Of the hundreds of guys who consult us about gynecomastia surgery in NYC, bodybuilders are often the most frustrated about their condition. Whether they engage in competitions or pump iron for their own enjoyment, the appearance of their chest is key. Their physique reflects the work these men put into strengthening and sculpting their muscles along with pursuing good nutrition. For many, even a minor case of man boobs is unacceptable.
At the same time, it can be difficult to find a board certified plastic surgeon with the expertise required to treat this special group of men. By the time they come to us, many have consulted numerous other physicians without feeling that they’ve found the right match, and some have elected surgery with an under experienced plastic surgeon and now need revision.
Here’s a look at how we approach gynecomastia surgery for bodybuilders, and how the strategy compares to male breast reduction for average guys.
Breast Tissue Strategy
Men have breasts that are similar to female breasts – just smaller. Guys have breast gland and fat just like women do, and both types of tissue intermingle.
When an average guy grows a persistent case of man boobs, most often there’s excess gland and fat to confront. Sometimes there’s a blob of breast gland in the center of the breast, creating the unwanted “puffy nipples,” but gland tissue is generally present throughout the breast.
Plastic surgeons sculpt both gland and fat to achieve natural looking contours. For most men undergoing breast reduction, some of each type of tissue is retained to create smooth, masculine curves.
Bodybuilders whose man boobs or “bitch tits” are steroid-induced usually grow hard, fibrous balls of gland mainly under the nipple/areola complex. As this tissue expands, it pushes aside the small amounts of normal breast fat and gland these patients have.
During male breast reduction surgery, the lump of breast gland is completely removed. It is virtually impossible to leave a little of this solid tissue and sculpt it to create normal looking contours. Therefore, we focus on finding and relocating small amounts of fat to fill in any gaps that are left behind. In addition, we evaluate the surrounding tissue and judge how best to sculpt a thin, uniform layer of skin and fat to develop the desirable “cut” appearance.
Additional Surgical Considerations
Whether on the skin’s surface or underneath, scarring is particularly undesirable for patients who are bodybuilders. No patient welcomes scars, it’s true, but “flaws” of any sort are magnified in the eyes of these men.
For this group of patients, we make tiny incisions at the edge of the areola. It is challenging to perform the sculpting required through the small openings, but the resulting scars are very nearly invisible.
To avoid irregularities under the skin’s surface, we take great care to avoid contact with the pectoral muscle and the fascia, or sheath of tissue that encloses it. We frequently use our own specially developed cannula to gently sculpt remaining tissue, often with the suction turned off.
The Patient’s Role
Patients have a part to play in achieving the best surgical results possible. It can be difficult for bodybuilders to suspend regular practices, but most guys are eager to do everything they can to ensure a great outcome.
– Prior to surgery: Generally, patients need to refrain from consuming substances that tend to thin the blood prior to their procedure. Bodybuilders have a tendency to bleed more than the average patient due to increased vascularity, so we make sure to have a discussion about what’s ok and not ok to take a week or two before gynecomastia surgery.
– Compression garments: It is especially important for bodybuilders to wear compression garments as directed. This accomplishes two goals: prompting internal tissues to re-adhere and reducing swelling.
– Minimizing exertion: We advise our patients to keep from using the pectoral muscles as much as possible for several days and to refrain from raising their blood pressure as well. These steps help prevent excess swelling and blood pockets called hematomas.
– Understanding future risk: Because it is impossible and undesirable to remove every breast gland cell during surgery, bodybuilders need to understand that future consumption of steroids, prohormones and even supplements can pose the risk that gynecomastia will reoccur.
Knowing that gynecomastia surgery is especially challenging with patients who pump iron, bodybuilders should put extra effort into finding the right plastic surgeon. After locating prospective surgeons with hundreds of cases to their credit, patients can increase their chances of a good outcome in a number of other ways. One is to ask for references to patients who are willing to talk about their surgical experience. Guys can also request to see dozens of before and after gynecomastia photos to make sure the doctor achieves consistently good results.

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