The only treatment for gynecomastia is surgery. The breast in a male or female is a combination of fat and glandular tissue. Most of the time, the operation to remove the gymecomastia combines liposuction (to remove the fat) and surgical excision (to remove the glandular tissue.

If the breast is substantially composed of fat with little glandular tissue, liposuction alone may treat the problem. However, since liposuction does not remove glandular breast tissue, any substantial amount will require excision. Using more aggressive liposuction technique, small amounts of glandular tissue can be removed. This allows a satisfactory result by liposuction alone in about 90% of cases. The remaining 10% will need direct surgical excision.

Yes. If liposuction alone cure the problem, only a small puncture wound is made in the armpit (to allow the liposuction tube to get to the breast) that leaves a very inconspicuous scar. With more modern technique, now about 90% of men are adequately treated by liposuction alone.

The other 10% require an incision partially around the areola that allows the surgeon to access and remove the excess breast tissue. This usually fades to a nearly imperceptible scar over a number of months.

Occasionally, a patient may have a very large breast, the removal of which leaves a surplus of skin. In these circumstances, longer incisions are needed to remove the excess skin.

Gynecomastia can accompany the onset of puberty but usually fades away after a couple of years. This is related to the generation of sex hormones and the breasts’ new exposure to these agents. As puberty becomes complete, the hormones come into balance and the breast tissue responds to the predominance of testosterone over estrogen (yes, men do have some estrogen).

Gynecomastia can be a byproduct of anabolic steroid use. It can be seen in heavy marijuana users as this drug can lower testosterone levels. It is seen as a byproduct of some medications (spironolactone). Alcoholics can develop gynecomastia as damage to the liver decreases its ability to breakdown estrogen which may stimulate breast growth.

Aging can bring for the development of gynecomastia as testosterone levels fall. There are also some rare tumors of the endocrine system that produce estrogen and cause the problem. These are quite rare.

The development of gynecomastia after puberty is, most of the time, idiopathic. That is, we really don’t know what causes it. It is usually bilateral, but can be a problem on one side or the other.

Usually it is not. Some patients may experience some tenderness, but most of the time it is exclusively an aesthetic problem-an embarrassment.

Breast cancer in a male is rare and I am unaware of any increased risk in men who suffer with gynecomastia.