Male breasts are something we have heard of on TV shows or movies but this is actually a condition known as gynecomastia. CMDL spoke to Dr Robert Shenker of The Cosmetic Surgery Clinic in Waterloo to discover more.
CMDL: Gynecomastia is the swelling of breast tissue in males. How common is this condition and what causes it?
Dr. Shenker: Asymptomatic gynecomastia is very common and occurs in three age groups: neonates (newborns), teenagers and older men. Asymptomatic gynecomastia has a prevalence of 60-90% in neonates, 50-60% in adolescents and 70% in men 50-69 years old.
The cause of gynecomastia is often multi-factorial, however, the unifying pathophysiology lies in an imbalance of the hormones; estrogen and androgen. Lower androgen levels increase the growth of breast glands, and higher estrogen levels will stimulate their growth.
Known causes of gynecomastia include:
- Physiologic gynecomastia: the normal enlargement of the male breast during infancy and puberty. This will present as a temporary enlargement on both sides that is smooth, firm and symmetrical. This will usually resolve in 6 months to 2 years.
- Persistent pubertal gynecomastia
- Idiopathic gynecomastia (idiopathic means no identifiable cause)
- Underlying health conditions such as chronic kidney disease, liver cirrhosis, feminizing adrenocortical tumour, hyperthyroidism and hypogonadism.
- Testicular tumours.
- 5-alpha reductase inhibitors (e.g. Dutasteride and finasteride)
- Cardiovascular drugs (e.g. ACE inhibitors, spinolactone, calcium channel blockers)
- CNS-acting drugs (e.g. diazepam, methadone, tricyclic antidepressants, phenytoin)
- Anti-ulcer drugs (e.g. cimetidine, omeprazole)
- Hormones (e.g. androgens, anabolic steroids, estrogens, human growth hormones)
- Recreational drugs (e.g. amphetamines, alcohol, heroin, and marijuana)
- Over-the-counter herbal drugs (e.g. lavender oil and tea tree oil)
CMDL: Are there different grades of gynecomastia?
Dr. Shenker: There are two systems of grading gynecomastia. These systems can help guide the choice of surgical procedure.
The Simon grading system categorizes gynecomastia as:
- Grade I: small enlargement without excess skin
- Grade IIa: moderate enlargement without excess skin
- Grade IIb: moderate enlargement with minor excess skin
- Grade III: marked enlargement with excess skin and ptosis (drooping)
Rohrich et al’s system for grading gynecomastia is as follows:
- Grade I: Minimal hypertrophy (<250 g) without ptosis
- Grade II: Moderate hypertrophy (250-500 g) without ptosis
- Grade III: Severe hypertrophy (>500 g) with grade I ptosis
- Grade IV: severe hypertrophy with grade II or III ptosis
CMDL: What is the difference between gynecomastia and pseudogynecomastia?
Dr. Shenker: Gynecomastia is a benign (enlargement) of glandular tissue in males. In contrast, pseudogynecomastia is increased breast fat with no glandular enlargment.
CMDL: What are the best treatments for this condition? What is the recovery time and is it a permanent solution?
Dr. Shenker: If there is an inciting drug or an underlying condition, gynecomastia will resolve after these causes are managed.
For idiopathic gynecomastia, a surgical procedure is the only consistently effective treatment with long-lasting, essentially permanent results. The surgery involves removing the excess breast tissue along with liposuction of the fatty component of the breast.
After surgery, patients will have to wear a compression garment for a few weeks. The garment helps to reduce swelling and optimizes tissue recovery. To reduce soreness, pain medications can be taken. Normally, patients will be able to return to work within 1 week of surgery and exercise within 3 weeks. Each patient heals differently so it is crucial to attend follow-ups with the cosmetic surgeon.
About Dr. Robert Shenker
The Cosmetic Surgery Clinic’s principal surgeon and medical director, Dr Robert Shenker, is the clinic’s founding father and backbone. He is the former Chief of Surgery and Vice President of Medical Affairs at Cambridge Memorial Hospital, an adjunct professor at McMasterUniversity, a lecturer, a father of three sons and an adoring husband. His many involvements fuel his passion for his craft and for improving the confidence and lives of his patients through plastic surgery. It is this passion that distinguishes him from the rest.
“I have personally experienced how profoundly cosmetic surgery affects people. It gives men and women confidence and makes them feel more at home in their own skins. Most people aren’t even aware of the possibilities plastic surgery offers. They ponder and think and deliberate for months and years, and, with every operation I do, I inevitably hear ‘I wish I had done this years ago’.”
Dr. Shenker’s passion extends beyond the clinic to the community he serves; in addition to his cosmetic practice, he has worked tirelessly to create a cutting-edge breast reconstruction program right here in the Tri-Cities area – a passion project built on the belief that the boundary between aesthetic and reconstructive surgery is an arbitrary construction, and that everyone deserves to look and feel their best.
Having dedicated his career to nurturing quality outcomes, quality relationships, and quality experiences from start to finish. It is his hope that anyone considering cosmetic surgery, no matter how simple or extensive, meet his team first. He believes that once through the door at The Cosmetic Surgery Clinic, patients won’t have to look any further.