When Men's Chests Cause Shame

Merle Yost endured taunts and cruel nicknames as a young man, all because he developed a condition called gynecomastia, or abnormal growth of male breast tissue. "I was this skinny little boy with this big chest who got tortured," recalls Yost, 45, now a psychotherapist in Oakland.

Other boys groped him, while girls offered their bras. He grew to dread hearing the phrase "shirts and skins" during gym class. Although doctors say gynecomastia is a benign condition, it can cause deep feelings of shame and embarrassment, as well as interfere with intimate relationships.

The term gynecomastia is a combination of two Greek words that translates roughly as "female-like breasts." All males have breasts; anatomically speaking, the term simply refers to the front portion of the chest. Boys often develop at least some excess breast tissue when they reach puberty. The condition usually disappears within a few months or years, though that may as well be an eternity for a young man who must tolerate catcalls from his classmates. But some young males such as Yost never outgrow the problem.

Gynecomastia also can arise in adulthood, particularly among older males. By one estimate, as many as 40% of adult men in the United States have some sagging or protruding flesh in their chest. Men who seek medical attention for gynecomastia tend to do so for one of three reasons. Some are worried that they have male breast cancer. Others experience pain and tenderness in the breasts, which can be a symptom of gynecomastia. The rest don't like having prominent breasts and want to do something about it.

After ruling out male breast cancer (which rarely resembles gynecomastia), a doctor will determine whether the breast enlargement is caused by too much flab. "The more weight you gain, the more fat you get behind the breast," says Dr. Glenn D. Braunstein, an endocrinologist at Cedars-Sinai Medical Center in Los Angeles. Chubby chests are sometimes called pseudogynecomastia.

True gynecomastia, however, is caused by the overgrowth of breast tissue, which can occur if a man's body has too little testosterone or too much of the female hormone estrogen. This hormonal imbalance can be induced by a variety of medical conditions and medications. For example, men born with a genetic disorder called Klinefelter's syndrome often develop gynecomastia, as do males with adrenal tumors and liver disease.

Many drugs also can disrupt hormone levels and lead to breast growth. Some experts say smoking marijuana can cause gynecomastia, though the evidence for that claim is unclear. Overweight men are doubly at risk for gynecomastia, says Braunstein, because fat tissue produces enzymes that convert testosterone to estrogen.

Many physicians treat gynecomastia by lowering a man's estrogen levels with the drug tamoxifen, which is better known as a treatment and preventive therapy for breast cancer. In a letter to the British Medical Journal published in August, Dr. Hamed Khan, of Nottingham City Hospital in England, reported that up to 80% of gynecomastia patients respond well to tamoxifen. Although he concedes that more research is needed, Khan said several small studies of gynecomastia patients taking tamoxifen had shown "extremely positive" results, with few side effects.

Each year about 18,500 men in the U.S. undergo breast-reduction surgery. The procedure used to be performed with a scalpel and left large scars, which meant some men were still reluctant to be seen in public without a shirt. Today, surgeons use smaller instruments, which require relatively tiny incisions. "You don't maim the chest," says Dr. Rod Rohrich, a plastic surgeon at the University of Texas Southwestern Medical Center in Dallas and president of the American Society of Plastic Surgeons.

The most commonly used surgical procedure for treating gynecomastia is ultrasound-assisted liposuction. Surgeons use ultrasound tools to melt the fat and breast tissue, which are then removed with a liposuction device. Rohrich estimates that the procedure is adequate for up to 90% of patients; for the remainder, who have large amounts of breast tissue, surgery similar to a mastectomy can remove excess skin and reshape the chest.

In most cases, the liposuction technique is performed on an outpatient basis, though a man must wear a compression vest for a month while his chest heals. Male breast reduction usually isn't covered by insurance and costs $3,500 to $6,000. Before deciding to have surgery, a man should examine his reasons, says Yost, who started an Internet site for men with the condition (www.gynecomastia.org).

Some men who are haunted by deeper traumas, such as childhood sexual abuse, may "hyperfocus" on the appearance of their chests as a distraction, says Yost, so "simply removing the breasts is not going to solve that problem."

Yost, who had breast-reduction surgery in 1993, says the procedure can be transforming for men who are truly ashamed of their chests. Being able to do what other men take for granted, such as pulling off a shirt at the beach, says Yost, "allows a man to feel normal, maybe for the first time in his life."