Gynecomastia that occurs in body builders who use steroids or prohormones is uniquely different. These patients typically have very little body fat, and their gynecomastia is mostly firm, rubbery gland that is easily felt on examination. Puffy nipples and an odd shape to the chest occurs, with the nipple-areola complex looking downwards and an area of fullness along the bottom of the chest muscle. Needless to say, gynecomastia from bodybuilding is a very disturbing feature on men who have spent an enormous amount of time and effort working their bodies to a state of strength and muscular definition.
The physiology of the development of breasts in body builders can be complex. However, in its simplest form, the hormones or pro hormones are partly converted to estrogen (the female sex hormone), and this can cause gynecomastia in some men. The exact number is unknown.
From a treatment standpoint, these men have hard, well localized glandular tissue that I remove in its entirety. The gland can adhere to the overlying skin and to the underlying muscle. The goal is to remove as much of the gland as possible so that recurrence is uncommon even in those who continue to use hormones or pro hormones. I may use my internal “turnover flaps” and liposuction to ensure that the contour of the chest is smooth and masculine.
Post-operative considerations are very important. All efforts are taken to avoid a hematoma or seroma. Compression garments need to be worn for several weeks and massage and “rolling” are started about 10 days afterwards. Don’t resume chest work until two weeks after surgery.