January 26th, 2012
In 1997 the FDA approved finasteride, a drug marketed by Merck under the label of Propecia and Proscar. Propecia and Proscar inhibit androgen conversion to testosterone, the male sex hormone. Originally used for the treatment of symptomatic benign prostate enlargement. This would decrease the problems of high testosterone such as male pattern baldness and prostate enlargement. In Merck’s 5 year testing they found 9 out of 10 men had improved appearances by visual assessment.
However, recently there has been multiple personal injury lawsuits filed against Merck due to serious side effects claimants have made, including:
- Heightened prostate cancer risk
- Gynecomastia (male breasts)
- Decreased arousal and libido
- Erectile dysfunction
- And more
The FDA made an announcement in June of 2011 requiring Merck to add new drug label warnings to Propecia. The FDA is also advising
Healthcare professionals to be aware of the “warnings and precautions” sections of the labels for the 5-Alpha reductase inhibitor class of drugs which includes Propecia.
Interestingly, Merck updated the warnings for the United Kingdom, Sweden and Italy in 2008. Propecia sales are almost a half billion dollars a year and Merck’s patents don’t run out until 2013.
Lawsuits against drug manufacturers are very hard to win unless you can prove “failure to warn”. If you go to Propecia.com, the website is “currently not available” but encourages patients to report negative side effects to the FDA!
For San Francisco Bay Area male breast reduction patients, it is very important to be aware of all drugs you are taking and inform your surgeon who will be trying to discover the cause of your gynecomastia and to determine your gynecomastia treatment.
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December 9th, 2011
The importance of nipple sensation varies greatly between men. If there is some sensation loss after male breast reduction surgery, many men are not concerned because the trade off of getting rid of their “man boobs” outweighs this consequence. But for some men the nipple sensation is very erogenous and the thought of losing this is enough to negate surgery. It is very important to discuss all of the pros and cons with your surgeon before proceeding with surgery.
The vast majority of San Francisco Bay Area gynecomastia patient’s have temporary loss of fine sensation of the nipples and surrounding skin, this is normal. This is referred to as neurapraxia. In neurapraxia, there is no alteration in the structure of the nerve; however conduction of impulse is interrupted due to injury or surgery. This type of injury can be recovered from completely. Blood supply disruption and nerve compression are the effects of such nerve injuries. Nipple sensation usually returns within a few weeks, but for some it can take a long time even 6 to 12 months. Nerves regenerate slowly, how it returns is extremely variable depending on the surgical techniques used and the extent of surgery. Return of sensation is typically preceded by dysesthesia/paresthesia (pins and needles sensations).
Dr. Delgado advises his Marin County cosmetic surgery patients to massage during the recuperation phase which helps reduce hypersensitivity of the skin as sensation returns.
Gynecomastia.org has comments by post surgical patients regarding changes they have experienced with nipple sensation. In order to read posts you need to sign up, but there is no charge to become a member and the site has a tremendous amount of valuable information.
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November 22nd, 2011
In the hands of a less experienced surgeon doing male breast reduction surgery, all too often we see unacceptable results. That’s why it is imperative that you seek a Board Certified Plastic Surgeon that specializes in gynecomastia surgery.
About 35% of my gynecomastia cases are for corrective surgery. One common problematic result is referred to as “crater deformity”. This is where the surgeon has removed too much breast gland underneath the areola without blending in the surrounding tissue smoothly.
Fortunately there are procedures available that can help correct this. Once the patient has fully healed from the first surgery, fat transfer, (also called fat injection or fat grafting) is a medical procedure that uses the patient`s own fat tissue to increase the volume of fat in the subcutaneous area of the body. In the fat transfer procedure fat is harvested from one part of the body where an excess exists and then places it in another part of the body. Another popular technique is a fat flap. This is fat tissue that is attached to its blood supply and can be rotated into the crater deformity. The fat flap is a very useful technique. It would be optimal to avoid having to go through this process (avoiding extra surgical costs and down time) by doing your homework and finding the right surgeon the first time.
Click on the links below for a short video on before and after Crater Deformity Correction.
Crater deformity prior surgery Crater deformity 1 week post op
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October 22nd, 2011
With all of the issues to consider when contemplating gynecomastia surgery, the question of resulting scars comes up often. This is understandable as men who want to get rid of their male breasts, don’t want to trade for another unsightly result.
It is extremely important to be sure your surgeon is an expert in gynecomastia surgery. Dealing with the resulting scars from male breast reduction surgery is secondary to the correct placement and technique of the surgical incisions. By placing the incision at the bottom of the areola most men find it difficult to see any resulting scar after all healing has taken place. However, to ensure the best possible result, Dr. Delgado has his patients use silicone gel sheeting about 10 days after the incisions are completely healed. The silicone helps soften and lighten the color and appearance of the scars. 
Directions for using the silicone gel sheeting are as follows:
1. Cleanse and thoroughly dry the scar area.
2. Cut a piece of the silicone sheeting slightly larger than the area of the scar.
3. Apply the adhesive side directly to the area and secure in place with tape or bandage.
4. Clean the silicone sheeting and the scar area on a daily basis using mild, non-oil based soap (Ivory or Neutrogena soaps are recommended). The silicone sheeting may be reapplied to the scar until the patient notices excessive wear or reduced adhesion and then a new strip of silicone sheeting should be administered. Product wear will depend upon the scar location and patient activity level. Typically, the silicone sheeting should be replaced every 10 to 14 days.
5. For best results, the sheeting should be worn 12 to 20 hours per day.
6. The surgeon is responsible for determining the treatment time for the patient. Generally, the minimum duration of treatment is 4 to 12 weeks.
Sun exposure on the healing incision must be avoided for the first few months. The sun can cause the pigment of the skin to darken and the tissue may thicken. Keep the scar covered with clothing or a bandage.
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September 27th, 2011
Many gynecomastia patients ask what they can do to get prepared for surgery. This is an excellent question and I am happy when a patient asks as I know they will be proactive in their recovery. For my part, to make sure a patient is ready for surgery I order blood tests and dependant on age sometimes an EKG. At the preoperative visit, besides a physical I ask many questions about the patient’s health history and any current medications. The patient is then instructed to avoid any blood thinners for two weeks before and after surgery, and is given a comprehensive list of things to avoid. In addition to all this, the patient meets with our patient coordinator who gives him further instructions and a detailed booklet for reference. Patients are always encouraged to call the office if they have any other questions or concerns.
Dr. Delgado has always encouraged his male breast reduction patients to take good quality multiple vitamins before and after surgery as it will greatly enhance the recovery process and so the patient can be at his optimal health for surgery of the gynecomastia breast . It can be a challenge to find a good multi-vitamin that does not have vitamin E, as vitamin E has blood thinning qualities. In most cases if the vitamin has 400 units or less it will be OK, but to find one without any vitamin E is even better.
After a lot of research Dr. Delgado found VitaMedica vitamins and supplements that he found to be of superior quality
and now has them available to his patients at his office. The multi-vitamin does not have any vitamin E and an increased level of vitamin C for strengthening of capillaries and veins. Also available is Bromelain and Arnica for swelling and bruise prevention. Dr. Delgado and his patient coordinator will be able to advise patients what supplements would be best for them based on their health history and blood test results. The whole array of supplements can be viewed on Dr. Delgado’s main website at www.sanfranciscocosmetic-surgeon.com under the store tab.
In addition to getting the body as healthy as possible for surgery, the patient should be sure that all medications prescribed have been filled and are ready at home upon return from surgery. Be sure to arrange to have someone pick you up and to stay with you for the first 24 hours. Due to medications and anesthesia you may be in need of assistance for that short period of time. This is a non-negotiable requirement by Dr. Delgado for the safety of his patients.
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August 14th, 2011
Hormonal changes for both men and women are normal and part of the aging process. For women, menopause is a complete cessation of reproductive ability, which usually starts around age 51. For men, “andropause” is a very gradual decrease in testosterone beginning around age 30 at a rate of about 1% a year. Generally men do not lose total ability for reproduction and can father children late in life, even into their 90’s. Otherwise there are a lot of similarities between menopause and andropause. For some andropause doesn’t cause any symptoms. For others, the symptoms may involve:
• Gynecomastia (male breasts)
• Increased body fat
• Depression and mood swings
• Lack of energy
• Insomnia
• Loss of strength or muscle mass
• Low sex drive
• Hot flashes
• Memory loss
• Osteoporosis
• Hair loss
The word andropause is currently not recognized by the World Health Organization as it is a term of convenience to describe the stage in life when men have symptoms of aging. The concept is more accepted in Australia and parts of Europe. Some clinicians feel the symptoms are not enough to be considered a medical condition and that “andropause” is just low testosterone. But whatever name we give it does not lessen the impact of the symptoms for San Francisco men’s physiological and psychological well being.
A blood test is required to diagnosis low testosterone. One way of treating andropause is with testosterone replacement, but the treatment is controversial as it may increase the risk of prostate cancer as well as other medical issues. The gynecomastia breast is one of the most upsetting symptoms and while testosterone replacement is not an option for many men, male breast reduction surgery is.
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July 20th, 2011
One of the most common forms of the gynecomastia breast is the “puffy nipple”, according to Wikipedia. I find this to be true with my San Francisco, Bay Area patients seeking male breast reduction.
The dome effect is caused by dense breast tissue under the nipple areola area. This is the area where the breast bud develops and can grow to various sizes in the teenage years. Young men, more than older men, seem to be affected by the “puffy nipple syndrome”.
Many gynecomastia patients have noted that when the nipple is cold or in water that the puffy nipple is improved, this is because the muscle in the areola contracts upon stimulation, but once the stimulation is removed, the puffiness will return. The cone shape of the nipple is caused by lack of fat making the tissue protrude, thus the appearance of puffy nipples.
Sometimes gynecomastia (moobs) will resolve on its own by the end of puberty. However for some it will become a permanent condition. When my patients ask what their options are, I tell them that the treatment for the puffy nipples is the same as for the gynecomastia surgery, in that the gland needs to be excised. This is done by an incision around the areola freeing up the gland from deeper tissue, then the nipple is allowed to shrink and flatten out once the fullness is removed.
Treatment of puffy nipples is very successful and the satisfaction rate is extremely high.
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June 21st, 2011
According to a report by the Mayo Clinic, 20% of all cases of gynecomastia, also known as moobs, in adult males are caused by various drugs. There is a delicate balance between testosterone and estrogen hormones. Testosterone controls male traits such as body hair and muscle mass. Estrogen controls the female traits, including the development of breasts. Taking some drugs, including prescription and illegal, may have the unfortunate side effect of upsetting the balance of sex hormones, which could lead to gynecomastia breast growth. Estrogen is not exclusive to females, men also produce it but in small quantities. If these hormones should be out of balance or get to high levels, gynecomastia or male breasts can be the result. 
Medications that can cause gynecomastia:
- Anti-androgens used to treat prostate enlargement or cancer and some other conditions. Examples include flutamide, finasteride (Proscar) and spironolactone (Aldactone).
- Anabolic steroids and androgens.
- AIDS medications. Gynecomastia, male breast, can develop in HIV-positive men who are receiving a treatment regimen called highly active antiretroviral therapy (HAART). Efavirenz (Sustiva) is more commonly associated with gynecomastia than are other HIV medications.
- Anti-anxiety medications, such as diazepam (Valium).
- Tricyclic antidepressants.
- Antibiotics.
- Ulcer medications, such as cimetidine.
- Cancer treatment (chemotherapy).
- Heart medications, such as digoxin (Lanoxin) and calcium channel blockers.
Street drugs and alcohol can cause gynecomastia and include:
- Alcohol
- Amphetamines
- Marijuana
- Heroin
- Methadone
This is not a complete list, these drugs will not necessarily cause gynecomastia, drugs affect everyone differently. The evaluation of the San Francisco Bay Area patient needs to include a comprehensive drug history including over-the-counter medications as well as illicit drug use. Patients from Sacramento and Los Angeles, as well as all over the United States have found it convenient to see Dr. Delgado for their gynecomastia surgery for male breast reduction. Many have their initial consultation regarding their gynecomastia breasts, by Skype or by phone.
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May 3rd, 2011
With exercise and weight lifting, the pectoral muscle which lies underneath the breast tissue will lift the breast making it higher and more prominent. While this is a goal for many women, men that have a propensity for gynecomastia(moobs) may get results they do not desire. By developing the pectoral muscle, especially to an extreme, as bodybuilders do, the result for those with some form of gynecomastia will see a much more pronounced condition of the male breast. 
When gynecomastia occurs naturally, it is a slower growth process of both glandular and fatty tissue. But with the addition of an anabolic steroid, which is very popular with bodybuilders, the gynecomastia breast develops much faster and mostly consists of glandular tissue. When there is too much testosterone in the body, it tries to reduce it by a process called aromatization. Aromatization converts testosterone to estradiol which can cause an increase of breast tissue to grow. Once the breast tissue has developed, it most likely will not go away on its own and would have to be removed surgically. Abruptly stopping the use of steroids will throw the estrogen and testosterone balance way off and even more breast tissue is likely to develop until the natural testosterone level returns.
There are drugs that may block the development of estrogen if taken before the gynecomastia occurs and estrogen levels get too high, but these drugs have not been fully studied for their effectiveness. Dr. Delgado advises his San Francisco and Bay Area patients that most experts agree that once the breast tissue has formed there is no drug available that will remove or reduce gynecomastia.
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April 2nd, 2011
WHAT IS STAGE TWO GYNECOMASTIA SURGERY?
In more severe cases of gynecomastia or male breast reduction, also known as “moobs”, it is recommended to have a secondary procedure. This is when there is too much redundant skin that will not shrink back to the chest wall after the surgical removal of gland and fatty tissue. This does not happen very often, however Dr. Delgado knows in advance if a patient will need this in order to get the optimal result and will discuss this at length prior to any surgery.
Dr. Delgado prefers a secondary procedure for his San Francisco Bay Area patients, which is a peri-areolar lift. The other option is to do all in one stage, but includes a mastectomy-type of scar that goes across the chest. This is possibly an option for some; however, Dr. Delgado feels that the scar going across the chest in most cases would be as obvious as the gynecomastia itself. 
Therefore, he has developed his techniques that work with the skin and excision of skin around the peri-areolar area. This seems to work extremely well with most of his patients with gynecomastia breasts. However, in patients who may have had extreme weight loss, 100-200 pounds, they may be in a different category and may need to have a mastectomy type of scar, depending on the clinical situation. The second-stage procedure can be done approximately four to six months after the first procedure once the blood flow establishes itself underneath the nipple-areolar complex. The stage-two procedure, in addition to tightening skin, can also modify small things to improve the overall appearance of the male breasts. Not all patients opt to have the second stage done, but choose to see the outcome of the first procedure. Many are happy after the first procedure, but most want the best outcome possible.
Here are two examples of patients after their first stage.
And here is a picture of a patient who had the secondary procedure performed. He had fat injections and revision of the left side with a peri-areolar lift.
Every case is individual and you need to discuss your options with your surgeon to make an informed decision for surgery of the gynecomastia breast.
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