Patrick Hudson MD, FACS

It has been suggested that some degree of breast enlargement occurs in half of all men. This can be a major problem and one which prevents many men from going to the gym and otherwise living a normal life.

There are two main reasons to excise breast tissue in men. The most common is the embarrassment of having large breasts. When the size of the breast is interfering with your lifestyle it is probably time to talk to a plastic surgeon.

The second is a concern about malignant change in the breast tissue. Whether or not gynecomastia predisposes to breast cancer in men is not clear. However some surgeons feel that in some cases removal and examination of breast tissue under the microscope is needed. Most feel that fatty tissue, which is soft, only needs to be removed if cosmetically significant. When firm masses are felt in the male breast this is a hint that the problem may be more serious and biopsy is need. Breast cancer in men is unusual but can occur. About 0.5% of all breast cancers are seen in men and when it occurs it tends to be in the outer part of the breast. This is different from true gynecomastia where the mass is usually diffuse or centrally located. Mammograms can sometimes be used to distinguished abnormal breast tissue. If there is any doubt a biopsy is needed.

Removal of excess breast tissue is usually not appropriate in teenage boys because the excess of adolescent fat will probably disappear in its own. Most surgeons do not operate on obese men and prefer to encourage patients to undergo a routine of diet and exercise to see how much of the breast tissue will go without surgery. Because heavy drinking and marijuana use predispose to gynecomastia, surgery is often not recommended for these men. Some surgeons feel that the breast tissue may return quickly unless these patients change their lifestyle.