When Kathy Holler first met her future husband Erik Holler in high school, it was love at first sight.
"He was the good-looking guy," she said.
More than a decade later, their paths crossed again, and it felt as though they were never apart. But something was different about him.
"Actually, when I was in the military in 1994, I was in boot camp and noticed like a lump right under my left nipple," he said.
Fortunately, a biopsy showed it wasn't cancer, but the problem got worse, even after he had surgery to remove the first lump.
"It actually grew more," he said. "And then the right side started growing, too. And they expanded themselves to their current condition, which, I'd probably say, I'm at least an A cup -- at least."
Holler had a condition called gynecomastia, which causes male breast tissue to swell and take on a female shape. Gynecomastia should not be confused with the kind of enlarged chest caused by an excess of fat cells in overweight men. People with gynecomastia actually produce the kind of breast cells found in women, and the shape and distribution of those cells create a chest that looks female rather than overweight.
Holler was worried about how his high school sweetheart would react.
"Because it had been 10-plus years since we had been together, is she going to just try to be nice to me and then run away screaming later?" he wondered.
Gynecomastia is also very common in adolescents and is often caused by a hormonal imbalance.
"During adolescence, male breast enlargement is mostly due to a rapidly increased production of testosterone, which will be converted to estrogen during the pubertal growth spurt," said Dr. Pisit Pitukcheewanont, a pediatric endocrinologist at Children's Hospital Los Angeles.
There are also drugs that can lead to gynecomastia, including marijuana and steroids. Certain medications, such as the baldness drug Propecia, can also cause the condition.
If gynecomastia is caused by something that can be treated or stopped, such as a certain medication, then treating the illness or stopping the drug will resolve the gynecomastia, as well. Surgery can also get rid of the excess breast tissue.
Holler looked into corrective surgery years ago, but was worried that the procedures were too invasive. He decided to try to live with it, but thoughts about his appearance consumed him.
He thought about it "every day, multiple times a day, 30, 40 times a day, easy," he said.
He heard about a less-invasive procedure that involved liposuction to get rid of the fat followed by a laser to smooth out the skin and decided to give it a try.
Dr. Aaron Rollins, a cosmetic surgeon in Beverly Hills, Calif., recently performed liposuction on Holler's breasts.
"Erik [was] somewhere between a B and a C-cup," Rollins said. "It's very typical that one is much more enlarged than the other, and Erik's [an] example of that."
Some doctors are concerned about an increased risk of breast cancer, but so far no studies have shown a link. As a precaution, however, Rollins did prescribe mammograms for Holler before the reduction operation.
Male Breast Condition Stigmatizing
The procedure lasted about three hours, and ABC News' "Good Morning America" followed up with Holler for a few months after the surgery as he recovered.
Before having the procedure done, Holler was very embarrassed by his appearance, something common among men with gynecomastia.
"The psychosocial impact is significant," said Dr. Julius Few, founder of the Few Institute for Aesthetic Plastic Surgery in Chicago. "Often, patients are subjected to wearing multiple tee shirts or being afraid to go swimming, even in warm weather."
Holler didn't even want to play in his own pool with his kids without a shirt. But since the surgery, there's been a remarkable change -- he went on a beach vacation with his family and played in the water with no shirt on.
"That was something I never thought I'd see him do," Kathy Holler said.
Erik Holler also remembers painful taunts from his own family members.
"They'll say something somewhat demeaning in some ways like, 'Wow, pretty soon you're going to be borrowing your wife's bras.'"
Gynecomastia was even the subject of an episode of the TV show "Seinfeld" that featured two of the characters debating whether to call their male bra a "mansiere" or a "bro."
While seeing that show was difficult for Holler, one plastic surgeon who specializes in gynecomastia surgery said it was helpful for men who live with the condition.
"The 'Seinfeld' episode made men aware that this is a condition," said Dr. Rick Silverman of New England Plastic Surgical Associates in Brighton, Mass. He also credited the Internet.
"We are seeing more patients now than in the past," he said. "The Internet has done a lot to make men aware that this is a medical condition that can be treated."
Holler feels better now than he ever did, and he's sharing his story to get the message out to other men.
"I'm very proud of him, and I'm hoping that he helps other men who are out there, going through the same suffering and frustrations that I watched him go through every day," Kathy Holler said.