Transcription:

Bill Klaproth (Host):    Welcome to Aspirus Health Talk. I'm Bill Klaproth. Today we're discussing surgical solutions for enlarged breasts in men known as gynecomastia. Joining us is Dr. Thomas Howard, a Plastic Surgeon at Aspirus. Dr. Howard, thank you so much for your time. It is great to talk with you. So explain to us, what is gynecomastia?

Thomas Howard, MD (Guest): Gynecomastia is a common development of excessive breast tissue in men, that can occur really at any age. In fact, we see it kind of in three different age distributions from newborn children to very commonly adolescents, and then, occasionally, in some older gentlemen as well, but it's benign excessive breast tissue and breast development in a gentleman.

Host: So, as you mentioned, this is very common, but who is at risk for developing this?

Dr. Howard: Yeah, like you said, it's very common, maybe 10 to 15% of young men that have had it, had a family member that had some gynecomastia as well. But really, I mean, it's so common that some people report up to 30, even to 60% of men at some point in their life will suffer from gynecomastia. Now the majority of these cases, well over 90% are going to be transient and then whatever kind of hormonal imbalance that's occurring at that time, will eventually, settle itself out. And then that excess of breast tissue will resolve spontaneously. But there are a few, albeit rare medical conditions or genetic conditions that predispose people towards gynecomastia, but by and large, the majority of cases are seen kind of just in the general population.

Host: You said earlier, this is benign and you just said, generally this will resolve spontaneously. So, it sounds like this isn't a serious problem then?

Dr. Howard: I think it's something that needs to be evaluated, it can be serious. And certainly if you, or a loved one are experiencing gynecomastia or you're worried about your breast development at any age, I think it's important to get in with your regular doctor. Because it is so common, undoubtedly, that physician who sees you is going to have experience and knowledge about when is it appropriate to just observe that gynecomastia tissue.

   I would certainly say that, the majority of the cases are certainly not life-threatening, but it can be a serious problem that has both physical, emotional and psychological ramifications on a man's life. We should spend some time on it and not just sweep it under the rug. This can be very distressing, especially for some of the adolescent patients that deal with this. This is a very formative time in their life when they're establishing their own body images, their self-esteem and so forth. And, the way you look, the way you feel, ties into that. If you have an adolescent son who's dealing with this, it might be a big darn deal to them. And as a parent, like, oh, they'll grow out of it. And, I think we all remember being kids, like, it can be pretty stressful if even, you're just a little bit different or struggling with these problems.

Host: I would imagine this can be embarrassing for, like you said, especially those coming of age years for boys and even men who have this issue. So, if someone does come to see you, is there ways to treat this? I think you mentioned even potentially surgery in some cases. How do you generally treat this?

Dr. Howard: If you go in and you're seen by your primary care doctor or your surgeon and so forth, they're going to do a wonderful job of getting the history of this gynecomastia. When did you first notice it? How long has it been going on? Are there other symptoms, other things that you noticed as well? Because there are several other possible medical reasons why you might have this breast development. It could be a medication that you're taking. It could be substance that you're using. So, before we talk about how do we treat it, sometimes we have to figure out why is it there? Thankfully, in a large majority of cases, it's not some big, huge medical, endocrine or genetic problem, but rather it's just this idiopathic breast development.

Then it comes down to timeframe. If you've had it for three months, and we can't think of any reason why you would have it; there's no medication, there's no other medical problems and no suspicion for this gynecomastia. Chances are it may resolve within a year. Now, if you tell your doctor well, I've been kind of hiding this for the last two years, or I had it when I was 14 and now I'm 16, 17, 18, and it's no better; in fact, I think it might be getting worse; we'll then you're going to be more likely to be seen by a surgeon to discuss correction of that gynecomastia.

Host: So, then Dr. Howard when it does come to surgery, can you tell us more about that?

Dr. Howard: Yeah, absolutely. There's many different ways that correction of gynecomastia has been done and can be done. A lot of it depends upon the degree or the amount of breast tissue that's developed. The majority of the time there is relatively small, although it seems large to the patient, but in the world of surgery is not a huge development of breast tissue. Nevertheless, it's something that can be addressed with a simple, straightforward, outpatient based procedure. So, you come in the morning, you get your surgery, it lasts a couple hours and you go home later on that day.

But, typically how most individuals will approach this, we'll do a fair amount of liposuction removing fatty tissue from the chest wall and the upper abdomen to smooth out any contour of the chest. And then immediately underneath the nipple, there's usually a firm breast bud of tissue that has to be surgically excised. So, we'll make a small incision from maybe the three to nine o'clock position along the nipple-areolar border. And then go down and dissect out that firm breast bud tissue. It's simply doesn't come out with simple liposuction. So, oftentimes that is needed to remove that tissue. Once that's done, we have a small little wound out in the armpit or the lateral chest area. And then a little one underneath the nipple-areolar complex and a significant improvement to the chest contour.

Typically these patients will then be in some sort of compressive garment, around the clock for the first month or so, just to help out with swelling and bruising and trying to get everything nice and flat and smooth as much as possible, as soon as possible. But, it's usually a very well tolerated procedure and typically patient satisfaction rates are extremely high. They go from having an emotionally distressing condition to having a straightforward surgery. There's some risk of complications, but they're typically minor and infrequent. And then coming out the far side of it, feeling much better about their chest contour and their body image.

Host: I could see that being certainly a self-esteem booster and a confidence booster as well.

Dr. Howard: Absolutely. Yeah.

Host: So, we've been talking about this condition and it's easy to see how this can be embarrassing, certainly for a young boy coming of age years, even an adult male. This can cause somebody to be really self-conscious. So, for someone listening to this podcast, right now, what would you say to them? Because we know this can be an embarrassing condition.

Dr. Howard: Well, I think it's good to hear that being self-conscious about excessive breast tissue is very understandable. It's a common issue. If you had visited with dozens of patients who have dealt with this, it is embarrassing. It changes the way that you approach the world and has a significant impact on your body image and your self-esteem. And, certainly when summertime comes around and all your friends are going to the pool, and you're not really confident doing that, it's gonna affect the social side of your development and the psychological side. And if you have concerns about your body image, if you're an individual that's suffering from gynecomastia, I think it's important for them to know that there are a lot of great ways to treat this. If you're at one of the unfortunate few that you developed it, it never went away, like someone may have promised to you; there are surgeons out there that can correct this and can guide you through from where you are today to hopefully where you want to be, as far as the way you want to look and feel, and create a better, more positive body image for you going forward.

So, it's common. It is disturbing. A lot of patients do suffer quite a bit with their gynecomastia, not only physically, but also emotionally and psychologically and socially. And so, it's definitely, an understandable medical condition that any physician should feel confident in helping you get through and take care of.

Host: Right. Well, that makes sense and is very well said. So, then Dr. Howard, I know you said generally, this will resolve on its own. However, at what point should someone consider seeing a doctor? What is the length of time where it may not go away? When is that time to consult a physician?

Dr. Howard: The common time, we're going to see it is around adolescence and certainly as we get older. But if you're noticing breast tissue development, and you have other physical findings, maybe there is a lump or a bump or you feeling fatigue or sick in any way, then you should probably get in at your earliest convenience.

   If you have a son who is 11, 12 years old, and you're noticing that they have a little bit more breast tissue development, keep an eye on it. If it rapidly progresses, I think if you were seeing a significant increase in size in a short period of time, I would go in early on. If you went in and saw your primary care physician in that first several months, they're probably gonna tell you, oh, we should just keep an eye on this. Now if there's other, co-existing findings or if it's been a period of time, like over a year, then it's probably time to start talking about going on and seeing specialists. So, if you have other medical findings, or concerning symptoms, they might have you go in and see a specialist for endocrine looking for an endocrine abnormality.

Or if everything else checks out and we think it's just run of the mill, but persistent gynecomastia, then coming in to see your local plastic surgeon, I think at about a year from development and certainly sooner. There's no reason why, if it concerns you, if you have severe emotional distress or if your child has these issues, you can go in visit with your plastic surgeon and talk about options within a couple of months. They may say like well, we'll keep a close eye on this. However, if the kid is really struggling with body image and so forth, this is actually an area where we are able to kind of lean in with surgery.

It can be such a detriment to their overall wellbeing and mental wellness, that we can step in sooner and do surgery to correct that and restore their body image, get back some self-esteem and certainly if it's a problem for you now, it may go away. It may not. But I'm all for being proactive, getting in early and establishing that relationship because there's going to be a lot of questions, a lot of things to figure out and the last thing you want to do is have a young man or anyone at home, not in the dark, not knowing their options, not knowing what to expect or to watch out for.

Host: That is really good guidance and advice. Well, Dr. Howard, this has really been a fascinating and insightful. Thank you so much for your time. We appreciate it.

Dr. Howard: All right. Take care.

Host: That's Dr. Thomas Howard. And thank you so much for listening to this episode of Aspirus Health Talk. To learn more or to get hooked up with a provider, please visit aspirus.org slash/renew, or call (715) 870-2162. And please remember to subscribe, rate and review this podcast and all the other Aspirus podcasts. And for more health tips and updates, follow us on your social channels.

Thanks for listening.