Answers About Gynecomastia

— -- First, I wish to thank ABCNEWS for presenting this topic on national television. I have been deluged with thousands of e-mails from fellow sufferers and friends of sufferers. Although I can not respond individually to every e-mail, there are a number of frequently asked questions. I hope that the following questions and answers will help many of you.

Q: What exactly is gynecomastia and how do I know if I have it?

A: Gynecomastia is the presence of breast tissue in a male and it is often mixed with fatty tissue. It can occur in a newborn but frequently disappears. It often occurs during puberty and disappears in most young men, although it may persist forever in some of them. It can also occur later in life due to a variety of factors, which include use of bodybuilding steroids, marijuana, various medications, etc. Oftentimes it is due to hereditary factors. There are rarely severe hormonal irregularities. Gynecomastia is not related to obesity but may coincide with it. It may be as small as a firm area of tissue just under the nipple or as large as a DD cup pendulous breast.

Sometimes one can feel firm breast tissue under the nipple or in the surrounding chest area when the arm is stretched over the head. However, most often a doctor will be able to determine if you have gynecomastia.

Q: How is your procedure performed?

A: During my surgical training, I was disappointed in the usual surgical treatment for this problem, for many people were left with large scars or deformities which in some cases was worse than the original problem. As an answer, I designed my own set of surgical instruments specifically for this problem. In my hands, it is performed on an outpatient basis in my office operating room. The average case takes 90 to 120 minutes and is performed under "twilight sleep" sedation. Routinely there will be some swelling, bruising and temporary diminished feeling in the chest and the nipples. All of these symptoms subside within several weeks. The extra skin tightens by itself and the areola often shrinks in size. The pain after surgery has been described as " I feel like I just did 300 pushups." Most men are able to return to sedentary-type work within four to seven days after the surgery. A compression dressing is placed on the chest and worn under the clothing for approximately three weeks. Strenuous exercise and sports may begin three weeks after surgery. Complete healing may take up to three or four months.

Q: At what age can surgery be done? Can a youngster or a teenager qualify for surgery? Is there an upper age limit for surgery?

A: There is no right or wrong age for surgery to be performed. In my view, if gynecomastia has been present for two or more years and is stable and not increasing in size, then surgery may be considered. Obviously, this is on an individual basis. All too often, teenagers with this problem are given a pat on the shoulder by their doctor and told to wait it out until it disappears by itself. Unfortunately, many teenagers spend their entire teenage years waiting for this to occur and are subject to ridicule and embarrassment during this critical time in their lives. On the other hand, one should give it adequate time to resolve by itself. The vast majority of gynecomastia is not due to hormonal imbalance and frequently a complete hormonal work up will be negative. Older men suffering with this condition are also candidates, but must understand that the skin may not totally tighten after the surgery in performed. Again, decisions must be made on an individual basis.

Q: Does insurance cover the cost of gynecomastia surgery? Are payment plans available?

A: Unfortunately, insurance companies over the past few years have adopted a position that this is a cosmetic procedure and therefore refuse to pay for it. In my experience, at the present time, very few, if any insurance companies will provide coverage for this surgery unless it is an extreme condition. The insurance companies remain immune and uncaring as to the emotional damage that this condition engenders. For my patients, credit cards are accepted and a payment plan is available by application.

Q: How can I locate a doctor who does this procedure in my area?

A: I would strongly recommend that you consult a board-certified plastic surgeon. You may call the American Society of Plastic Surgeon's referral line (800) 635-0635. Make sure that you visit at least three surgeons for their opinions and ask to see their personal photographs of before and after gynecomastia patients.

Q: Do I have an increased risk of cancer if I have gynecomastia?

A: The presence of gynecomastia does not make you more prone to breast cancer. It is important to note that one percent of all breast cancers occur in men so that any new lump or one-sided growth (asymmetry of the breast) should be investigated by a physician.

Q: Is there a relationship between gynecomastia and drugs or medications?

A: Many drugs and medications produce gynecomastia as a side effect. Some illegal drugs such as marijuana, heroin and bodybuilding steroids can also produce gynecomastia. In some cases, stopping the medication may result in a diminishment of gynecomastia but in my experience, once the gynecomastia is present it usually will remain unless corrective surgery is performed.

Q: Am I more prone to develop gynecomastia if I am overweight?

A: Patients who are overweight may have a flat chest and thin patients may have gynecomastia. Oftentimes, the two conditions coincide and treatment for the gynecomastia will also be addressed towards treatment for the enlarged fatty breast. Occasionally, additional liposuction of the chest area under the armpit is necessary in order to achieve an improved overall contour of the chest.

Q: Will exercise and or weight loss diminish my gynecomastia?

A: Weight loss may diminish the fat (and hence the size) of an enlarged breast slightly, but breast tissue does not respond to weight loss because it is a different type of tissue. Exercise will not diminish gynecomastia because it will build up muscle and the chest muscle will still be camouflaged by the overlying excessive breast tissue.

Q: Are there any other methods of treatment of gynecomastia?

A: Surgery for established gynecomastia is the only known and recognized treatment. Creams, lotions, massage, injections, exercise, "magic pills" all will do nothing for established gynecomastia.

Q: If surgery is performed, will the results be permanent? What if I gain weight after the surgery?

A: Surgery will remove virtually all of the breast tissue and it will not regrow (much as a woman's breast will not regrow after a mastectomy for cancer). Should you gain substantial weight after surgery, then some amount of fat will find itself on the chest but it will also be distributed over other parts of the body so that you will not regain the specific enlargement on the chest that you had prior to surgery. Conversely, if you lose weight after gynecomastia surgery, the results of the surgery will be enhanced.

Q: How can I contact Dr. Jacobs? What if I am not in the NY metropolitan area?

A: You may contact Dr. Jacobs at 815 Park Avenue New York, NY 10021 or call him at(212) 570-6080. You may also write to Dr. Jacobs about your personal situation and enclose photographs as well. Dr. Jacobs will make every effort to reply.

Q: Can liposuction be performed on other areas of the body (for example, abdomen or love handles) at the same time as the gynecomastia surgery?

A: Yes, but the decision must be based upon your doctor's best surgical judgement.

Q: Is gynecomastia more common in any particular race or ethnic group?

A: No. Gynecomastia can affect anyone — it is an "equal opportunity" condition.

Q: I have had prior surgery for gynecomastia and I am not pleased with the results. Can anything be done?

A: Scars from prior surgery are permanent, although they may be improved by scar revision surgery. Contour irregularities can be improved on occasion. Each of these problems must be decided upon on an individual basis. Consult a plastic surgeon for an evaluation.

Q: I have an underlying medical condition (HIV positive, prostate cancer, heart disease, etc.). Can surgery for gynecomastia still be done?

A: Oftentimes successful gynecomastia surgery can be performed despite an underlying medical condition. A thorough evaluation by your physician is most important to clear you for elective gynecomastia surgery.