finding a surgeon for gynecomasti

November 16, 2009 5:35 AM

I'm a male in my late 20s - I am about 5'7" and weigh 170 lbs. I have gynecomastia, or enlarged male breasts. I want to have them shrunk.

Even when I was thinner, I still have always had enlarged breasts (fat tends to concentrate on my stomach and chest). They are far larger than they should be for my slightly overweight body.

My father had gynecomastia as well, and had surgery to shrink them.

I live in the DC area, and I'd really like to figure out how to best find a specialist/surgeon in the area that will be able to (affordably) and safely remove the stubborn, excess fat with a minimum of time off of work.

I've never had comestic surgery before and I know that my insurer (Blue Cross) won't cover it, so this is new territory for me. Any suggestions from Mefites who have had gynecomastia, or simply have had plastic surgery?

posted by anonymous to health & fitness (13 comments total)

I don't have an answer to your question, but you might want to ask the mods to post an anonymous email address, so that other men who might be reluctant to answer with their username can contact you privately.
posted by desjardins at 5:52 AM on November 16, 2009

Are their medical treatments you can try before going with surgery?
posted by gjc at 6:37 AM on November 16, 2009

Start with a conversation with your regular physician. He or she should be able to refer you to one or more surgeon who you can evaluate. Schedule a consultation with the doctor to meet them and discuss your options.
posted by onhazier at 6:40 AM on November 16, 2009

Actually, you may be covered. I also have BC and I've been researching another plastics procedure. From what I've been researching, gynecomastia can be covered if it is deemed medically necessary to have them removed. IANYIG (I am not your insurance guy) and every policy is different but it would be worth it to go to your PCP, discuss the issue and the problems they cause you, have him refer you to a surgeon that is in your network. Once you meet with the surgeon, they will help you to get the surgery covered. The office staff in a plastic surgeons office knows all the hoops to be jumped through in order to get things covered. I'm not saying that it will work, but if you take the right steps, and can show a medical and emotional need for surgery, you just may get it covered. Good luck!
posted by pearlybob at 6:44 AM on November 16, 2009 [1 favorite]

I'm going to second starting with your doctor and a referral to a surgeon. I am a woman who recently had breast reduction, and although it took awhile for my insurance to issue the approval , they did pay for it. My history of back and neck pain, and the extremely colossal size of my breasts, meant it wasn't "cosmetic" surgery, but a medical procedure for my well-being. Before you decide to pay out of pocket, at least make the effort to get it covered. As someone else said, the surgeon's office knows all about how to pitch it; they took care of dealing with my insurance company for me.
posted by not that girl at 7:20 AM on November 16, 2009

Another data point on why the plastic surgery may be covered: I knew a guy with this condition who claimed to have spoken to doctors about removal. The doctors apparently said that some plans might cover male breast reduction because gynecomastia can lead to a higher risk of breast cancer in men, and the surgery can be considered preventative care.

Obviously, this is just an anecdote but you may want to discuss this possibility with your doctor/insurer.
posted by mesha steele at 7:21 AM on November 16, 2009

The decision to have surgery is a difficult one and you must have considered all the other options before you came to this stage. I just want to make sure that you have tried weight training. I know a couple of guys who have had this issue and have solved it by sufficiently developing their pecs through exercises like the bench press and dumbbell flyes. When their pecs filled in, the excess breast tissue stretched over the muscle and everything looked like a man's chest should.
posted by sid at 7:49 AM on November 16, 2009

sid, true medical gynecomastia won't be helped by weight training. All you'll get are muscular pecs under your breasts. They might even become *more* noticeable.

Men have breast tissue just like women. In some unfortunate men, their breasts are unusually sensitive to the normal amount of female hormones and they produce breasts - voila gynecomastia. I suppose if they were women, they'd be walking around with D cups. Obviously breasts consist of fatty tissue and fatter men often get "breasts" but even there, the fatty tissue responds to female hormones that all men have so that they develop fatty deposits like female breasts. If you are overweight, losing weight will help that somewhat, especially fat actually produces female hormones and inhibits male hormone production, but there is no such thing as spot reducing for male boobs, and the muscles will develop below the breasts.

I think this also serves to make the the person who suffers from this even more miserable than he is, because he'll say, "If only I tried more, or of only I weight trained..." All the flies in the world won't help. Just not gonna happen.

Surgery is the only way. Technically it is a double-mastectomy.

Good to know, given the psychological hell other people put people with this through, that insurance companies realize this is not simply cosmetic. Being afraid to take your shirt of in a gym or on the beach becase people stare and point at you isn't fun.
posted by xetere at 8:09 AM on November 16, 2009 [2 favorites]

I am also a woman who recently had a breast reduction and agree that you should try as hard as you can for your insurance to cover it. Do some research online before you go see the doctor - see what other people have said to their doctors and insurance companies to get covered and then when you see your GP for a referral, say that stuff! Then say it to the surgeon.
posted by elsietheeel at 8:10 AM on November 16, 2009

Unfortunately, gynecomastia is considered purely cosmetic, kind of like wanting a smaller nose. I doubt a man's breasts would be large enough to warrant it being a medical issue, apart from the psychological aspects. I would be utterly shocked if an insurance company would pay for it, unfortunately. The only other way is if the man had breast cancer.
posted by xetere at 8:35 AM on November 16, 2009

OK, I had this or at least a variation thereof. Not sure if it was true gynecomastia or it was a benign cyst that was growing but I had it removed in 9th grade. It appeared somewhere in the 7th-8th grade area for me. Notice the use of the singular. I had the unusual case where I had only one breast grow but not the other. That was pretty embarrassing for a teenager or perhaps maybe it wasn't as bad as it could have been since at the core everyone could tell it was at least a medical issue.

Anyways, insurance covered if I recall correctly because the mass in general was pressing on my lungs and reducing capacity. They said it was grapefruit sized! but I never got visual confirmation of this. Surgery was done by a plastic surgeon and they went in through the areola to remove the mass. I also had a tube in my side that let fluid drain for a few weeks afterwards...that was kinda creepy. I'm left with a little less nipple sensitivity on that side but otherwise I'm ok.
posted by mmascolino at 8:48 AM on November 16, 2009

MeMail Me.
posted by Lutoslawski at 10:12 AM on November 16, 2009

Ah fuck it. I'll just up and post about my experience with this; privacy is so 2005. This is going to be TMI. Apologies in advance.

So I had the great (mis)fortune of having gynecomastia through my middle and high school years. I discovered it in sixth grade...I was sort of chubby at the time, so I my large-ish breasts didn't alarm me, until I was sort of ok feeling myself up and lo and behold I had those quarter-ish sized lumps behind both my nipples that are for all intents and purposes the beginning of breasts.

I started running a lot around this time and lost a lot of weight...and the breasts remained. To make a long story short, this really, really sucked. I wore lots of layers to cover it up, I couldn't go swimming, I walked with horrible posture, hunched forward, which still haunts me to this day. Mean kids would do what mean kids do, grab them, twist them, etc. I was a Jesus kid at the time and I did a lot of beg-praying that they would vanish. I squeezed them a lot, hoping to force them into submission. But no, they were there to stay.

So finally in my junior year of high school, after dealing with this for some six years, I just totally lost it and went balling like a baby to my parents. I had researched everything I could find out about it on the internet (this was when the internet was still quite young) and I knew that, while some form of gynecomastia is quite common in boys going through puberty, it usually fades away after six months or so, as hormones balance out, but in some unfortunate cases, the breasts don't go away. Alas, my friend, welcome to our world. I knew that surgery was the last option at this point, and I wanted it.

My parents, understandably, were very sympathetic. We went to see the doctor about it and he said sure, surgery could be done, but insurance probably wouldn't cover it. We put in a request anyway. The whole surgery was going to cost somewhere in the ballpark of $12,000.

Our insurance company called us back and told us it was going to be covered. Rejoicing all around. Then, a few days later, another call from the insurance company. They had made a mistake. Insurance doesn't cover 'cosmetic' surgeries - but because they had already given us the go, they agreed to pay for it anyway. This was a very happy day, and I got very lucky.

The surgery is simple. They cut around the bottom half of each nipple and a little incision to each side, making the scars look sort of like an upside down omega. After the initial surgery, your breasts fill up with blood and other bodily fluids as your body tries to heal and, essentially, fill this now empty space in your chest. So you have to go to follow-up appointments where a nurse basically sticks a huge ass needle in each boob and sucks out this fluid with a syringe, depositing it all in a pan, which is fairly disgusting. This must be done several times.

Overall, I am really glad I had it done. It relieved a weight, no pun intended, from me that is hard to express. I still have scars, my nipples look funny because they are sort of perpetually inverted, and I lost most of the feeling in my nipples (it has come back somewhat). But as soon as I could wear a t-shirt and stand-up straight, well, I knew it was worth it.

It's a weird thing. MeMail me if you have other questions or want to talk about it. Looking back, I can laugh at it, but at the time, as is true for so many things in life, it felt like a living hell.
posted by Lutoslawski at 10:32 AM on November 16, 2009 [5 favorites]