A new study published in the February issue of Plastic and Reconstructive Surgery examines gynecomastia in the physically fit male population of bodybuilders. Drs. Mordcai Blau, White Plains, NY, and coauthor Ron Hozani, Beverly Hills, take a closer look at the greater complexities of gynecomastia in this distinct patient group as well as best practices for correcting the condition.
Taking a closer look: men and cosmetic surgery
Gynecomastia in bodybuilders typically arises through the use of anabolic steroids or over-the-counter hormones, and becomes permanent in most cases. The physical demands of competitive bodybuilding make this a unique condition that goes beyond aesthetic concern for this patient population, as their low body fat levels emphasizes glandular tissue and, in the author’s experience, patients in this particular group experience heightened symptoms such as tenderness or pain related to the condition. There is also significant aesthetic perfectionism related to competition, not characteristic of gynecomastia candidates generally.
In this retrospective study, study authors examined the charts of 1574 male bodybuilders surgically treated for gynecomastia (aged 18 to 51) between 1980 and 2013, 1073 of whom were followed up for one to five years. Due to low body fat liposuction was performed in less than 2 percent of patients. Subtotal excision using subcutaneous mastectomy to remove 95 percent or more of glandular tissue was used in all others.
The primary patient goal was removal of the entire gland. A 98-percent satisfaction rate was reported with aesthetic outcomes based on patient satisfaction survey results. The hematoma rate was 6 percent overall, though study authors report a 50 percent decreased rate of hematomas during the latter 15 years compared with the first 15 years as a result of more effective verbal/written instructions for pre- and post-operative care. Less than 3 percent of hematomas required exploratory surgical intervention. All others were effectively treated using needle aspiration. There were no major complications that required hospitalization, no surgical-site infections and no contour deformities. No one required a transfusion.
The authors emphasize the merits of direct excision of glandular tissue under direct vision and warn against piecemeal excisions and any injury to the underlying pectoral fascia. They also have words of caution for “novice surgeons” whom they advise to take “less challenging” cases, initially, than those of bodybuilders, where the amount of glandular tissue to be excised is significantly higher.
Importantly, they note, “There is a higher tendency for intraoperative bleeding in patients who use androgenic steroids and unregulated (over-the-counter) supplements. These include protein shakes, vitamins, omega-3 fish oils, and others.”
