ANATOMY MAN BOOBS NO LAUGHING MATTER

Unwanted breasts common for 25 percent of older men

WRITER: RICHARD T. BOSSHARDT, MD, FACS

K, guys. Let’s talk breasts. Whoa! Before you get too excited, let me hasten to add that I want to talk about your breasts. Don’t look so disappointed; it will be interesting and useful, too. Trust me.

Let’s face it, men. While breasts look terrific on women, they are not a good look for us. We may have nipples, but we aren’t supposed to have actual breasts. Male breast development, called gynecomastia, can occur for a number of reasons and can be a source of distress, a sign of a medical condition or both.

reasons and can be a source of distres a medical condition or both.

Male breast often effects of the female hormone, estro testosteron common and is due to the effects of the mother’s estrogen, which can cross the placenta into the fetus during pregnancy, on the nascent breast tissue. This type of breast enlargement invariably goes away soon after birth. verse occurs in women. If t level is too low, brea in B

Male breast development often results from an imbalance between the effects of the female hormone, estrogen, and the male hormone, testosterone. Both sexes have both hormones, but in men, the effects of testosterone overshadow any estrogen effects and the reverse occurs in women. If the estrogen level is too high and/or the testosterone level is too low, breast growth can occur in men.

Breast development in males can be broken down into three periods of life: infancy, puberty and adulthood.

Male infants sometimes are born with visible breast development. This is

Breast growth also is common in adolescent boys. With all the hormonal changes of puberty, there may be breast development ranging from very subtle to obvious. (As if acne, a voice that cracks at the worst possible moments and hair sprouting in new, unusual places weren’t enough.) This can be very disturbing to teenage boys at a time when they are especially vulnerable to social pressures and teasing from peers.

Most of the time, this breast devel- opment will subside spontaneously in a few months to a couple of years. Boys with significant breast development should have their testosterone levels checked. They also should be examined to be sure the testicles are normal and properly descended into the scrotum because there are some genetic conditions that may cause the testicles to fail to develop. y ears. evelopment osterone should be examined ticles nded into the scrotum ay e-aged e elopment here auses.

In middle-aged and older men, an estimated one in four has some degree of breast development — so-called “man boobs.” There are a large number of potential causes.

The most common cause is obesity. Body fat, especially the so-called visceral fat around the abdomen, is biological- ly active and can convert the male hormone, testosterone, into the female hormone, estrogen. Lower testosterone levels also accompany aging, so the combination of obesity and aging may result in breast development in middle-aged and older men. The first and foremost solution is to lose weight.

Excessive alcohol intake also can cause gynecomastia. Alcohol directly suppresses the production of testosterone. The liver breaks down estrogen, which can lead to elevated levels of estrogen in the body. Most long-term, heavy drinkers have some degree of gynecomastia.

Declining levels of testosterone is another cause. Some decrease in testosterone production with age is normal and usually isn’t enough to cause problems (though it can do so in some men).

There also are numerous medications associated with breast development, such as steroids, drugs to treat prostate and other cancers, anti depressant and anti anxiety drugs, some antibiotics and some drugs used to treat AIDS. Street drugs such as marijuana, amphetamines and heroin may also trigger breast growth.

Tumors of the adrenal or pituitary glands, thyroid problems, kidney disease and liver disease all can trigger breast development.

Breast cancer, while rare, does occur in men. Approximately 1 percent of all breast cancers occur in males. These tend to be diagnosed at a more advanced stage than in women, and the prognosis is often poorer as a result.

The treatment of gynecomastia depends on the circumstances. If there is a specific cause identified, correcting it is the first step.

Your doctor can correct hormone deficiencies with hormone supplements. Have your doctor check to see if breast development is a side effect of any medications you’re taking, and if possible, stop them or prescribe an alternate drug. If you drink heavily, cut back, or better yet, stop.

If you are overweight, drop some pounds, and you just might lose the “man boobs.”

Unfortunately, once breast development occurs, it can’t always be reversed, even when the inciting cause is eliminated. In that situation, surgery becomes an option.

For young men with true breast development that doesn’t resolve itself within a couple of years, or when the problem is just too distressing, the best option usually is a traditional surgical removal through an incision along the edge of the areola. This leaves the best scar and provides the most complete removal of the breast tissue. Sometimes, if the areola is small, the incision will have to extend across the breast, which will leave a more visible scar. There may be an indentation under the areola, at least for a while. Young men are especially prone to hematomas — collections of blood in the space created by removal of the breast tissue — so small drainage tubes often are placed in the site for a few days.

For older men, traditional surgical removal is often recommended, but because the breasts here are often very fatty, another option is liposuction. Suctioning out f through tiny “stab” i an eighth of an inch a very popular p d in other areas ofhb d In the breast a h f more fibrous dl does not work ll h use of a lase hlb k down the faf l h made the pr d effective. On bl h liposuction, ll lder men, is thah k not retract, ev h f laser, and they will be left with unsightly, loose hanging skin. o fat incisions ch or so is rocedure of the body. area, the fat is and liposuction rk as well. The er to help break at for removal has rocedure more ne problem with especially in oldat the skin may ven with use of a

M h l b ll d afllb d m hlk h d o h l l b h ad l en with very large breasts may actually need a full breast reduction very much like the operation done on women with overly large breasts. This is major surgery leaves extensive scars.

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As with so much in medicine, prevention is much better than cure. Keep your weight near where it should be for your height, limit or avoid alcohol, try to stay medications by staying healthy and fit and the odds are good that you won’t someday find yourself shopping for a “bro.”