The treatment for "man boobs": Male breast reduction explained [Kyle Baltrusch, MD, Portland]

Eva Sheie (00:00):
You're listening to Where Before Meets After.

Dr. Baltrusch (00:03):
My name's Kyle Baltrusch. I am a plastic surgeon at Portland Plastic Surgery Group in Portland, Oregon. Today we're going to be talking about male plastic surgery. Certainly the procedures that men seek versus women differ. The one that men seek the most or that we're seeing the highest increase in as male breast reduction or gynecomastia surgery.

Eva Sheie (00:25):
I once titled an episode about gynecomastia, make polo shirts great again.

Dr. Baltrusch (00:31):
Yeah.

Eva Sheie (00:34):
What kinds of things do men do to maybe obscure gynecomastia when their chest is not flat? Have you ever seen any interesting wardrobe choices to cover that up?

Dr. Baltrusch (00:45):
I mean, really when men come in seeking reduction or gynecomastia surgery, often there's a self-esteem issue, and this has been since puberty, that's most commonly when this arises and becomes an issue. And often men don't even realize that there's something that can be done for it. They think it's just kind of natural and it is, it's just a hormonal issue or the product of hormonal differences. But often it's men just wear oversized clothing. So we see them sizing up in clothing or wearing larger sweaters or shirts to disguise it and nothing athletic or tight or fitted. And so that really does affect their self-confidence.

Eva Sheie (01:28):
Do they say anything in particular? Have you ever noticed a pattern in what they ask you when they come in for that?

Dr. Baltrusch (01:37):
They want to feel validated and reassured that this is something that can be done and that they're not doing this in vain. I get a lot of questions of, is this common? Do other men seek this? And I think that group think they want to feel like they're not alone in seeking plastic surgery for something like this that has often caused them self-esteem and self-confidence issues since they were a teenager.

Eva Sheie (02:04):
And is it common?

Dr. Baltrusch (02:05):
Very common. Yeah. So gynecomastia, which is just development of male breast tissue. It's a hormonal imbalance. So when estrogen levels are higher, and so we see this commonly three different times in our lives. When we're babies, so we still have the maternal estrogens in our system. And then at puberty, so certainly when we're undergoing puberty, there's hormonal imbalances. And so about two thirds of teenagers going through puberty do see development of breast tissue. This typically does resolve within the year as those imbalances stabilize. But if it's beyond a year, it typically is going to be persistent and grow proportionally with them and is likely a surgical issue at that point. And then the third time we see this is when testosterone levels drop when you're older. And so estrogen levels are higher. And then when you're larger, you have fat cells that aromatize testosterone into estrogen. And so this is why older men also have slightly larger chest.

Eva Sheie (03:12):
It's nice to know that you all have similar indignities. Can you work out enough to make gynecomastia go away?

Dr. Baltrusch (03:21):
Typically, no. So gynecomastia, it's usually centric behind the nipple areolar complex, and so there's breast tissue there. And so it can be anything from just a small mound that may cause slight herniation of the areola or kind of a pointy chest to a full-blown male chest. So it can become a soft tissue issue, meaning like the skin envelope. So if there's enough breast tissue, it can kind of stretch that skin envelope and it can require more than just the glandular excision.

Eva Sheie (03:59):
So you can't just do a great chest workout every day.

Dr. Baltrusch (04:03):
Typically. No, typically not.

Eva Sheie (04:06):
Thanks for listening. I'm your host, Eva Sheie. Follow the show and submit questions for our experts at wherebeforemeeetsafter.com. Where Before Meets After is a production of The Axis.