Why some men get chest fat no matter how hard they train [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'm a plastic surgeon at Portland Plastic Surgery Group in Portland, Oregon. Today we're going to be talking about male plastic surgery. One of the things that causes gynecomastia is steroid use or chronic steroid use. So we see men who are very built, very muscular, but you can still see that there is breast tissue overlying the PEC muscle, and these are people that have very large PECs. So typically gynecomastia is idiopathic, meaning kind of spontaneous during these times of hormonal imbalances, but there are certainly other things that can influence the development of male breast tissue. And these are things that we go through at the consultation just to make sure, because if there is an inciting event that we would ask the patient that they stop the inciting event. So things that can cause gynecomastia, there are genetic as well as environmental factors.

(00:58):
So genetically there are certain congenital disorders that may lead to gynecomastia like Kleinfelters, typically very uncommon. Male breast cancers, so if there's a strong family history of breast cancer, there could be concern that does the patient have a BRCA mutation. So genetic mutations for breast cancer are not strictly female. So men, if they have a BRCA2 mutation, they have a 6% lifetime chance of developing breast cancer. Also not very common, but it is certainly something that could occur. And then these are things that would be more unilateral. So if you see a unilateral gynecomastia, then you think something underlying and you may get labs to see if there's anything or imaging biopsy potentially. There's medication, medications can influence gynecomastia. So a chronic history of antidepressants or antipsychotics can lead to gynecomastia. Like I'd mentioned steroid use. So if a patient has a history of anabolic steroid use, these are things that we would have the patients stop for a year to see if there's any resolution or improvement of their gynecomastia before pursuing plastic surgery.

(02:13):
Other cancers like testicular, so if a patient has a testicular mass, this would be something that we would look into with imaging and labs, biopsies. There can be hormone secreting testicular masses. Oftentimes it is idiopathic, meaning just these times of hormonal imbalances. Patients usually typically come in saying, "I remember this from when I was a teenager." That's when I first noticed it.

Eva Sheie (02:41):
It's interesting that sudden onset of gynecomastia could be a symptom or like a signal that something else is wrong somewhere else and not just a cosmetic issue.

Dr. Baltrusch (02:53):
Yeah. So if a patient comes in and says that this is more of a recent thing in their 20s, 30s, 40s, or unilateral, then we start thinking that there might be an underlying cause and it's worth working that up to due diligence, get labs, get potentially imaging, and make sure that we're not missing something. And then you can always send the tissue to pathology as well. I typically don't if it's bilateral and it seems like it's idiopathic, but there have been instances where I've sent tissue to pathology.

Eva Sheie (03:27):
Thanks for listening. I'm your host, Eva Sheie. Follow the show and submit questions for our experts at wherebeforemeetsafter.com. Where Before Meets After is a production of The Axis.