Body builders are a unique sub-set of patients with gynecomastia, since their gynecomastia is usually small (confined to the area just under the areola) and is largely due to self-medicating with hormones and anabolic steroids. For the most part, bodybuilders have very low percentages of body fat and are in excellent physical and nutritional shape.

Many of them have taken anabolic steroids without proper physician supervision. The obvious goal of these steroids is to help bulk up their muscles. Some men knowingly take anabolic steroids and then attempt to prevent the development of gynecomastia (a common and well known side effect) by self medicating themselves with other drugs to block the side effects of the steroids. This often becomes a circus of self prescribed medications, which can seriously disrupt one’s delicate hormonal balance.

Some men do not specifically take anabolic steroids. But they may take “protein supplements,” prohormones and other seemingly harmless supplements, available at health food stores or through the internet. The problem is that many of the listed ingredients are not specific and these supplements may indeed have hormone-like qualities. The net effect is that gynecomastia may develop most unexpectedly and sometimes very quickly. And once it has developed, there are no treatments for it other than surgery.

The most visible side effect of anabolic steroids is the development of excess breast tissue (commonly called “bitch tits”). This is due to the conversion (termed aromatization) of the testosterone they have taken into estrogen. The estrogen, in turn, then promotes the growth of breast tissue. Bodybuilders complain mostly about very localized gynecomastia (just under or around the areola) and/or puffy nipples, although some very large growths of breast tissue have been encountered. When the pec muscle is flexed, the nipples protrude excessively and detract from the contour of the chest.

It is our strong professional opinion that tampering with one’s delicately balanced hormonal system – particularly without appropriate physician supervision and blood testing – is totally inappropriate, dangerous to one’s health and should not be done. Nevertheless, for those bodybuilders who have developed gynecomastia, appropriate surgery is the best answer. The surgery should provide for a flat nipple/areola on a contoured, muscular chest.

GYNECOMASTIA SURGERY FOR NEW YORK BODYBUILDERS

Male breast reduction surgery for New York bodybuilders is very similar to the standard procedure described elsewhere on this website. There are some significant differences, however.

The difference begins with the actual breast tissue itself. Steroid-induced gynecomastia is solid, white, hard and extremely fibrotic tissue, as compared to pubertal gynecomastia in which there is somewhat softer, thickened breast tissue under the nipple which then fans out and is interspersed with fat as it extends outward. There is very little peripheral fat in bodybuilders.

In these patients, a peri-areolar incision (incision around the edge of the areola) is done 100% of the time. The solid tissue is removed in pieces through this small incision. A liposuction cannula (frequently without the suction turned on) is used to help re-distribute the skin across the chest. Drains are frequently used to promote faster healing, encourage the skin to attach to the underlying muscle and prevent build-up of fluids. The net effect after healing is that of a very thin and uniform layer of skin and fat which is now draped over the large pec muscle, thereby providing the desired “cut” appearance.

Anesthesia for this surgery is usually safe “twilight sleep” anesthesia, provided by a separate anesthesiologist. Sometimes, if the “bitch tits” are very small and localized directly under the areola, the procedure can be done under local anesthesia. But there may still be some discomfort during the procedure if only local anesthesia is utilized.

A compression garment is provided and should be worn 24/7 for several weeks. A return to strenuous exercise should be deferred for several weeks as well, to allow for appropriate healing.

WHAT RESULTS CAN BE EXPECTED?

The results of gynecomastia surgery are usually permanent provided that additional illicit drugs are not used in the future. There is always a small amount of breast tissue deliberately left under the areola to prevent a crater deformity. Should additional drugs be taken in the future, it is that residual breast tissue that can conceivably re-grow again.

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