enlargement could be tied to their lifestyle choices, meaning that continuing these substances after surgery could cause gynecomastia to return.

Dr. Schiesel can accurately diagnose true gynecomastia during a physical examination. Before opting for surgery, Dr. Schiesel may work with your primary care doctor to try medication that can reduce the amount of estrogen your body is producing or block its effects. If conservative treatments don't provide adequate improvement, surgery becomes the most effective option. It's important that patients still have good elasticity in their chest skin so that it can tighten down over the slimmer contour after surgery. Men with poor skin elasticity may require additional procedures to address excess skin.

The Gynecomastia Surgery Procedure

Gynecomastia surgery is performed under general anesthesia as an outpatient procedure, meaning you'll go home the same day. The specific surgical approach depends on the amount of glandular tissue and fat that needs to be removed. For men with primarily glandular tissue, Dr. Schiesel will make small incisions, often around the areola border, where scarring can be minimized, to remove the excess breast gland. If excess fat is also present, liposuction may be combined with direct tissue excision to achieve optimal contouring. The goal is to create a flatter, firmer, more masculine chest appearance with minimal scarring.

The incisions made by Dr. Schiesel are small and strategically placed. There will be some swelling and discomfort following surgery, but this is short-lived and easily managed with prescribed pain medication. Patients will wear a compression garment for several weeks to help the chest adhere to its new contour and minimize swelling. This garment also provides support and comfort during the healing process. There is often some temporary loss of sensation in the treated areas after gynecomastia surgery, but this is almost always only temporary, and sensation typically returns within a few weeks to months.

Most men can return to work within a few days to a week, depending on the physical demands of their job. Strenuous exercise and heavy lifting should be avoided for about four weeks to allow proper healing. After that, patients can gradually resume all normal activities, including weightlifting and sports. Final results become apparent once all swelling has subsided, typically within a few months, revealing a flatter, more masculine chest contour that looks natural and proportionate.

To ensure the best possible aesthetic outcome and minimize visible scarring, Dr. Schiesel may recommend Biocorneum, an advanced silicone gel scar treatment with SPF 30. Once your incisions are fully healed, applying Biocorneum twice daily can help soften, flatten, and fade scars while protecting them from sun exposure that could cause darkening.