Treatment of Gynecomastia or Man Boobs in Men
Gynecomastia or the so-called “man boobs” has been a significant problem in several men. Majority of men with gynecomastia are typically uncomfortable removing their shirts at the beach or swimming parties. Gynecomastia may be present at birth, during the adolescent teenage years or during weight gain.
A careful history and physical examination by your plastic surgeon or primary care physician is probably the most important part of any work-up for gynecomastia.
Potential Causes of Gynecomastia
Klinefelter’s syndrome with Marfanoid body habitus
Cardiac medications such as Amiodarone, Digoxin, etc.
Anti-ulcer medications such as Zantac
Liver, kidney and adrenal problems
A thorough examination is important especially if one has a family history of breast cancer. Your plastic surgeon will typically examine you for any thyroid mass, breast mass, testicular masses, and abdominal masses (liver enlargement) to rule out other potential causes of gynecomastia.
In a healthy young male patient with a normal examination, long-standing gynecomastia do not need work-up
For patients with a breast mass or family history of breast cancer, a mammogram or breast ultrasound may need to be done. A typical mammogram for the most common gynecomastia would reveal a subnodular density on lateral view of the mammogram.
If a male patient has feminizing characteristics, it is imperative to rule out Klinefelter syndrome. This is associated with increased estradiol levels and decreased testosterone levels.
In patients with enlarged liver or if an abdominal mass is present, your primary care physician will likely order liver function tests, serum LH/FSH, estradiol, testosterone, and DHEAS. An abdominal CT-scan may be ordered to determine the nature of the abdominal mass.
In patients with a testicular mass, a testicular ultrasound is needed to evaluate for a possible testicular tumor. Serum testosterone, estradiol, LH, DHEAS, urology and endocrine consultation will likely be needed if a testicular mass is found to be present.
Neonatal or Pubertal Gynecomastia
Neonatal and pubertal gynecomastia rarely requires any medical intervention and is most appropriately treated with expectant management. Neonatal gynecomastia typically resolves within 1 or 2 months. For pubertal gynecomastia, children are typically examined for any breast mass or testicular masses. If this is wihin normal limits, they may be observed for a year, and then re-evaluated.
Typically, for drug-induced gynecomastia, cessation of the inducing drugs or medications typically result in resolution of the gynecomastia. In circumstances when the inducing drug causing the medication cannot be discontinued, then surgical excision may be warranted.
There has been a number of non-operative approaches to gynecomastia. These medications include Tamoxifen, anti-estrogens and aromatase inhibitors. Danazol, an androgen, has been shown to successfully reduce gynecomastia by as much as 85%. Clomiphene has been shown to improve symptoms associated with gynecomastia.
Depending on the severity of the gynecomastia, surgical treatment may involve using the VASER liposuction, surgical excision or a combination of VASER liposuction with surgical excision. I recommend being evaluated by your plastic surgeon, and discuss with him/her your surgical options.
Emmanuel De La Cruz MD, PLLC
Plastic & Reconstructive Surgeon