Gynecomastia: The causes, the problems and some treatments – Irish Examiner

Posted: August 14, 2020 at 4:51 pm

A tranquil break in sunny Marbella with his girlfriend probably seemed like a good idea to Hugh Grant but the 55-year-old has paid dearly for his fun. He attracted a vicious onslaught of body-shaming after being snapped splashing in the Med.

The reason? Grants once buff physique had deteriorated into what some called a 'dad bod'. Commentators sneered that the former heart-throbs chest muscles had melted into moobs. However, while Grant could very reasonably cite an ageing body for the decline of his renowned physique, man boobs or gynecomastia can be the cause of great distress for younger men.

Putting it simply, gynecomastia is defined as an enlargement of the male breast, which although usually benign, can cause significant embarrassment and psychological distress.

Gynecomastia, which appears during puberty, usually resolves naturally. Most cases of gynecomastia are believed to result from an imbalance between estrogens and androgens. However, pseudo-gynecomastia, or fatty breasts, is a condition commonly seen in obese men and differs from gynecomastia in that the resultant breast enlargement is due to increased fat deposition.

Not surprisingly, in a world saturated by images of the perfect male body, having either condition is increasingly problematic, particularly for young, image-conscious men research shows that exposure to media images of lean or very buff male bodies has a noticeably negative impact on mens mood and body satisfaction.

A study published in the Journal of Social and Clinical Psychology in 2004 concluded that viewing ideal male images contributed to a significant increase in depression in men, after researchers at the University of Central Florida found that appearance-related media exposure has a significantly negative effect on a males body image.

Societys increasing shift towards a culture saturated by social media, including visual platforms such as Instagram and Snapchat, is, therefore, bringing an ever more intense attitude towards body image. So, surrounded by images of the 'ideal', muscular, wide-shouldered, lean-waisted male body, young men can fall prey to societal pressure to look buff' and feel self-conscious and distressed if they cannot match up to this physical ideal.

In such an environment, having man-boobs, or gynecomastia, is at best an embarrassment, at worst, as in the case of Grant, an invitation to severe body-shaming.

Expert in aesthetic medicine says pseudo-gynecomastia accounts for 90% of surgery cases he's handled

There is more pressure on young men today. There is a level of narcissism that never existed in previous generations and a lot of it is to do with image, says Dr Patrick Treacy, an expert in aesthetic medicine and medical director of the Ailesbury Clinic. He is multi-award-winning and author of a number of books, the latest of which, The Living History of Aesthetic Medicine, is due for publication shortly.

Exercise and losing weight will not reduce gynecomastia, which is usually related to the presence of excess female hormones in a man and not to overweight. However pseudo-gynecomastia is linked to weight, so exercise and diet can help to an extent, he says.

Treacy adds that gynecomastia caused by hormone changes during puberty is relatively common and often resolves itself. In most cases, the swollen breast tissue will go away without treatment within six months to two years," he says.

Pseudo-gynecomastia is the most common and would account for up to 90% of the cases I see, says Treacy, who has treated men aged 19 and upwards, using a variety of techniques.

These include surgery, which costs about 7,500, or another treatment, Vaser. This is a form of ultrasonic liposuction which takes about half an hour, is carried out under local anaesthetic and costs about 3,000, he says. However, he adds that afterwards, people who are very overweight and have fat removed may sometimes find that they are left with flaps of loose skin.

Sometimes people need surgery for that loose skin. You can also use a radiofrequency technique to tighten up the skin.

Another technique. cryolipolysis, freezes the fat, which then disappears after about three months, he says. This process costs 1,500. Meanwhile, radiofrequency treatment, which costs around 1,500, breaks down fat and tightens the skin.

Not surprisingly, young men are increasingly seeking treatment for the condition figures show that between 2017 and 2019, the HSE spent around 235,000 on gynecomastia treatments for just under 50 patients.

Man diagnosed with the condition says surgery "changed his life"

However, many young men, like Conor seek treatment privately.

Now in his mid-20s, he recalls the distress he experienced with the onset of gynecomastia during puberty. It started when I had hit puberty. I was about 12 when it began. I was quite athletic and played a lot of sports so I wasnt overweight," he says.

Conor adds that one of the doctors he consulted explained that the condition usually happens with children who are slightly overweight. When I was in sixth class, my nipples got very inflamed. At the same time, there was a lot of hard tissue underneath the nipple. It looked like I had a pair of hard little bumps. My nipples were large. I was severely embarrassed by it, he says.

Conor never took his top off in public and in situations where going bare-chested was unavoidable, such as while swimming, he would worry about it for days in advance.

This went on for about two years, or so. When I was nearly 15, I had to get a check-up with my GP, and, as part of the physical exam, he spotted it and told me I had gynecomastia. He explained there was a procedure you could have for it and referred me to a consultant. However, she thought I was too young for the operation. She felt that I might grow out of it and that it would probably go away of its own accord.

But Conor was having none of it.

I had quite a severe case and I wasnt taking no for an answer. The sheer thought of living with this for another two or three years was definitely not for me.

In the end, he was referred to a plastic surgeon who is experienced in the procedure, although he had normally operated on older males.

Conor underwent surgery at the age of 15.

I was in hospital for a few days and the most traumatic part of it was that I had to have drains put in under my nipples to prevent fluid build-up. That was very uncomfortable because you had to lie flat on your back most of the time. After I came out of hospital, I had to wear compression bandages for several weeks to prevent fluid building up in the cavities which had been created by the removal of the breast tissue."

I was able to go to playing sports after about two months and I never looked back. It changed my life if I hadnt been able to have the operation it would have affected me because I had become very self-conscious about my body."

If I hadnt been able to have that operation I think my confidence would have been destroyed by my mid-teens because I had been confident in primary school and second-level. It may not have been extremely obvious to other people but it was the biggest thing in the world for me. The procedure was covered by my parents health insurance so we were lucky that way.

However there are issues to think about before having treatment. Dr Treacy cautions that men thinking about undergoing treatment for gynecomastia need to check for issues such as hormonal disturbances, systemic diseases such as kidney or liver failure, genetic conditions that may be problematic, or drugs which can interfere with the normal hormonal balance of the body.

This includes many cardiac medications, some antibiotics, tricyclic antidepressants. Withdrawal of causative drugs can result in resolution of gynecomastia in 60% of cases, he points out.

Dr Treacy adds that the best candidates for gynecomastia surgery are men who are physically and mentally healthy, have realistic expectations and are willing to accept the scars associated with surgery.

They should also have already lost the weight they want to lose (if this applies) and have maintained a stable weight for at least six and ideally 12 months.

Gynecomastia surgery may not be suitable for certain candidates:

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Gynecomastia: The causes, the problems and some treatments - Irish Examiner

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