“I am embarrassed by enlarged breasts and have tender nodules under each nipple.    Why do I have this condition and how do I get rid of them?” John M. Newport Beach

John, you have a common condition that affects males called gynecomastia, a benign enlargement of breast tissue.  It occurs transiently in newborns, in one half of adolescent boys, and as a result of decreased testosterone in older males.  As mentioned, this is a common condition in adolescent males going through puberty but in more than 85% of cases, the nodules will resolve spontaneously within two years – for this reason, we do not remove these nodules in teenagers who have had the nodules less than two years.  But if the nodules persist longer than two years, or appear later in life, they will not go away spontaneously or in response to any medical treatments and have to be surgically removed. Gynecomastia may rarely arise as an abnormal condition associated with metabolic or endocrine disorders, always talked about but I have never seen such a case in my career.  One of the more common causes seen in our practice relate to excess marihuana use or illegal steroid use in athletes. But in the vast majority of cases we see, there is no known cause for the appearance of gynecomastia.

We see an influx of gynecomastia patients at this time of year, as people start preparing for warmer summer weather and going to the beach.  There are basically two clinical presentations of gynecomastia. One involves breast enlargement, usually in heavier males, due to a fatty collection in the breast area but without the presence of a nodule.   The other involves the presence of a hard nodule under the nipples, like you have. In the former, the excess adipose tissue can be removed by liposuction alone. If a nodule is present, small incisions will be made around the bottom part of the areolae (the dark skin surrounding the nipples) and the nodules have to be excised.   The result is a flatter, firmer and more normally contoured chest. In very thin patients, removal of a large nodule can cause a visible indentation that is difficult to change surgically. It should be noted that the fatty layer over the chest wall will be about a half inch thick after the procedure, a normal thickness for someone without gynecomastia.   With both hands lifted into the air, the chest wall should look flat! But with the arms down, particularly in more mature males, some skin folding will occur and this is normal for people of this age! Likewise, some young adults who lift weights and are very fit will have very well developed pectoralis major muscles – in such patients, even if the excess breast tissue has been removed and the fatty layer is half an inch thick or less, chest protrusion can be caused by normal muscle development!   

The procedure to treat gynecomastia takes about an hour and a half to perform and is done under deep IV sedation or a light general anesthetic to supplement the local anesthesia injected by your surgeon.   Recovery is usually rapid – most patients who have an office job or are students can have the procedure on a Friday and return to work by Monday. Once removed, the tissue does not grow back. I would encourage you, John, to come in for a consultation and to have all of your questions answered.   The following is an example of a young male with a similar condition who sought relief at our office.

Patient B&A

Male in his mid 30's with a combination of a nodule and excess fatty tissue, before and after a combination of an excisional and liposuction removal of breast tissue/chest wall fat for gynecomastia - actual patient of Dr. Juris Bunkis of Orange County Plastic Surgery in Newport Beach, California.

If you have any specific questions about cosmetic procedures, your best bet would be to see a qualified plastic surgeon to review your options. Please feel free to contact our office at 949-888-9700 to set up an appointment with Dr. Bunkis; you may also check out our website at www.orangecountyplasticssurgery.com  to see further examples of similar patients.

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.