During high school Adam* was teased a lot. So much so that he stopped swimming and playing water polo, sports he thoroughly enjoyed.
It pained him not to take part in interschool galas. And he never took his top off at the beach.
The source of his embarrassment? His “moobs” or “man boobs”, jocular names the 1.9m teen endured from fellow pupils. He says sometimes people grabbed at his chest to squeeze them. “It was… horrible.”
Adam wasn’t to know, until much later, that he had a medical condition called gynaecomastia, “an abnormal enlargement of one or both breasts due to the benign increase of breast glandular tissue”.
As a teenager, Adam didn’t understand why the region around his chest was the only area where he couldn’t lose weight. He didn’t think to seek help from anyone. “I thought I was just fat.”
But as he got older, his condition continued to bother him. It limited him emotionally. He considered himself a smart and well-groomed man, yet this was “the part of me I was always trying to hide”.
He ensured he had a vest on at the pools and beaches. He avoided wearing T-shirts, as he felt his breasts were more prominent in them. He ensured his golf or collared shirts were loose-fitting. He always tried to wear a jacket to cover up the bulge of his breasts.
“But I still remember being asked by a photographer if I had something in my jacket pocket when I wore a suit,” says Adam, now 28 and an accountant at a large corporate firm in Joburg.
He decided to research his condition on the internet. He began to suspect he had gynaecomastia.
“I hoped I could have something done to remove it.”
Cape Town plastic surgeon Dr Stuart Geldenhuys says gynaecomastia is a common occurrence among males of all ages. In some cases lactation or milk production may be present.
In Geldenhuys’s experience, gynaecomastia is a source of embarrassment, intense frustration and mental anguish necessitating modifications to many aspects of a patient’s daily routine and lifestyle.
Geldenhuys says there are various reasons for the overdevelopment of male-breast tissue, which is a result of changes in levels of hormones that act on the tissue.
It is thought it could be caused by increased levels of oestrogen, too little free testosterone or the sensitivity of breast tissue to circulating hormones.
Several medications are also implicated. These include anti-anxiety medications, antidepressants, antibiotics, ulcer medications, anabolic steroids, androgens, growth hormones, and the use of oestrogen creams, chemotherapy, certain heart medications and HIV drugs.
Street drugs, too, such as marijuana, amphetamines and heroin, as well as alcohol abuse, are known to cause breast enlargement.
Health conditions such as hypogonadism, hyperthyroidism, kidney and liver failure, cirrhosis, injuries to the chest wall or spinal cord, genetic disorders and certain tumours have also been shown to cause gynaecomastia.
Hormone-secreting tumours of the lung or other organs may rarely be implicated, he says. Fortunately, treatment is available to give sufferers their confidence back.
Gynaecomastia surgery, otherwise known as reduction mammoplasty, is a safe and effective solution, says Geldenhuys.
The surgery is ranked as one of the top five cosmetic procedures performed on men. It involves the removal of excess glandular tissue or excessive fatty tissue in the male breast. In more severe cases, removal of lax skin is also needed.
Although the medical condition itself is common, the surgical procedure is not, says Geldenhuys.
“We do a lot of other types of breast surgery, but in the context of gynaecomastia, the percentage of patients who end up having this surgery is substantially less.”
Many men are too self-conscious to seek assistance. There is a stigma attached to it because of its association with female breasts, which can cause men to question their sexuality on some level, he says.
The procedure has also not been brought to the attention of many men with gynaecomastia.
Adam was fortunate that the gynaecomastia didn’t have a negative impact on his relationships.
“I’d talk about it with girls and tell them that it was my most hated part of my body. However, I was in relationships with caring and understanding human beings.”
But after living with gynaecomastia for 15 years, Adam finally made the decision to undergo surgery this year. Before that he had tried a range of diets, working out at the gym and had even considered laser liposuction.
Speaking to a friend who worked for a medical aid company was the turning point for him. She researched the procedure and told him the surgery was not risky. She made his appointments and encouraged him to go for it.
“I felt it would make a difference in my life, and I understood that it was not only a physical issue but an emotional one as well.”
The treatment would cost him R30 000, but he didn’t mind. He felt it would be the best investment he knew he would make.
Adam went to Geldenhuys, who addressed his fears and concerns.
Geldenhuys says gynaecomastia is usually treated by a combination of liposuction and surgical excision.
In pseudo-gynaecomastia (excess fatty tissue) cases, liposuction techniques alone may be used. This is when fat is vacuumed out through a hollow tube.
Liposuction also serves to contour the chest shape, further enhancing the overall result. These procedures are usually performed under general anaesthesia or deep intravenous sedation, and patients are generally not required to stay in hospital overnight.
Excision techniques are used in most cases of gynaecomastia. The specific technique used depends on the size of the breast or glandular tissue present, and the amount of skin excess requiring cutting.
To limit scarring, incisions may be confined to the areolar (nipple) border.
Adam says his operation was “basically painless”. Even if it hadn’t been, he expected the outcome would have been worth the pain.
He had to remain in bed for about two weeks, and the pain was bearable. “It was uncomfortable,” he admits. “You have to wear a compression vest with drainage pipes in your chest for about a week.”
Geldenhuys says recovery from this procedure depends on what you’re recovering to.
“If it’s back to work, it takes about a week to 10 days, and if you have a more active job, it takes longer.”
Those who are keen to go back to their exercise regime can do so in about four weeks. And to get back to a full normal life can take between two and three months, Geldenhuys says.
Adam says there has been a significant reduction in the size of the breast tissue on his chest, especially from a side angle.
The final result will be visible only after a year.
“As with all procedures, bruising and swelling are to be expected from gynaecomastia surgery, but it usually dissipates within two to three weeks after the procedure.”
Geldenhuys says some patients also report itchiness and dry skin, especially around the incision sites. Post-operative scar-management regimes include taping, use of topical creams and silicone.
“It is not uncommon to experience discomfort and altered sensations in the breasts following the procedure. But this is temporary.”
All surgery leaves scars, some more visible than others. Although good wound healing after a surgical procedure is expected, abnormal scars may occur within the skin and deeper tissues, says Geldenhuys.
He says the amount of scarring usually depends on the extent of tissue removed. Scars may be unattractive and of a different colour from the surrounding skin.
In the event that scarring is too prominent, many treatments are available to reduce its appearance.
Geldenhuys says the expected final outcome of the surgery results in “a flattened, natural male breast shape and enhanced chest contours, specifically removing the appearance and stigmatisation associated with the female breast”.
In most cases, scars can be concealed in the areolar margin or contours of the breast, he says.
Adam was thrilled with the immediate effects of his operation.
He felt confident enough to wear T-shirts and it was great “not having to check in the mirror to see whether my breasts were bulging through”.
A month ago, Adam went on holiday and for the first time he felt confident enough to walk on the beach topless.
“I felt like a burden had been lifted, and I was now free.”
To other men with gynaecomastia, he says: “There is a solution out there. Don’t let it affect your emotional state. It’s unnecessary. If it doesn’t bug you, fair enough. If it does, then do something about it.
“Having the operation has made me a more confident person.
“Others might not notice it, so don’t do it for another person, only for yourself.”
Subject did not want to be identified.
Published in the Cape Time, written by Noor-Jehan Yoro Badat – 11 September 2012 (http://www.iol.co.za/capeargus/an-sa-man-s-struggle-with-his-man-boobs-1.1380520#.UYOHG0rhd8E)