The causes of this problem range from hormonal changes, to intake of medications, to genetic predisposition. In fact, it is not uncommon for healthy teenage boys, usually around 14 years of age, to have this problem for 1 to 2 years. The reason is hormonal and usually goes away after puberty.

Often, the cause of gynecomastia is never identified. Certain diseases and medications can be the cause and these need to be looked into by your family doctor. The medical causes range from deficiency of testosterone to excess of estrogen. Being overweight can cause too much estrogen and, therefore, it is highly recommended to lose weight.

Medications that are known to cause gynecomastia are as follows:  Estrogens, digitalis, clomiphene, ketoconazole, metrondazole, cisplatin, spironolactone, cimetidine, isoniazid, methyldopa, tricyclic antidepressants, valium, heroin, and marijuana. Liver problems can also be the cause. These are the common causes but there are many more possibilities and only a medical evaluation can determine them with any certainty.

The good news is that with modern plastic surgery, gynecomastia can be effectively treated so that you no longer have to be embarrassed to take your shirt off. Normally, gynecomastia is treated with liposuction because the majority of the breast tissue is fat. If you are relatively young with good healthy skin, the skin shrinks back after the fat is removed and a good result is obtained.

Sometimes the gynecomastia is so bad that liposuction alone will not get rid of the sagging breasts. In these cases, the plastic surgeon must also remove skin in addition to the fatty tissue in order to obtain the desired results.

Another tool used to treat gynecomastia is ultrasonic liposuction. This is particularly useful when the excess tissue is very hard and fibrous. The ultrasonic liposuction does a great job in removing this type of tissue.

Benefits

The benefits of male breast reduction surgery are both physical and psychological. From the physical perspective, you are able to get rid of those unattractive, sagging breasts, and allow the more defined pectoralis major muscles hidden below to show through like they should. From a psychological perspective, you no longer have to suffer with the embarrassment of having breasts. You can take your shirt off in public and not have to worry about being made fun of.

Another benefit of getting rid of fatty, sagging breasts is that it allows for shirts to fit much better. After the surgery, you will be able to buy better fitting shirts and feel confident.

Are you a good candidate?

The question as to whether or not you are a good candidate is easier to answer than finding out the exact cause of the gynecomastia. A good candidate is simply any man who feels self-conscious about his breasts or that his looks could be improved if only his breasts were made smaller. If this problem is treated by a competent plastic surgeonthe fat can be effectively and safely removed.

Remember, gynecomastia is usually not caused by any serious medical problems. In fact, the cause is usually never identified. However, it must be emphasized, that there are some significant medical problems that do cause gynecomastia and must be looked into. To determine if you have treatable medical reasons for your gynecomastia you must see your family doctor. When seeking consultation, it is important to list all the medications you are taking as well as providing a complete medical history.

Possible complications

The most common complication after male breast reduction is asymmetry or incomplete removal of breast tissue. It must be pointed out, however, that all breasts have some asymmetry. In men, this asymmetry is usually not noticed but it is present. A male breast reduction, in fact, can do a lot to correct asymmetry but it is unreasonable to expect both breasts to be identical. Another potential complication is over reduction.

Loss of nipple sensation is possible. In men, this is not usually a problem. Normally, the sensation returns within a few months. Other complications that must be considered, but are possible with any operation, are the risks of infection, wound healing problems, fluid or blood collection, and contour irregularities.

Do's and Don'ts prior to surgery

• Medications. Certain medications thin your blood and should not be taken within 3 weeks of surgery. The most notable is aspirin and aspirin containing products. Vitamin E and many herbal products also thin the blood and should not be used within 3 weeks of surgery. Your doctor will go over this more thoroughly prior to the procedure.

• Sleep. It is important to get a good night's rest prior to the procedure. If you think this may be a problem, please, do not hesitate to ask your doctor for something to help to sleep.

• Smoking. Please do not smoke within 3 weeks before and after surgery. Smoking has a profound effect on reducing wound healing capabilities. It significantly increases the likelihood for infection, wound healing problems, and scar formation. It also affects your airway, therefore, making anesthesia much more difficult.

• Eating. Do not eat within 8 hours of surgery and do not drink within 6 hours of surgery. It is OK to take medications with a sip of water. Please discuss all medications with your plastic surgeon and the anesthesiologist.

• Washing. It is a good idea to wash the surgical area thoroughly the night before and the morning of surgery. This includes cleaning crevices such as the belly button and any folds in an effort to prevent infection.

• Arrival. It is best to arrive on time to ensure that things run smoothly. Please be sure to have someone else drive you.

• State of mind. Remember, this should be a happy and exciting time. A certain amount of nervousness is normal but you should not be overly concerned. Excessive worrying can actually be detrimental and you should discuss this with your doctor prior to surgery so that something can be prescribed to make sure you remain calm.

Anesthesia

The anesthesiologist will discuss with you what type of anesthesia is best for you. He/she will take into consideration your medical history, the procedure, and your personal wishes.

If only the breasts are being worked on it is possible to perform the procedure under local anesthesia if you are willing to tolerate some pain and inconvenience. Usually, it is done under general anesthesia or twilight anesthesia. The choice is up to your doctor will help you with this decision at the time of consultation.

After the procedure

The procedure itself will take about 1 to 2 hours.

Immediately. Right after the operation you will be watched for 1 or 2 hours and encouraged to walk around. You will be given as much pain medication as necessary both immediately after the operation and for the next 4 to 5 days. You'll have tape around your breasts as well as a compressive dressing. Keep this tape and dressing on until you shower the next day.

That evening. It is recommended that you take it easy. You can walk around, eat, but not too much more. It is very important not to move your arms too much so that bleeding is not started. Aggressive arm movements should not be done within the first 4 weeks after the procedure. You should take as much pain medication as necessary and try to go to sleep early. It is best if you sleep with your head and chest slightly elevated to promote proper lymphatic drainage

First 48 hours.  You can take a shower the day after. Just be gentle. Remove the compression dressing and just let the water run over your chest. Do not move your arms too much. Remember, your chest will be swollen and it will take approximately 3 to 4 months before your skin stretches back. Until the skin stretches back, it will hang somewhat and be swollen. When you are done with the shower put the compression dressing back on with a little bit of bacitracin over the incision and then gauze. The incisions will continue to ooze for about 3 days.

First week. At about day 3 you can move around normally. Just continue limiting movements of your arms. The majority of the bruising and swelling will go away in about 2 to 3 weeks.

Beyond. Swelling will not completely resolve for about 6 months but, as mentioned above, the majority of it will be gone by 3 weeks. You can start moving your arms aggressively at about 2 weeks at that time you can also start working out with your arms. Skin contraction will not start until about 4 weeks after the procedure and will continue to contract until about 6 months. The final result will not be evident until 1 year when all the swelling has resulted and skin contraction is complete.

Recovery time

Some people with sedentary jobs go back to work after 2 days. If your job, however, requires a lot of aggressive arm movements it may take as long as 2 weeks to return to work. Most people return to work in about 1 week.