With a big smile I explained to them that these were just patients expressing a medical condition. Gynecomastia, bitch tits or "the bodybuilder's tumor" all mean the same thing, the embarrassing development of male breasts.
The treatment of gynecomastia has become a specific interest of mine due to all the bodybuilders I treat. I have long ago set the world's record in performing these surgeries and have lectured to other surgeons on my techniques.
It is a problem that has existed through antiquity. Ancient hieroglyphics show the condition on several of the Pharaohs. It is not all that uncommon. The Navy did a study during World War II and classified one quarter of their recruits as having excessive breast tissue.
The condition can occur naturally or as a side effect of anabolic steroids and other medications. It has also been implicated with the excessive use of marijuana.
The use of anabolic steroids is especially implicated. Of course not all steroids will cause it, only the ones that aromatize. Anadrol, Sustanon and Dianabol are especially known causes. Some others are weaker stimulators and are dose related.
When gynecomastia occurs naturally, it is a slower process and usually consists of both glandular and fatty tissue. Anabolic steroid induces gynecomastia occurs much more rapidly and is usually a sheet of pure glandular tissue. Of course there is a range between these extremes
When the body senses too much testosterone or a testosterone like substance, it tries to reduce the level by a process called aromitization. This converts the testosterone to estradiol, an estrogen like substance. All men have some glandular tissue. If there is also genetic receptor sensitivity, the increased estradiol level will stimulate this tissue to grow.
It is first noticed as some sensitivity in the nipple area often going on to real discomfort. As the tissue further develops, the area will swell and extend laterally under the arm. The condition can run the range from a mass under the nipple with perhaps some coning to fully developed breasts.
It is most noticeable when you least want it to be. If the weather is cold, everything tightens up. But in the warm weather, when you want to take your shirt off, it all pouts forward and is noticeable.
I've lost track of the number of my patients who continuously pinched themselves or used ice cube and cold water to keep things from being too noticeable. Estrogen blockers like Nolvadex or Arimidex can prevent the occurrence but only surgery can cure it.
The surgery consists of a combination of liposuction and direct glandular excision through a small incision at the nipple border. Beware of any surgeon who claims to be able to treat it with liposuction alone. I have had to operate on many patients who have had this previous surgery elsewhere.
Liposuction merely removes the fatty component and after the swelling subsides, you merely have a smaller version of what was there before.
I have also seen patients scarred across the entire chest and others who have had parts of their pectoral muscles removed.
It is done under general anesthesia and lasts about 2 hours. Liposuction is first done to remove the fatty component allowing the glandular tissue to condense. A small incision is then made at the lower nipple border.
The glandular tissue is then carefully removed tracing the extension under the arm. Too many inexperienced surgeons fail to do this creating a crater in the middle of the chest. A small amount of glandular tissue is left just behind the nipple to prevent collapse and indentation.
Often suction drains are used for the first few post-operative days to prevent fluid collection is the pocket previously occupied by the tissue. I do all the suturing with dissolving, buried sutures to minimize scarring and avoid that railroad track look. A compression vest is worn for several weeks to control the skin shrinkage.
Post Surgery Health
It is very important to be off any anabolic cycle for at least 6 weeks prior to the surgery. Anabolic steroid side effects such as slowing of blood clotting and increased blood pressure add to the possibility of surgical complications. In addition altered liver chemistry due to some anabolics can add to the risk of anesthesia.
Low impact aerobic activity can resume in a week. Light weight training can resume in 3 weeks with the exception of chest and back. Chest and back can start lightly at 4 weeks and full routines can be resumed at 6 weeks.
It is my greatest pleasure when the patients can tell me they can happily walk around with their shirts off.
For more information I can be contacted at 1-800-445-0505 or through my web site at www.drnadler.com.