Male breast reduction: Surgeon explains link between 'man boobs' and mental health

MANILA, Philippines — A toned pectorals or pecs is arguably one of man's physical attributes that he would be proud to show off especially with summer coming and temperatures rising.

The urge to go topless for most is even greater even if going to the beach has to be canceled for the time being.

This is true for most cases, but there are some of them who might not be comfortable showing theirs for health reasons.

Most people are not aware that man boobs or gynecomastia is a common condition wherein men's breast tissue swell or overdevelop and become larger than normal. This can occur at any age, however, as most cases of gynecomastia occur during puberty and may persist until adulthood.

According to a board-certified surgeon who is known in the industry for specializing in gynecomastia surgery, Dr. Vicente Firmalo, many Filipino males suffer from gynecomastia and most males who have this condition are looking for a way to rid of their big breasts.

"Men and women both have breast tissue but usually in smaller amounts in men," Firmalo said.

The American Society of Plastic Surgeon said that gynecomastia happens due to several factors such as hormonal changes, heredity, obesity, or the use of certain drugs. It is often characterized by excess fat, excess glandular tissue development, sometimes excess breast skin, and may appear on one breast or both breasts.

"We all know that men produce a hormone called testosterone while the female hormone is called estrogen. Males also produce a small amount of estrogen. These hormones steer sexual growth in boys and girls. When there is an imbalance in the production of these hormones, it can affect their growth. For example, when a male produces less testosterone, and more estrogen, this causes male breast tissue to swell during pubertal years," Firmalo explained.

Signs, symptoms, complications

Dr. Firmalo is a Fellow of the Philippine Association of Plastic, Reconstructive, and Aesthetic Surgeons (PAPRAS); Diplomate, Philippine Board of Plastic Surgery; International Member, American Society of Plastic Surgeons; and Member, International Society of Plastic and Regenerative Surgeons (ISPRES). He is a volunteer surgeon for non-government organizations Smile Train and Operation Smile.

The surgeon has conducted over 300 gynecomastia surgeries. He observed that the most common signs and symptoms are a lump of firm tissue under the nipple or whole breast in one or both sides, tenderness or puffy areola. There are times that the patient feels discomfort due to tenderness as well as discharge from the nipple. Another sign could be increased diameter of the areola.

"If you have these signs and symptoms, it is best to have an appointment with a doctor to rule out signs of other illnesses such as cancer and can help you with the right treatment and procedure for your condition," he advised.

Apart from obvious signs and symptoms, he also pointed out that gynecomastia can also impact one's mental health.

"Those who have decided to correct gynecomastia through surgery are  not just fixing their physical appearance but it is also their way to improve their mental health since this condition can make the sufferer feel embarrassed, depressed or anxious. Some of my patients were bullied because of their gynecomastia, they became the laughing stock in their group or even in the family," he shared.

Firmalo added that because gynecomastia usually starts during pubertal years in a man's life, some patients experience bullying. "People in their community would tease them and they may seem okay with it but they may be suffering inside --feeling sorry, insecure, anxious among others," he noted.

He explained that the condition is "usually a harmless medical condition" but because of bullying, it can trigger depression and anxiety.

Treatments

Most cases can be addressed through surgical procedures.

"Some chests increase in size from weight gain and I usually recommend regular exercise to decrease the fat in their chest. This will help see which is the gynecomastia. To those who have hormonal imbalance, they will also have to see an endocrinologist. However, when the hormones have become normal, this is not an assurance or guarantee that the gynecomastia or or gland will vanish, some will achieve their desired results, but not everyone will respond to hormonal treatments. In this case, if they are willing to go under the knife and their gynecomastia is causing them pain or distress, we can fix this through surgery," he said.  

The surgeon also stressed that it is important to only consult with board-certified plastic surgeons and the patients should also be careful in choosing their doctors. "It is also best to know your surgeon and his experiences in doing the procedure, the number of gynecomastia surgery he's done, and what sort of follow-up a patient should do after the surgery."

According to Firmalo, gynecomastia surgery or male breast reduction might involve liposuction to rid of the fats, removal of excess tissues and areola reduction. It takes a couple of hours and the patient can be discharged from the center the same day.

Full recovery might take between four to six months up to a year and patients are advised to refrain from doing strenous activities. Proper hygiene and wound care should be observed. He advised that the patient and his surgeon should do a calendar of allowable activities that would detail the gradual progression of his activities, from manageable to heavy.