Breast cancer is one of the leading causes of death in women. But did you know that women aren’t the only ones affected by this disease? Believe it or not, men are also susceptible to breast cancer. While this occurs in men far less than in women, it is still a cause for concern. According to the American Cancer Society, approximately 2,240 cases of breast cancer in men will be diagnosed in 2013. About 410 men will die this year from breast cancer. And, though it is less likely (approximately 100 times less likely) for men to develop breast cancer than women, with statistics like this, it is still a cause for concern.
In order to help you better understand this disease in men, it is important to understand the causes and why it happens.
Image courtesy of ShutterStock
What is male breast cancer?
Cancer refers to any malignant tumor, or the development of a group of abnormal cells, in any part of the body. Cancer becomes harmful to the body when these abnormal cells divide uncontrollably and form lumps or tumors. Tumors can grow and interfere with the digestive, nervous, and circulatory systems and they can release hormones that alter body function. These cells can develop in the breast tissue of a male. The development of this disease is rare in men and is quite worrisome. The collection of abnormal cells can grow quite large and take over surrounding tissues. It can also metastasize, or spread, into other parts of the body. Many men don’t know they are susceptible and in turn aren’t getting screened by a doctor the way women have been taught to do.
What causes male breast cancer?
Just like in women, we are not exactly certain what causes the development of breast cancer in men. It could be linked to genetics or environmental conditions, and recent studies are indicating that it could also be linked to gynecomastia.
Gynecomastia refers to an increased production in the amount of tissue in a man’s breast. Men naturally have breast tissue, but since their breasts are not used in the same manner as women’s, they normally don’t produce large amounts of this tissue. However, in the case of gynecomastia or pseudogynecomastia, there are instances when there is an increase in the development of this tissue.
When there is an excessive amount of breast tissue, it is believed that there is a greater chance of the development of abnormal cells, which can lead to the development of breast cancer.
Signs of Gynecomastia
Typically, breast tissue in men is too small to be felt or seen. However, in cases of gynecomastia, there is usually the feeling of a growth under or around the nipple and areola. In more extreme cases, men can actually develop small breasts.
Link between Gynecomastia and Male Breast Cancer
The development of gynecomastia is linked to an excessive production of estrogen. Extra breast tissue and an increased amount of estrogen in the male body is thought to increase the chance of breast cancer developing in men. While the studies on this connection are still in the beginning stages, evidence does suggest a link. More needs to be learned and studies are continuously being conducted in order to determine the exact correlation of these two conditions.
While breast cancer occurs less in men than in women, it is still important for both genders to check themselves regularly.
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As 2012 comes to a close, we’d like to evaluate the journey our practice has gone through in the past year and highlight some of our accomplishments.
The practice recently submitted statistics to the American Society of Plastic Surgeons on the number of surgeries done over the past year. In 2012, Dr. Blau performed 317 gynecomastia, or male breast reduction surgeries, which was over 95% of the total procedures performed at his practice. Considering that on average, each plastic surgeon only performs 2-3 surgeries of this nature a year, it is quite impressive. Only a handful of other surgeons worldwide perform more than 100 male breast reduction surgeries each year. Of these surgeries about 100 were performed from patients residing outside of the country. Dr. Mordcai Blau and his staff make concerted effort to cater to international patients by providing extensive information on staying in the White Plains area and by providing individualized instructional packets designed for each patient based on his individual needs far in advance of the surgery to ensure each patient is prepared. His staff was more than happy to do this for all 317 gynecomastia patients, regardless of whether they came from out of state, out of the country, or right in town.
Since Dr. Mordcai Blau is an expert who specializes in gynecomastia surgery, he often gets many patients who require revisions from previous gynecomastia surgeries. In 2012, 100 of Dr. Blau’s surgeries were revisions. Throughout the year, Dr. Blau has found that patients have generally been satisfied and that none of his gynecomastia patients experienced a recurrence. He has found that his signature technique, the Natural Blend technique, which requires careful consideration of the contours of each individual patient’s body prior to surgery, contributes to the success of his surgeries. As an artist who has had his work showcased in several exhibitions throughout the U.S. and Europe, the Natural Blend technique combines Dr. Blau’s skills as an artist and a surgeon and helps him to map out his surgical plan to create a natural-looking contour in which the skin drapes naturally over the chest. Dr. Blau finds that this technique works especially well for bodybuilders, who represent a large portion of his gynecomastia patients. The fact that such a large percentage of his practice is comprised of bodybuilders serves as a testament to Dr. Blau and his surgical techniques as this group holds a much higher standard for physical appearance than the average patient. In an effort to further improve upon aesthetics, Dr. Mordcai Blau followed cues from his patients’ wishes and has also developed nipple reduction surgery in order create an appearance of the chest which is more typical. To see the results of his work, browse through his collection of 2,500 before and after photos.
Among his other accomplishments in 2012, Dr. Blau was featured on The Learning Channel (TLC). In the segment, the film crew followed the journey of one of his patient’s Cristian, from his early struggles with gynecomastia to his results from his gynecomastia surgery. This segment helps shed light on the problems commonly faced by those with gynecomastia.
Also in 2012, Dr. Mordcai Blau has started working on compiling his surgical knowledge of gynecomastia into a book. He hopes that this compilation of experience working on patients with gynecomastia will help inform the public and other plastic surgeons about best techniques and practices for male breast reduction surgery. He hopes to incorporate successes from 2013 into his book.
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Body Dysmorphic Disorder (BDD) is a condition which is frequently on the minds of many plastic surgeons. In the U.S. it affects 2% of all men and 1% of all women. According to the Mayo Clinic, Body Dysmorphic Disorder is a chronic illness in which a patient fixates on a particular real or imagined physical flaw. In relation, to gynecomastia, each surgeon who performs this surgery has to consider the possibility of whether a prospective patient has a realistic body image in comparison with the average population. For a condition like gynecomastia, which is characterized by enlarged male breasts, it is possible for a man to fixate on the flaws in this particular area of the body. With the connotations related to how men with enlarged breasts perceive themselves on the gender spectrum, it is understandable that some men might fixate on this. According to Dr. Blau, who is a specialist in gynecomastia, he finds that he is especially wary of this when working with the body-building community. As bodybuilders need to be conscious of their physique on a consistent basis in order to remain competitive. To minimize the likelihood of operating on someone with Body Dysmorphic Disorder, plastic surgeons evaluate their patients psychologically in order to ensure that the surgery is really in the best interest of their patient.
Handling a gynecomastia patient with Body Dysmorphic Disorder is always a tricky situation for any physician. It takes a skillful physician, who has a lot of experience working with patients to learn how to communicate realistic expectations to patients. However, even after spending a great deal of time discussing what outcomes a patient can realistically expect, sometimes, patients whose results objectively look good to other still look like they are in great need of fixing from the perspective of the patient. At this juncture, the physician should discuss with the patient, the possibility of benefitting from counseling for Body Dysmorphic Disorder.
Body Dysmorphic Disorder needs to be taken seriously. Those with BDD can also experience unfortunate symptoms like depression, anxiety and suicidal ideation. Fortunately, BDD can be managed through medication and cognitive behavioral therapy. If you think you may be suffering from BDD, please consult your healthcare professional.
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After working in the field for 25 years, Dr. Mordcai Blau created and perfected his technique of choice, which he refers to as the Natural Blend technique. The natural blend technique focuses on the male chest as a whole, not just the breast gland tissue. The Natural Blend technique is so comprehensive that Dr. Blau begins its implementation as early as the consultation stage. During the consultation process, he examines the particularities of each patient’s chest and devises a surgical plan based around the idiosyncrasies of each patient’s chest. He closely examines the amount of glandular tissue and excess skin. The patient’s age is also taken into consideration as this will affect the elasticity of the skin. He asserts, that these factors play a huge role in defining the shape of the patient’s chest. By examining this, along with the patient’s particular composition of adipose tissue, breast gland tissue, fibrous tissue, muscle and skin, Dr. Blau can adapt his surgical procedure to fit the natural contours of each patient’s body.
As an accomplished artist, Dr. Mordcai Blau pays close attention to the symmetry and proportions of each patient’s chest, knowing that the optimal result is a product of both a strong artistic sense, and extensive surgical knowledge. In addition, he is well-versed in anatomy and has held positions as an anatomy instructor at both Albert Einstein and NY Medical College. The right proportions of the chest can make an astounding impact on one’s overall appearance, and getting the right proportions and symmetry is Dr.Blau’s ultimate goal.
During the surgery, Dr. Blau begins to implement his strategy based on his observations during the consultation. As a true aesthetician, Dr. Mordcai Blau takes precaution to minimize the incision, which, in general, is less than one inch, and remove the exact portion of the breast gland necessary for optimal results. His copious notes in the consultation beforehand, informs his decision about how small he can make the incision and how much of the breast gland to remove. Removing the exact right amount of the breast gland is a critical component of this type of surgery. Using the natural blend technique which emphasizes adhering to the uniqueness of each patient’s body, this is especially true. Removing too much of the gland can result in a depression underneath the nipple-areola-complex, and removing too little could result in a reoccurrence. Excising the appropriate portion of the gland makes a huge difference in terms of the overall appearance of the chest, so using the natural blend technique is particularly useful in terms of removing the right amount of gland, which is usually between 95-98% of the gland. In his experience conducting thousands of surgeries, Dr. Blau has noticed that the breast gland tissue can appear in areas other than directly under the nipple-areola-complex. The thoroughness of the natural blend technique helps him to ensure that he does not miss any glandular tissue.
The next stage in the natural blend technique is to remove the fat tissue. Again, Dr. Mordcai Blau takes careful note of the appropriate amount of fat to remove on a case-by-case basis. For his patients who are bodybuilders, which comprises about 20-30% of his client-base, he removes glandular tissue only, since bodybuilders have such little body fat. Bodybuilders are particularly attentive to the shape of their chest as their competitive edge relies on the build of their chest. Dr. Blau sees this as a testament to the quality of his natural blend technique. Patients with psuedogynecomastia, which is characterized largely by a great deal of fat tissue, on the other hand, have to have a lot of adipose tissue removed. In the rare case in which gland excision and fat removal are not enough, Dr. Mordcai Blau will employ an adipose flap to create the ideal chest shape. This is more likely to be the case if it is a secondary surgery as opposed to a primary surgery. If there is a little depression or deformity, the adipose flap can be used to mold the fat into place to fix the depression or deformity. The flap is often a better option than a fat injection, as the adipose flap leaves one side of the fat attached to ensure blood supply.
By taking great care and paying attention to the unique features of each patient’s body, Dr. Mordcai Blau manages to create a surgical technique specific to their needs. Using the natural blend technique, many patients see results which, appropriately, suit their body quite naturally.
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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.
Significance!
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).
Treatment
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
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
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.
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Gynecomastia Surgery: A Closer Look
Gynecomastia is an unacceptable condition when it comes to bodybuilders. Gynecomastia can develop in bodybuilders for many reasons. Some hormones affecting growth and differentiation of breast tissue are growth hormone, estrogen, androgens, and progesterone. A myriad of other peptides both endogenous and exogenously introduced can contribute to developing this condition. Whatever the cause, the development is analogous to female breast development and the results are devastating. It is unacceptable for a bodybuilder who invests the most time, energy, and money per day of life than any other sport or form of human competition to be hindered by breast tissue development.
Drug based therapy is not a viable solution for gynecomastia in the bodybuilder. Surgery is the only effective means of treating this condition. It is important to note that of the general public gynecomastia patients, 50% are not satisfied with the post-operative outcome, as their aesthetic expectations have not been meet. That being said, what the bodybuilder considers aesthetically acceptable is drastically more demanding than a general patient according to Dr. Mordcai Blau who frequently works with this community. One can deduce from this, bodybuilders who do not extensively research for an exceptional, experienced surgeon will likely be disappointed with the results.
Gynecomastia is unacceptable to athletes, recreational bodybuilders, and especially competitive bodybuilders. The staple poses of the competitor are the: quarter turn, front double bicep, front lat spread, abs and thigh, side chest, side tricep, rear double bicep, rear lat spread, and of course most muscular. Competitors suffering from even a mild case of gynecomastia will be most vulnerable in posing the: quarter turn, side chest, and side tricep.
Most Vulnerable Poses
Quarter Turn
Side Chest
Side Tricep
Apex of Aesthetic Points
Contour
A surgery in which the primary intention is to remove mammillary glandular tissue will often result in failure. There are several features that demand more attention in catering a corrective surgical protocol to bodybuilders. Bodybuilders obtain an extremely low percent body fat for a duration of time. Percent body fat is inversely proportional to the aesthetic appearance of the gynecomastia present. This is another reason why correcting the condition is required. The musculature of the chest is a focal point in posing and more generally an accented feature on bodybuilders. Breast tissue proceeds to develop as follows: growth and division of ducts, formation of club-shaped terminal end buds, then forming alveolar buds, clusters of buds make up a lobule, lobules differentiate into ductules. This is significant because of the protrusion caused behind the nipple often made more pronounced by adipose tissue behind the gland. The amount of tissue removed will be unique to the severity of each bodybuilder’s condition and physique. Not removing enough tissue results in the failure to meet aesthetic requirements and enables the possibility of further breast development. Removing excess tissue may result in depressions that cannot be acceptably fixed. Achieving a natural contour is key to a successful surgery. Achieving a natural contour will require a plastic surgeon with specialized experience, perfected technique, and skill.
Scars
Scars are unwanted by a general patient and as such are absolutely unacceptable for bodybuilders. Avoiding scars requires delicate cosmetic surgical techniques. A periareolar incision does not rule out the possibility of scaring. A specialized surgeon with experience is key.
Example of Successful Surgical Treatment of Gynecomastia
Post-Operative Photos: 1 Year
Before photo: Bodybuilder with Bilateral symmetric gynecomastia. Post Op Photo: No scarring.
Before photo: 3/4 Turn showing protrusion feminizing chest. Post-Operative Photo: Tight, natural contour with no scarring or depressions.
Gynecomastia Corrective Surgery performed by Dr. Mordcai Blau
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