Initial Diagnosis

[rollo6]

Hello Doctor

I am in my early 40s and never really knew the name of this problem that I had until I came across this website.  I first noticed my enlarged chest area or fatty growth aroun 10-12 years old.  My parents just dismissed this as I was chubby and overweight. At sixteen I really became self consious about it and at 18 I had surgery to reduce which was wonderful, and I had surgery again at 21 to further reduce.  I have not had any problems since then... although I am still somewhat self conscious at times.  I work out regularly although I am still a little bit on the heavy side. at 6'0 215.

My questions are.. should I get an endocrine or hormone study done to see what actually caused this growth?  i am constantly worried they will grow back, and I am wondering if I should get some hormonal treatments or something to fix this.

Also I am considering taking a short cycle of steroids but I don't want to develop the bitch breast syndrome.  Am I more prone to this since I had gynecomastia when I was younger?

Any help or advice would really be greatly appreciated.  If I had not found this site I would have never known what was wrong with me

[Dr. Elliot Jacobs]

No harm in getting a complete endo evaluation although, from your history, my gut feeling is that your present situation is due to having gained weight slowly over time (and it tends to go to the chest area, unfortunately).

Best would be to conscientiously lose weight to about 190 lbs or so -- your chest should decrease substantially.  If there is still extra tissue, then surgery might help.

Would absolutely, absolutely not do any steroids -- you are asking for trouble.

Dr Jacobs

[DrBermant]

Hello Doctor

I am in my early 40s and never really knew the name of this problem that I had until I came across this website.  I first noticed my enlarged chest area or fatty growth aroun 10-12 years old.  My parents just dismissed this as I was chubby and overweight. At sixteen I really became self consious about it and at 18 I had surgery to reduce which was wonderful, and I had surgery again at 21 to further reduce.  I have not had any problems since then... although I am still somewhat self conscious at times.  I work out regularly although I am still a little bit on the heavy side. at 6'0 215.

My questions are.. should I get an endocrine or hormone study done to see what actually caused this growth?  i am constantly worried they will grow back, and I am wondering if I should get some hormonal treatments or something to fix this.

Also I am considering taking a short cycle of steroids but I don't want to develop the bitch breast syndrome.  Am I more prone to this since I had gynecomastia when I was younger?

Any help or advice would really be greatly appreciated.  If I had not found this site I would have never known what was wrong with me

Not all patients need an Endocrinology evaluation. For my patients, I use a Red Flag system evolved with a number of Endocrinologists over the years to determine who needs such a consultation.

Have you checked your Body Mass Index with a BMI Calculator?  By definition you are almost obese at the high range of overweight. BMI does not differentiate between fat, muscle, and bone.  Body Fat Calculators can help with the fat percentage and are better at helping define the fat component.

Plastic Surgery is not an alternative to losing weight.  With surgery, a fat person will still look like a fat person, just one with smaller breasts.

The problem is that Male Fat Pattern extends around the chest, under the arms, and around the back.  Plastic Surgery is not a good tool for a global fat problem.

I advise my patients to get to a weight / body fat percentage they are comfortable with before considering surgery. 
 
Weight Loss Before Gynecomastia Surgery can help with the fat, but not the gland.  However, you cannot pick where your fat comes from. Plastic Surgery is also not a good jump start tool for weight loss.  I have seen disasters from patients from other doctors with deformities from significant weight loss after their surgery.  Men tend to put fat on first in the belly and chest bands.  We tend to take of those areas last.  Early surgery and depending on weight loss to predictably change the body is a nasty gamble.  No Surgery Body Shaping Garments are a better temporizing choice.

As a surgical sculptor, I view weight loss as a coarse tool and my plastic surgery as a refinement tool.  I prefer to use the coarse tool first, and then my sculpture for refinement.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia

[Litlriki]

Your story is not particularly unique, as it sounds like you developed gynecomastia during puberty, worsened related to weight gain and mild obesity, and you had it corrected surgically.  Evaluation by an endocrinologist now in the absence of current health issues or recurrence of your gynecomastia is likely to provide little information other than age-appropriate hormonal levels.  Similarly, recurrence is unlikely unless some other source of hormonal alteration is present--for example, use of a "short cycle of steroids."  I ask all of my steroid-using patients if they had problems with gynecomastia as teens, and many will admit to a transient case.  This is hardly a big surprise, since so many adolescents experience gynecomastia briefly during puberty, but my gut instinct is that those who do develop it even transiently are more susceptible to recurrence in the face of steroid use. 

So, you might get an endocrine work-up to satisfy your curiosity, or even if you are considering "anti-aging hormone replacement therapy," but I don't think it will shed much light on your history. And like Dr. Jacobs has already said, I'd avoid the steroids if you're trying to avoid recurrence, unless a low level would dictate replacement.

Good luck,

Rick Silverman