Can an Injury to the Pec Area Trigger Gynecomastia?

Question

I was hurt in 2008 at work lifting some heavy stone. I tore my rotator and labrum and had surgery in 2009. I also had a pop in my right pec that went from the nipple to almost under my arm. The area was 2 to 3 times the size of my left pec and black and blue for a few weeks. The swelling went down after about 6 months, but is still bigger than the left. My doctor sent me to a cosmetic surgeon that was unsure and said i may have damaged the pec minor, but also it looked like gynecomastia.

Richard H. Tholen, MD, FACS · Answer

Your description is quite accurate for a partial muscle tear causing an intramuscular hematoma (which is what caused the bruising and swelling). This should have been diagnosed and evacuated at the time of the injury, but letting this collection of blood reabsorb over 6 months' time has left persistent scar tissue in the right pec area.

	Shame on your "cosmetic surgeon" consultant for failing to diagnose this, though 6 months after injury this may well have looked less like an old collection of blood and more like a fibrous mass of scar tissue that closely mimicked the consistency of gynecomastia tissue. Damage to the pec minor would have been less likely than damage to the pec major, but whichever muscle was injured is immaterial to the diagnosis.

	At this point you require excision of the scar mass to equalize the chest/breast area. This can be done through a short periareolar incision, but beware--liposuction (including ultrasonic and laser-assisted) will be a spectacular failure and will NOT make any real improvement!  This scar tissue is very firm and fibrous--not at all like fatty tissue--and totally inappropriate for liposuction. Proper surgical treatment of this will require subcutaneous excision of the excess bulk, preserving a small disc of normal tissue beneath the nipple areola complex to prevent unnatural adherence to the underlying muscle, and placement of a drain for about a week. Make sure you see an American Board of Plastic Surgery-certified plastic surgeon, not a "cosmetic surgeon" who may have little true general surgical or plastic surgical training or experience!

Jeffrey E. Schreiber, MD, FACS · Answer

It sounds as though you may have ruptured part of your chest muscles. They then balled up can are causing your gynecomastia. The treatment may involve slightly larger scars, but the excess muscle may be amenable to excision in order to improve the appearance of your chest.

Ritu Chopra, MD · Answer

Even when a muscle tears and causes a deformity (the most obvious one is biceps tear), unless it is immediately repaired, it can't be repaired. What you can do is work on the soft tissue to disguise it. Liposuction or excision of some breast tissue can be part of the cure. Fat transfer or custom made implants for indentations.

Amy T. Bandy, DO, FACS · Answer

It sounds like you developed a hematoma from your injury that has now partially resolved, but you probably have scar tissue associated with the hematoma. You may have some excess breast tissue or fat on your breast as well, but this would not have developed from the injury.

Babak Dadvand, MD · Answer

Hi T71,Thanks for the post. The injury you sustained should not have any bearing on whether you have gynecomastia or not. Gynecomastia is due to an excess in breast tissue that gives the chest a more feminine appearance. Musculoskeletal injuries in and of themselves will not stimulate an increase in breast tissue formation.  It could be that you had a muscle injury and gynecomastia as well. You should be evaluated by a plastic surgeon experienced in gynecomastia surgery.Sincerely,Dr. Dadvand

Can an Injury to the Pec Area Trigger Gynecomastia?

Answers (10)