Man-handle Your Man Boobs

Beauty Uncovered explores the causes, symptoms and treatments for ‘man boobs’

Gynaecomastia or ‘man boobs’ is a common condition affecting almost 35% of the male population. Many men suffer with the condition unnecessarily as it is treatable, yet can have a serious effect on mental health, confidence and relationships. Here, Beauty Uncovered explores the causes, physical and psychological effects, and approaches to tackling the condition with consultant plastic and cosmetic surgeon Mr Mo Akhavani.

What exactly is gynaecomastia?

There are two types of gynaecomastia – true and pseudo. “True gynaecomastia is a common condition characterised by the appearance of what are socially known as ‘man boobs’ caused by a hormonal imbalance and prevalence of oestrogen, Mr Mo Akhavani, which can occur for a number of reasons,” consultant plastic and says Mr Akhavani, “It’s common but not cosmetic surgeon, Mo Akhavani Plastic widely known that it can affect men at any Surgery, London age and there are various treatment options.” IG: @moakhavani Pseudo gynaecomastia is the presence of a larger breast area in a man, but it is predominantly fatty build-up, not breast tissue and can be combated through diet and exercise, according to Mr Akhavani.

Who can get gynaecomastia?

Roughly 80% of male babies are born with true gynaecomastia, continues Mr Akhavani, due to the mother’s hormones acting on the baby’s breast tissue, and it usually disappears within a few weeks after birth. “The next stage we see gynaecomastia present is adolescence,” says Mr Akhavani, “Up to 70% of secondary school aged boys can develop the condition due to the common hormonal imbalances that occur throughout puberty when the body sees surges of both oestrogen and testosterone.” At this age, the male body is changing a lot and hormonal imbalances are common, causing other known issues like acne and vocal changes. “This type of true gynaecomastia usually goes away on its own as teenagers move out of puberty, but if it continues after the age of 18, then they might be a candidate for treatment,” explains Mr Akhavani. He adds, “It can also affect men in their 60s and 70s as they age and their testosterone levels decrease. Equally, although being overweight can cause pseudo gynaecomastia, the presence of excess fat cells can interfere with testosterone production and increase oestrogen, causing a hormonal imbalance.”

What are the causes?

“There are many external factors within our lifestyle choices that can cause hormonal imbalances and lead to true gynaecomastia,” says Mr Akhavani. The stress of sustained alcohol abuse on the liver can also have an impact on hormones, he adds, explaining, “The liver regulates the balance of testosterone and oestrogen, transforming or removing any excess from the body, and if the liver has been compromised then there is a risk of hormonal imbalances.” Sometimes genetics can play a part. One in 660 males are born with two X and one Y chromosomes, instead of the standard one X and one Y according to the NHS, basically with an extra female chromosome, resulting in a condition called Klinefelter syndrome. “This can lead to increased hormonal imbalances during puberty, causing true gynaecomastia due to a lower testosterone to oestrogen ratio,” says Mr Akhavani. Any medications that can affect hormones can be a contributing factor to gynaecomastia, including heart medication and anabolic steroids as they also disrupt hormone levels, he explains. “I see big guys coming into my clinic who are clearly muscular and work out, but due to anabolic steroid use, which is converted into oestrogen in the body, they have developed gynecomastia.” Mr Akhavani adds, “Obesity is often the main cause of pseudo gynaecomastia, an excess of fat tissue, but excess fat cells in the body can also cause true gynaecomastia,” says Mr Akhavani, “Fat cells make oestrogen which can cause an imbalance leading to more oestrogen than testosterone.” According to Mr Akhavani, there needs to be more research into the relationship between smoking marijuana and true gynaecomastia. He explains, “Medical professionals have begun to suspect there is a link as it can affect the hormonal receptors and testosterone production allowing for higher levels of oestrogen.”

Recognising gynaecomastia

It can be difficult to recognise whether you have developed gynaecomastia, pseudo or true, especially if you are still going through teenage hormones or are a little overweight. “I will happily see and offer a consultation to those under 18,” says Mr Akhavani, “But I won’t

Before After Before After

Left, a 21-year-old patient with severe gynaecomastia. Right, a mid-30s patient with mild gynecomastia, both before and six weeks after treatment. Images courtesy of Mr Mo Akhavani.

consider treatment until over the age of 18 as it’s important to rule out whether it is a result of teenage hormones, and gynaecomastia can disappear on its own when these level out." “Typically,” says Mr Akhavani, “True gynaecomastia presents as an enlarged fibrous breast tissue on the male chest which can cause discomfort or nipple tenderness. The tissue in the breast disc behind the nipple will feel fibrous and hard, whereas pseudo gynaecomastia will feel like soft fat.”

Effects on quality of life

“Gynaecomastia doesn’t come with any health risks itself, but it can be indicative of a health condition or lifestyle choice that is causing a hormonal imbalance as a symptom,” says Mr Akhavani. It is important to rule out breast cancer before treating for gynaecomastia says Mr Akhavani, “Breast cancer in men makes up less than 1% of all breast cancers, but it does need to be ruled out in the consultation before any treatment takes place.” The psychological effects of gynaecomastia, however, can be devastating. “To this day, I have not seen one guy that is only bothered by the aesthetic side of gynaecomastia,” says Mr Akhavani, “It really affects men’s mental health, from not having the confidence to be on the beach or at a pool, not feeling attractive enough to have sexual relationships, and it can make men very self-conscious and I often see them wearing baggy clothes who adopt a stooped posture to hide their enlarged chests.” If you are suffering with the psychological effects of gynaecomastia or know someone who is, Mr Akhavani encourages you to seek professional help. “Once I have ruled out all treatable causes that can be improved with diet and exercise, then I can recommend surgery,” explains Mr Akhavani, “If a treatable condition is corrected the gynaecomastia should not come back unless the treatment is stopped or if substance abuse of alcohol or cannabis is continued.” “If the patient has minor gynaecomastia and isn’t particularly overweight, we can do simple liposuction which isn’t too invasive with little scarring and roughly six weeks recovery time,” says Mr Akhavani, “More severe cases will require liposuction and removal of the breast gland, which I perform through the same

There are many incision as the liposuction to reduce scarring, but some surgeons may cut through the external factors nipple which can scar more. Finally, very severe cases require liposuction, removal within our lifestyle of the breast gland and the skin excess. choices that can Depending on how much skin needs to be removed, there can be quite a lot of scarring cause hormonal and both these two treatments also have around a six-week recovery time.” This imbalances usually means one to two weeks off work and driving, six weeks off sports such as and lead to true cycling and three months from contact sports. Non-surgical options are limited gynaecomastia in the correction of gynaecomastia and surgery is the mainstay of treatment. As with all surgeries, there can be risks. “The risks with gynaecomastia surgery are low,” explains Mr Akhavani, “But there is a possibility of adverse reactions to anaesthesia, thick and raised keloid or hypertrophic scarring depending on skin type, and it’s also possible to have an inverted nipple following the procedure, which is called saucer deformity.” It’s important your surgeon arranges follow-up appointments – Mr Akhavani sees his patients six weeks, six months and a year later. “If everything is fine at each of these consultations, I discharge them,” he says.

So what are the treatments?

Mr Akhavani recommends that anyone who is concerned that they might have developed gynaecomastia to visit their GP before anything else, to get a conclusive diagnosis, and to explore treatment options. "If there are identifiable causes that can be corrected such as teenage hormones or being overweight, then a diet and exercise plan can be hugely beneficial,” says Mr Akhavani. Mr Akhavani notes that it’s important the surgeon works with the patient’s GP, and he also likes to work with an endocrinologist, a medical doctor who specialises in diagnosing and treating conditions related to hormonal issues as well. “I also often refer my patients to a clinical psychologist, but I find men often decline as they’re embarrassed and less willing to accept this kind of support, which is a shame as it’s all related,” he adds.

You’re not alone and help is out there!

If you, or someone you know, is suffering with this common condition, then there is absolutely no shame or vanity in seeking help. Hormonal imbalances happen for a wide range of reasons and the treatment is effective. “I had a patient a while ago who came to me before he was about to start university,” says Mr Akhavani, “He was a little bit overweight and had already started exercising and changing his diet, but his gynaecomastia was quite severe. He told me there was no way he could go to freshers week like this and was worried about fitting in and making friends. When he came back in for his follow-up consultation he had the biggest smile on his face and was even wearing a tight white t-shirt and was so excited to start university.” So, don’t let this common and treatable condition affect your life any more than it needs to!