Volumes had been written on this topic.
Gynecomastia has many potential causes. Male breast over-development may be divided into two large groups: Physiologic or normal gynecomastia and Pathologic (or Abnormal) gynecomastia.
Normal (Physiologic) Gynecomastia affects up to 60% of men at some point in their lives. It is commonly seen with newborn boys (due to maternal circulating estrogens) and may last for a few weeks, as well as in obese boys and men and in older men. Normal Gynecomastia has two large peaks. The first peak begins and most often ends during the teen years. (Its incidence rises from about 2% of 11-years-old boys to a peak of about 60% of 15-year-olds and then falls to around 20% per cent of 17-year-old boys). This common occurrence of Physiologic gynecomastia in puberty may be related to transient rise in female hormones with a rise in the ratio of female-to-male hormones. At puberty, the testosterone level does not rise steadily. Over the first few teenage years, it continually fluctuates wildly. These dips in testosterone allow the small amount of estrogen (female hormone) in the circulation to stimulate the breasts resulting in enlarging and/or tender breasts. As a higher level of testosterone is produced inthe latter teen years, breast growth regresses and most affected boys outgrow it. The second peak occurs in around the age of 60, when gynecomastia rises slowly and affects over 40% of healthy aging men.
Pathologic Gynecomastia is caused by one or a combination of three processes :
1) Deficiency in Testosterone production or action (including androgen receptor defects) with or without a related increase in Estrogen production,
2) Increase in Estrogen production and, or Hypersensitivity of Breast tissue to Estrogens
3) In 10-20% of cases, man breasts may be also seen with long term use of certain medications, including taking either body-building steroids or estrogens, taking some drugs which have an estrogen-like effect on the breast or others which act by blocking the effect of testosterone.
The gynecomastia correction surgical technique that I would suggest to a patient will depend on the size of your breasts and their content (fat, glandular breast tissue), the ratio of breast fat to breast skin envelope and the amount and elasticity of the breast skin.
You can read much more about Gynecomastia on my website at - http://www.cosmeticsurgeryspecialists.org/breastsurgery/manbreastssurgery.html
Good Luck.
Peter A Aldea, MD, FACS
