Important Information about Gynecomastia by Dr. Mordcai Blau

What is Gynecomastia?
Gynecomastia is enlargement of the male breast. It is important to distinguish the enlargement present in gynecomastia from the adaptive response induced by resistance training (hypertrophy) of the pectoralis muscles. Gynecomastia is firm subareolar tissue and or diffuse fibroglandular tissue aggregating behind the nipple.

Facts about Gynecomastia?

Gynecomastia is present in 30% to 50% of healthy adult men. There are three times that males are most susceptible to developing gynecomastia. The neonatal period (infant), during puberty, and the age of fifty onward are the most vulnerable to developing the condition. Obesity greatly increases the chances of developing gynecomastia. Other factors that can increase the chances of developing gynecomastia are: genetic predisposition, smoking, drinking, prolonged high stress levels, physical inactivity, and drug use. The potential to develop gynecomastia with any combination of the aforementioned factors is directly proportional to age.

Ultimate cause of Gynecomastia

Males normally possess the equipment (glands + tissue) but lack the means (hormonal profile) to develop breasts. Most cases of gynecomastia result from an imbalance between estrogenic and androgenic effects on breast tissue. Estrogens stimulate breast tissue growth while androgens inhibit it. While there are many mechanisms caused by factors previously mentioned, most of their potential to induce gynecomastia is from ability to disrupt the estrogen / androgen balance present in healthy males.

Gynecomastia though not an immediately life threatening condition, can have negative effects on the quality of life of a patent. A male with gynecomastia can experience behavioral health changes serious enough to effects his social, mental, physical and thus overall health. A few examples of this are feelings of anxiety, psychosocial discomfort, and a chronic fear of breast cancer.

Will Gynecomastia naturally go away?

Gynecomastia during the neonatal period normally regresses spontaneously requiring no treatment. Gynecomastia in puberty commonly is asymptomatic and regresses spontaneously. Gynecomastia that has not spontaneously regressed from puberty will likely not do so. The only effective treatment is for this case is surgery. Gynecomastia onset in adulthood from: stress, drugs, refeeding following starvation (prolonged catabolic states), and obesity will likely not regress. Adult onset gynecomastia requires surgery for effective treatment.

Do I have gynecomastia? I have puffy looking nipples…..
It is common that overweight men may feel they have gynecomastia because of the protruding appearance of their nipples and chest area. It is possible that many of these cases are pseudogynecomastia. Pseudogynecomastia results from having excessive body fat. The fatty breasts behind the areola and chest area are swollen adipocytes (fat cells) and are a result of sustained energy input (diet), exceeding output (metabolic demands). Body fat is not site specific and its storage distribution throughout the body varies genetically. Pseudogynecomastia can be treated effectively with exercises and diet. It is important to emphasize that carrying excessive amounts of body fat increases the risk of developing real gynecomastia that is only effectively treated by surgery.

Both Nipples? One Nipple?

Gynecomastia is commonly bilateral and symmetric (both glandular mammilary tissue deposits are of equal size). Gynecomastia can also be unilateral (asymmetric tissue deposits).


Surgery is the only effective treatment for gynecomastia that has not spontaneously regresses during puberty or that is adult onset. The surgical method is to remove the glandular tissue through a periareolar incision. A lipectomy may or may not be necessary as determined by the surgeon. The surgical procedure requires skill and experience by the surgeon. Finding the right surgeon will determine the success of the treatment and meeting your personal expectations.

Example # 1 – Mild Case of Gynecomastia

Patient with bilateral symmetric gynecomastia
Surgeon: Dr. Mordcai Blau
Post-Operative Photo: 1 year

Mild Gynecomastia Before Photo

Mild Gynecomastia After Photo

Cosmetically: There are no visible scars present from the incisions. The size of both nipples was reduced as a result not being stretched over the breast tissue. The natural contour of the nipples resting on the chest has been restored. There are no protrusions or depressions present in the surgically corrected area.

Example #2 – Severe Case of Gynecomastia

Patient with bilateral symmetric gynecomastia
Surgeon: Dr. Mordcai Blau
Post-Operative Photo: 1 year

Severe Gynecomastia Before Photo

Severe Gynecomastia After Photo

Cosmetically: Patient was concerned that scar tissue would be a serious issue with his dark skin complexion. There is no visible scar and his severe case of gynecomastia was corrected, achieving a natural smooth contour of the chest.

About the author

Dr. Mordcai Blau is specialist in gynecomastia surgery and performs almost 300 gynecomastia surgeries each year. He has been published by the American Society for Plastic Surgeons as a gynecomastia surgeon. He has also been featured on The Learning Channel (TLC) as a male breast reduction surgeon. He is a surgeon's surgeon and has operated on and is highly recommended by other physicians-including plastic surgeons. Dr. Mordcai Blau is passionate about sharing his knowledge of expertise of gynecomastia and male breast reduciton surgery.

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