How To Get Abs As A 12 Year Old Boy The Diagnosis, Causes And Treatment Of "Gynecomastia" In Men

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The Diagnosis, Causes And Treatment Of "Gynecomastia" In Men

Gynecomastia is the development of female breast tissue and enlargement of the chest/chest in a male. Both men and women are born with breast tissue, but that tissue remains very rudimentary and minimal in the male chest. The nipple/areola complex is probably the most significant “reminder” of these tissues in men that we normally recognize. More than 50% of newborn males have feminine, full-looking breasts that are a temporary form of gynecomastia (due to maternal estrogen), but this condition essentially disappears within 2-3 weeks of birth. However, after a few years, many young men’s breast tissue will appear to be rapidly developing and enlarging. This soon creates a mass-like effect in the breasts which is then further accentuated by an increase in fat deposition. The fat that accumulates is actually a unique type of fat – it is extremely dense, fibrous and thick. It’s not like the normal, softer fat found elsewhere on the body. The combination of this increased fibrous fat and increased breast tissue begins to make each breast appear larger, fuller and more prominent. The breasts can become so large that they even begin to sag, just as a woman would. The nipple/areola may also grow and become wide, large, “swollen” and bulging. A firm lump of breast tissue, sometimes as large as a golf ball, can often be felt behind the nipple/areola. The breast or nipple area can become very painful and sensitive, unlike what many women experience during their menstrual cycle.

In rare cases, a milk-like discharge may even be released from the nipple. Gynecomastia is a physically and psychologically extremely distressing condition that is diagnosed in thousands of young men every year. Young men who are increasingly ashamed to ever be seen shirtless; some of whom can’t even put on a regular t-shirt without feeling incredibly self-conscious or humiliated. They skip the pool parties, avoid the gym and skip the trip to the beach. They can become too quiet, isolated, withdrawn; even antisocial. In fact, there is recent research evidence that reveals that many of these young men will develop features of mental illness that require psychiatric evaluation and treatment. It makes sense – their lives are literally thwarted; hijacked by a physical condition that only gets worse over time, that they can no longer fix with “exercise” or dieting, and that undermines their self-confidence, identity issues, and sense of masculinity. And all this takes place at the same time – during adolescence – that these questions are already in turmoil! Gynecomastia usually first appears during adolescence, but it often affects older men as well. Yet, despite all the downsides, treatment is often simple, results in a “cure,” and these men, young or older, can go on to lead normal, healthy, happy lives like any other guy!

What causes gynecomastia in so many young men is not entirely clear, but we know that it occurs regularly in some 50 – 60% of all adolescents! Most experts believe that this is somehow related to a huge increase in circulating hormones, probably an “imbalance”, or the hormones are somehow “mishandled”. Fortunately, in the majority (about 75%) of these affected teenage boys, gynecomastia will actually resolve without any treatment, on its own, within 1-2 years. However, for many, the psychological and emotional toll is too high and simply requires earlier intervention. Parents are often unaware that any of this is happening and may not understand where the sudden, terrifying change in their teenage son’s behavior and attitude is coming from. After treatment, the change for the positive is usually just as dramatic. For about one in four boys affected by gynecomastia, the condition does not resolve spontaneously and persists. Then it gradually gets just a little bit worse, year after year. This is because a vicious cycle of recurrent inflammation, tissue stimulation, and increased growth of fibrous fat and mammary glands repeats itself, becoming almost self-sustaining, even in the absence of adolescent hormonal changes.

Many commonly prescribed medications are associated with gynecomastia: antiulcer/reflux medications (eg, Pepcid, Prilosec, Zantac, Tagamet), ACE inhibitors for hypertension (eg, Capoten, Vasotec), calcium channel blockers (eg, Procardia), and diuretics (eg .Lasix, Aldactone). Valium, Proscar, Effexor, Motrin, Pepcid and Digoxin are also other common examples of drugs. Some chemotherapy agents can also cause gynecomastia, and HAART, a therapy used for AIDS patients, has also been found to do so. Many medical conditions (eg hyperthyroidism, liver failure/cirrhosis, pituitary insufficiency or renal failure requiring hemodialysis) and even some tumors (eg testicular, adrenal and pituitary) all of which can affect circulating levels of male hormones and which also can cause gynecomastia considered. Interestingly, malnutrition and starvation can also cause gynecomastia – circulating testosterone levels drop rapidly, leaving the unopposed effects of estrogen on the body under such conditions. Self-administered and abused anabolic steroids and testosterone supplementation are unfortunately probably the most common cause of gynecomastia today – special enzymes in the male system convert a good amount of the “extra” hormones floating around into estrogens which then directly stimulate the growth of breast tissue and the development of gynecomastia. Unfortunately, once this process begins, even when steroids are stopped, gynecomastia remains or may worsen as the vicious cycle described above begins and allows gynecomastia to persist and progress. Alcohol, amphetamines, marijuana, heroin, and methadone use are also recognized as causes of gynecomastia. Plant oils such as lavender oil and tea tree oil, often found in soap, skin lotions and shampoos, have weak estrogen-like activity and have been implicated in cases of gynecomastia. Similarly, soy, soy-containing foods and soy-based protein supplements, and sweet potatoes in the diet have been identified as potential links in the development of gynecomastia thought to be secondary to the effects of estrogen-like compounds associated with these foods.

Although rare, breast cancer can occur in male breasts and should be considered especially if there is enlargement and a solid mass effect on only one side or in an older man with one or both breasts enlarged and where there is no other reasonable medical explanation.

“Pseudogynecomastia” is not true gynecomastia because it is not characterized by actual overdevelopment of breast tissue, but simply by significant fat deposits in the breasts and breasts, usually in association with similar deposits elsewhere, such as the sides of the breasts (along/near the ribcage). “lats”) or abdomen and hips (or “love handles”). This is actually a localized fat problem that affects the chest and, as with problematic fat anywhere on the body, can be “cured” with diet, exercise or liposuction.

In most cases, liposuction will be the foundation of any gynecomastia treatment plan. In fact, in most cases, only the treatment that may be needed will be liposuction! Tiny incisions in the armpit area are used for breast liposculpture – the removal of fibro-fatty deposits while reshaping the entire breast to make it more masculine. The goals are for the breast and nipple/areola to be as flat as possible against the chest while at the same time the pectoral muscles are somewhat accentuated in the upper part of the chest. Most men will only need a day or two off to recover. A few weeks to “glue” everything and make it easier to use the muscles of the chest is over. The swelling locations will usually heal and be very subtle, almost invisible. Liposuction of the outer chest and sides (out toward the lats) is often included to further accentuate the overall breast flattening effect.

It is usually best to perform this type of liposuction using ultrasound (eg Vaser) or laser (eg SmartLipo) techniques. These methods allow the fat to “melt” which makes extraction easier. In addition, ultrasound or laser energy can be used to “break up” the dense breast tissue, allowing it to compress, collapse and flatten as aesthetically desirable. Finally, these technologies also create a better tightening and restoring effect on the skin because they heat and “shrink” the collagen on the inner surface, encouraging it to retract properly. This is a significant advantage because over time, gynecomastia usually causes the skin above the breasts to stretch, eventually leaving the skin loose and inelastic. Without the use of special technology, this existing limited skin tone would then make the skin even looser when the fat is removed. The dense nature of the fibrous fat found in gynecomastia makes it much more difficult to remove with simple mechanical liposuction than would be the case for “normal”, soft fat. More severe means more traumatic (ie more pain, more bruising and more post-op swelling), more likely to be at risk of contour deformity (ie too much here, not enough out), more likely to result in asymmetry between the sides, more numbness (because the nerves are hit more !) and cost more (ie takes longer). Moreover, traditional mechanical liposuction is virtually useless for making any progress in shaping the breast tissue itself and will have very limited effect (if any) in combating the skin’s tendency to be loose or saggy. This creates a greater chance that the surgeon will have to resort to more invasive and aggressive methods such as actual mass excision or even skin removal and male breast reduction. Very often these aggressive procedures can be avoided with the proper use of ultrasound or laser liposuction.

However, many cases of gynecomastia are associated with a hard lump of cartilage-like breast tissue that will not flatten or fall out unless it is “cut out.” Sometimes this can be predicted by pre-operative examination, but sometimes the breast is so hard and dense overall that the lump cannot be detected until significant liposuction is performed and the lump is “discovered”. Excision of the lump behind the nipple requires an incision. Some plastic surgeons prefer an incision placed on the perimeter of the areola, others will try to hide the incision as a slightly larger version of the underarm liposuction approach. The need for mass excision contributes little to recovery and increases the risk of possible complications (such as fluid accumulation, numbness, and long-term contour deformities) after surgery. The drain may need to be used and removed in a day or two. Recovery and time off limits are correspondingly more stringent.

In more severe cases of breast augmentation and skin tissue laxity, a male breast reduction may need to be considered. If the surgeon feels that the skin is too loose and the risk of puckered, hanging and sagging breast skin after surgery is too great, this will be recommended. It requires much more extensive incisions, more risk, more scarring, more cost, a longer procedure and more recovery. Breast tissue removal and relaxed skin removal are designed to create a regular, flat shape. Drains are usually used and will need to be removed at some point, as will the non-dissolvable sutures required for this more complex and involved operation. The discomfort and recovery for a male breast reduction is more significant than with other methods, but if needed, it’s well worth it.

Once healing and recovery is complete, all normal activities can be resumed. Weight lifting, exercise and sports are everything. We hope that the locker room, the pool, the beach and the confidence level will be the same! It may take several months for any small areas of bumps, numbness or stiffness to finally resolve, but usually without any intervention needed. However, even current “early” treatment results are usually quite satisfactory. Gynecomastia, once definitively treated as described here, should be “cured” and should never return. However, if circumstances, medical conditions, medications, etc. that may have caused the condition persist or recur, the process may also be restarted.

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