Gynecomastia-the growth of breast tissue in men-can be an embarrassment for adolescents, but for professional bodybuilders it can be a career-ender. Two plastic surgeons said steroid use is to blame and surgery-not liposuction-is the best treatment.
Gynecomastia—the growth of breast tissue in men—can be an embarrassment for adolescents, but for professional bodybuilders it can be a career-ender. Their sport has competitive events in which contestants are not allowed to have more than 9% body fat, which makes their glandular tissue even more pronounced.
Writing in Plastic and Reconstructive Surgery Journal, Mordcai Blau, MD and Ron Hazani, MD report that there is a plastic surgery solution. But having the condition addressed by liposuction—not surgical excision—can lead to recurrences, bleeds, and other adverse effects, they wrote.
The authors are surgeons practicing (respectively) in White Plains, NY and Beverly Hills, CA.
The condition occurs in many adolescents (an estimted 35% to 65%) and usually goes away. But it can be permanent when it reappears in bodybuilders. That generally happens from anabolic steroid use, or ingestions of over-the-counter hormones sold in sport and general nutrition stores, they said.
The surgeons treated 1,574 bodybuilders for gynecomastia from 1980 to 2013. Of those 1,073 were followed up for a period of 1 to 5 years. Only 2% of the men were candidates for liposuction; the rest had too much unwanted breast tissue and needed surgery.
Subtotal excision in the form of subcutaneous mastectomy was used and resulted in “aesthetically pleasing results in 98% of the cases,” the doctors wrote. “There were no infections, contour deformities, or recurrences”.
Surgery offers the best results, but there are challenges: there is an increase in vascularity of the chest because of their hypertrophic pectoralis muscles and the intake of different omega fatty acids—conditions that put them at risk of bleeding.
Also, the entire glandular tissue has to be removed or it will grow back. And before surgery, patients must be screened to make sure the condition is not due to endocrine system problems or testicular cancer.
“Based on experience, nearly full excision of the glandular issue is the most appropriate treatment of gynecomastia in is bodybuilders, whereas suction-assisted lipectomy should be used only scarcely,” Blau wrote. He added that while he had no personal experience performing ultrasonic liposuction, he had treated patients for whom that procedure had not worked.
The surgery is sometimes covered by insurance but “many payers consider gynecomastia surgery cosmetic,” according to the article.