Frank: “You want me to wear a bra?”
Kramer: “No. A bra is for ladies. Meet…the Bro.”
Who could forget the now infamous Seinfield episode in which Kramer invents a bra for men, known affectionately as “the Bro” or the “Manzierre”? While “the Bro” and “the Manzierre” are humorously etched in our memories the truth is “man boobs” or more specifically Gynecomastia is a very real and often times very embarrassing medical condition.
The condition of Gynecomastia is seen surprisingly often, although it’s not something that men tend to sit around and talk about over a beer with their buddies. For most men the condition of chest/breast fullness began to become evident during adolescence. This abnormal chest fullness would result in them to feel self-conscious about their appearance and frequently led them to avoid situations where they could be seen with their shirt off while in the presence of others, such as locker rooms. In some situations this could lead to the avoidance of sports activities resulting in diminished physical activity and subsequent weight gain causing further worsening of the condition.
In most situations gynecomastia results from the growth of excessive fibro-fatty tissue in the chest/breast area, which in more extreme forms can almost have an appearance of a female-like breast. Understandably, this can be quite distressing to a male who develops this condition. Taking certain steroid supplements or the use of Cannabis products has been reported to result in a worsening of the condition.
It is important to distinguish between two variations of the condition known as true gynecomastia and pseudo-gynecomastia because the treatments are different. The most common form, pseudo-gynecomastia, results from the excessive growth of fibro-fatty tissue causing an unnatural fullness in the chest/breast area. This condition is usually effectively treated by liposuction. The less common form, true gynecomastia or true breast tissue in males, is estimated to occur in about 1% of the male population. This condition typically presents as a firm or rubbery mass under the nipple area. Because the true breast tissue is very dense and firm it cannot be successfully treated with liposuction and must be directly excised usually through an incision along the border of the areola. It is not unusual for both conditions to be present in some men, and consequently a combination treatment of both direct excision of the true gynecomastia with liposuction of the surrounding pseudo gynecomastia is necessary to achieve a good overall appearance.
In my plastic surgery practice, over the past 20+ years of treating patients with gynecomastia, I have used almost every type of liposuction technique available including traditional liposuction, ultrasonic liposuction, and laser liposuction. Without a doubt, the laser liposuction technique (also known as Smartlipo) has proved to achieve the best results for a variety of reasons. As noted earlier, the most common form, pseudo-gycomastia, is a result of fibro-fatty tissue excess. In most situations the emphasis should be on the exceptionally fibrous character of fatty tissue excess. For this reason traditional liposuction techniques are not very effective or can produce excessive tissue trauma due to the aggressive nature of suctioning required to actually remove a significant amount of the tissue. Laser liposuction, which uses a high-energy laser probe to essentially destroy the fat cells within the fibrous tissues, successfully achieves a more complete and even removal of the fibro-fatty tissue excess.
The other important benefit of the laser liposuction is that the second part of the laser treatment involves passing the laser probe very close to the undersurface of the skin which causes heating of the deep layers of the skin where fibroblast cells reside. When the fibroblast cells are heated to a certain temperature level it stimulates the cells to produce collagen, which is an important part of skin tightening that is needed to obtain a cosmetically optimal result. A temperature sensor is located at the end of the laser probe and provides direct feedback on the tissue temperature to avoid excessive heating and prevent burning of the skin. For men with more severe forms of the condition, and hence greater distortion of the skin envelope, the skin tightening component of the laser treatment is very important in achieving a good, natural appearing result. It is important to recognize that the laser device is not a miracle machine, and for men in whom there is an advanced degree of skin distortion or laxity, sometimes an excision of the severe skin excess becomes necessary.
For men who are embarrassed by the unmasculine appearance of gynecomastia or man boob, there are effective treatment options available to give them a more natural male type chest. Because contemporary clothing styles can emphasize more form fitting dress shirts, even younger men with only moderate degrees of this condition can significantly benefit from modern laser treatment techniques. In some regards they are the optimal patients with a lesser degree of fibro-fatty tissue excess, and the enhanced skin retraction ability present in younger skin, however older males can still benefit from the reduction in tissue volume, although they may not see the degree of skin tightening seen in younger men.