If you think it’s unusual for men to develop problems with their body image – not so. In working with men with gynecomastia in Manhattan, New Jersey and the greater New York area, we have met many who seem to suffer from body dysmorphic disorder, or BDD.
In an article in World Psychiatry several years ago, Katharine A. Phillips of Brown Medical School described BDD as a relatively common, severe mental disorder that can dramatically impact a person’s quality of life. She said, “Patients with BDD believe they look ugly or deformed (thinking, for example, that they have a large and ‘repulsive’ nose, or severely scarred skin), when in reality they look normal.” Unhappy sufferers obsess about one or more body features, spending hours worrying and looking in the mirror instead of socializing, working or pursuing other everyday activities.
When you think about it, it makes sense that some men who suffer with the disorder end up in a plastic surgeon’s consultation room to discuss male breast reduction. Many who are obsessed with their physique spend hours in the gym pumping iron, and some turn to anabolic steroids – known to cause gynecomastia – for increased muscle development. Even those with only a hint of moobs or no man boobs at all may perceive that their chest is unsatisfactory and seek plastic surgery.
Ms. Phillips joined forces with two other authors, Harrison G. Pope and Roberto Olivardia, both of Harvard University, to publish a book on BDD in men titled The Adonis Complex: How to Identify, Treat and Prevent Body Obsession in Men and Boys. The researchers point out that men are impacted by media images of bodies that are next to impossible to attain – think Chippendale dancers and the male models plastered around Times Square – just like women are. The difference is, men can’t really talk about it. They tend to suffer in silence, assert the authors, and develop dietary rituals, seek hair transplants and yes, consider plastic surgery whether or not it’s appropriate.
When we meet prospective patients to discuss gynecomastia in Manhattan, we probe motivations and stay on the alert for possible BDD. When we encounter someone we believe has an inaccurate view of his physique, our first suggestion is counseling. Unfortunately, even if the patient has an obvious case of gynecomastia, we might very well decline to operate. Not because we might not deliver a good result, but because we know it’s likely the patient would not be satisfied.

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