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While we colloquially know the condition as 'man boobs,' the medical term for the swelling of the male breast tissue is gynecomastia. [According to the Mayo Clinic](https://www.mayoclinic.org/diseases-conditions/gynecomastia/symptoms-causes/syc-20351793), at least 25 percent of men ages 50 to 69 are affected by gynecomastia, and gynecomastia surgery (read: [male breast reduction](https://aedit.com/procedure/male-breast-reduction)) is among the most popular cosmetic procedures in the United States. The American Society of Plastic Surgeons' (ASPS) [2018 Plastic Surgery Report](https://www.plasticsurgery.org/documents/News/Statistics/2018/cosmetic-procedures-men-2018.pdf) found that there were nearly 25,000 male breast reduction procedures performed in the U.S. last year — a 22 percent increase since the year 2000.

## __What Is Gynecomastia?__

Gynecomastia is an endocrinology disorder where there is swelling in male breast tissue. The cause of gynecomastia is a hormone imbalance where there is a higher percentage of estrogen than usual. During puberty, boys’ bodies mainly produce testosterone and only a little bit of estrogen, which is the dominant hormone in girls’ sexual growth. When testosterone levels are lower than usual, the ratio between the two sex hormones is unbalanced. The higher estrogen levels can stimulate the male breast tissue to swell up. While gynecomastia does not impact health, it can be a cosmetic concern with emotional ramifications.

## __Causes of Gynecomastia__

Gynecomastia can impact men at different stages of life and is often (though not always) caused by hormones. “At birth, newborn males often have enlarged breasts due to the residual effects of their mother's estrogen," says New York City-based plastic and reconstructive surgeon [Umbareen Mahmood, MD](https://aedit.com/provider/umbareen-mahmood-md-23). "A hormonal imbalance can again occur at puberty or in older men, resulting in a higher estrogen to testosterone ratio."

Boys born with enlarged breast tissue as a result of the estrogen in their mother's placenta will usually see the swelling dissipate after a few weeks. Pubertal gynecomastia, meanwhile, impacts young men during puberty (beginning as early as age 10) and can last for several years (up to age 18). Cases of gynecomastia peak again later in life. As men age, they experience declining levels of testosterone and an increase of fatty tissue, which can lead to senile gynecomastia.

But it's not just hormones. Causes of gynecomastia can include medical conditions like obesity, malnutrition, liver disease, hyperthyroidism, hypogonadism, prostate cancer, and kidney failure. It can also be a side effect of drugs (marijuana or heroin), prescription medications (anabolic steroids, corticosteroids, digoxin and calcium channel blockers, Flagyl, Propecia, Spironolactone, Valium, and Zantac to name a few), and even herbals (e.g. [lavender or tea tree oil](https://www.nih.gov/news-events/news-releases/lavender-tea-tree-oils-may-cause-breast-growth-boys)). "There is not necessarily a distinct difference in appearance based on etiology,” Dr. Mahmood says.

## __How to Diagnose Gynecomastia__

When gynecomastia first starts developing, the breast pain can be startling. The first sign may be a lump of fatty tissue (not unlike male breast cancer), and your doctor can perform a physical examination and tests (e.g. a mammography or blood tests) to rule out the possibility of cancer. As the swelling continues, the lump may feel tender to the touch but the sensitivity usually subsides. While one breast may initially be larger than the other, they tend to even out. 

Dr. Mahmood notes that the word 'gynecomastia' only refers to any enlargement of the male breast, but there are grading systems designed to categorize the various degrees of the condition. Dr. Mahmood personally recommends [the Simon and Rohrich classification models](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706045/#JR27056-30), which have been condensed below:

- __Grade I__: Minor enlargement without excess skin (< 250g of breast tissue)
- __Grade IIa__: Moderate enlargement without excess skin (250 to 500g of breast tissue)
- __Grade IIb__: Moderate enlargement with minor excess skin (250 to 500g of breast tissue)
- __Grade III__: Severe enlargement (> 500g of breast tissue) with grade I ptosis (read: sagging)
- __Grade IV__: Severe enlargement with grade II or grade III ptosis 

## __Surgical Treatments for Gynecomastia__ 

While gynecomastia doesn’t necessarily cause medical concerns, male breast reduction procedures are on the rise to deal with the aesthetic and psychological impacts of the condition. The two most common (and effective!) procedures include liposuction, excision, or a combination of the two. 

“Patients with mild to moderate gynecomastia, involving breast enlargement with minimal gland hypertrophy and no excess skin, are good candidates for liposuction only,” says Dr. Mahmood. “Many patients also have a small amount of fibrous glandular tissue under the nipple and this part can be treated with direct excision by making a small incision around the areola. Techniques such as [power-assisted liposuction](https://aedit.com/procedure/power-assisted-liposuction) (PAL) or [ultrasound-assisted liposuction](https://aedit.com/procedure/ultrasound-assisted-liposuction) (UAL) are especially helpful when performing liposuction for gynecomastia as they can more effectively remove the fibrous tissue.”

More severe cases may require more invasive techniques. “Severe gynecomastia requires not only liposuction, but also skin excision to address the ptosis and excess skin,” Dr. Mahmood explains. “In many severe cases, the nipple-areola may need to be temporarily removed and replaced as a graft to a more appropriate position on the chest after the sagging skin and tissue has been removed.” 

During the recovery period, patients typically wear bandages and support garments to minimize swelling and support the chest as it heals. Depending on the type of procedure, a tube may temporarily be placed under the skin to drain excess fluid. Patients will experience swelling for several weeks, but most people can resume everyday activities within a few days.

The [ASPS reports](https://www.plasticsurgery.org/cosmetic-procedures/gynecomastia-surgery) the average cost of gynecomastia surgery in 2018 was around $4,000, and it should be noted that most insurance plans do not cover the procedure. 


## __Non-Surgical Treatments for Gynecomastia__ 

While non-invasive treatments for gynecomastia lack the same level of efficacy as their surgical counterparts, a recent study found there to be three classes of medical treatment for gynecomastia — androgens (i.e. testosterone, dihydrotestosterone, and danazol), anti-estrogens (clomiphene citrate and tamoxifen), and aromatase inhibitors (letrozole and anastrozole) — though many patients did not show significant improvement after the treatment.

“Testosterone can be given if patients have an abnormally low level of the hormone and danazol, a synthetic form of testosterone that decreases estrogen production, may be somewhat helpful,” Dr. Mahmood says. “Generally, there is no real medical treatment for gynecomastia.” 

Before turning to prescription medication, a better bet may be to eliminate any lifestyle factors that could be contributing to gynecomastia. “The first step in addressing gynecomastia is treating the underlying cause if it is due to a non-hormonal reason,” Dr. Mahmood explains. “This includes stopping any offending agents like medications or illicit drugs, removing a tumor, and treating underlying systemic disease.”

## __The Takeaway__

Gynecomastia affects a large percentage of the male population over the course of a lifetime, and, while the medical concerns related to the condition are minimal, men with enlarged breast tissue may seek treatment to reduce the size of their chest.

Whether patients opt for liposuction, excision, or a combination of the two, the results of gynecomastia surgery are generally permanent. It is important to note, however, that gynecomastia caused by non-hormonal factors like prescription medications, illicit drugs, or weight gain will require patients to maintain a healthy lifestyle. Consulting with a board certified plastic surgeon will ensure men receive the best course of treatment for their condition.

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Aesthetics

Gynecomastia surgery (a.k.a. male breast reduction) is one of the most popular cosmetic procedures for men in the U.S. Here, a deep dive into the condition colloquially known as 'man boobs' and how to treat it.

Guide To Gynecomastia And Male Breast Reduction Surgery 

Everything You Need To Know About Gynecomastia

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For most men, dipping their toe in the world of skincare can be overwhelming. There are so many products, so many hard-to-pronounce words, so many steps! But an [effective skincare routine](https://aedit.com/aedition/guide-to-mens-grooming-skincare-routine) doesn’t have to be complicated. That’s great news for men since they tend to favor simple, quick regimens with minimal steps.

When it comes to skincare, it’s all about the ingredients you’re using. Think of your routine like your diet. Your body needs certain nutrients to function properly, and most of us give at least some thought to what we put into our bodies so we can workout better, have more energy, and function at a higher level. Your skin is the same way. Considering what you’re putting on your face will ensure your skin is as healthy as it can be.

It’s been scientifically proven that [men’s and women’s skin has subtle differences](https://www.researchgate.net/publication/26337535_Gender-linked_differences_in_human_skin). Men’s complexions tend to be thicker (by up to 25 percent — depending on who you ask), have larger pores, and produce more sebum (read: oil). Men also sweat about twice as much as women, and their sweat contains more lactic acid, which raises the pH balance. This doesn’t mean, however, that men can only use products that say “for men” on the label. Many of these products are not actually formulated specifically for a man’s skin, and, even if they were, the [jury is out](https://www.wsj.com/articles/do-men-and-women-really-need-different-skin-care-11565279679) on whether the difference between men’s and women’s skin is drastic enough to warrant different products. 

Instead, men should choose products based on their skin type. If you don’t know your skin type, your first stop should be a trip to your dermatologist or your aesthetician, who will be able to analyze your skin and let you know. Many men, for instance, think they have oily skin but actually have dry skin. Once armed with your skin type, identifying products that will work best for you is a more straightforward process — and remember, you can ask that same provider for recommendations.

Another thing that makes decoding the skincare aisle a little easier? Knowing which ingredients to look for and what they do for the skin. We spoke to board certified dermatologist [Ron Shelton, MD](https://www.laserskinsurgery.com/Dermatologists/Ronald-Shelton-MD), of Manhattan’s Laser & Skin Surgery of New York to find out what ingredients should (at a minimum!) be in every man’s skincare routine.

### __1. Sunscreen__
“The most important skincare ingredient every man should have in his routine is sunscreen,” says Dr. Shelton. “Daily sunscreen use is very important to reduce further aging of the skin.” Something else it reduces the chances of? Sun damage and skin cancer, which has been shown to affect more men than women. What kind of sunscreen you use is a personal preference. Chemical sunscreens (like [Jaxon Lane Rise & Shine Sunscreen](https://jaxonlane.com/products/rain-or-shine-daily-moisturizing-sunscreen)) work by absorbing UV rays and dispersing them, while physical sunscreens (like [REN Clean Screen Mattifying Face Sunscreen](https://www.sephora.com/product/clean-screen-mattifying-face-sunscreen-spf-30-P442990)) form a protective layer on the skin to reflect rays. Shelton notes that “with perspiration, some sunscreens will run down from the forehead and irritate the eyes.” In that case, he recommends mineral-based, physical sunscreens. Remember to always use a sunscreen that is SPF 30 or higher.

### __2. Hyaluronic Acid__
Chances are you’ve seen the word ‘hyaluronic acid’ on bottles of moisturizer and serums and that’s because it’s one of the most important and universal skincare ingredients. This naturally occurring substance is vital to skin cells’ ability to retain moisture. It’s also a humectant, which means it has the ability to draw moisture from its surroundings. Make sure that whatever moisturizer you use contains a high percentage of hyaluronic acid (it should be listed towards the top of the ingredients list) and, if you want to go the extra mile, use a hyaluronic acid serum in addition to a moisturizer. We’re fans of layering the [Peter Thomas Roth Water Drench Hyaluronic Acid Cloud Cream](https://www.sephora.com/product/water-drench-hyaluronic-cloud-cream-P415701) on top of the [The Ordinary Hyaluronic Acid 2% + B5 Serum](https://www.ulta.com/hyaluronic-acid-2-b5?productId=pimprod2007107).

### __3. Antioxidants__
Another cornerstone of every skincare routine is antioxidants, which help control the negative impact free radicals can have on your skin. Free radicals are caused by UV rays, pollution, and other environmental factors and have been shown to increase signs of aging as well as contribute to overall inflammation of the skin. Using skincare products that contain antioxidants like vitamin C or vitamin E can reduce that inflammation and not only curb signs of aging, but also reduce the appearance of dark spots, uneven skin tone, and redness. Look for a moisturizer that contains antioxidants like [OleHenriksen C-Rush Vitamin C Gel Cream](https://www.sephora.com/product/c-rush-tm-brightening-gel-cr-me-P430337) or use a serum like [Skinceuticals C E Ferulic](https://www.dermstore.com/product_C+E+Ferulic_5230.htm).

### __4. Retinol__
Retinol, a derivative of vitamin A, is one of the workhorses of dermatology. These days, most of the conversation around retinol is about lines and wrinkles. While it’s a powerful anti-aging ingredient, it is also an effective tool against acne. It works by increasing cell turnover, which means it fast-tracks the production of new skin cells and helps clear away dead ones. Oh, and it’s especially important for men who haven’t been the best at wearing sunscreen. “Guys with sun damage should be using retinol,” says Dr. Shelton. “It can help reverse some signs of sun damage such as irregular coloration and can improve the collagen layers below the epidermis.” Retinols can be irritating at first, so start slow and apply it only at night. Once you start using retinol, you must wear sunscreen every day as sunlight can increase sensitivity. Beginners should first ease themselves in with a gentle version, like [RoC Deep Wrinkle Night Cream](https://www.ulta.com/deep-wrinkle-night-cream?productId=prod2097134).

### __5. Peptides__
Peptides are short chains of amino acids that make up of the proteins of our skin. Think about collagen and elastin (i.e. the components of skin that keep it tight and looking fresh): those proteins are made up of amino acids. Using a skincare product that contains peptides can help keep these proteins plentiful and healthy in your skin, which, in turn, will keep it looking healthier and younger. Peptides can be found in all types of products these days, but if you’re trying to keep steps to a minimum, look for a moisturizer that has them. We like [Drunk Elephant Protini Polypeptide Moisturizer](https://www.sephora.com/product/protini-tm-polypeptide-cream-P427421) and [First Aid Beauty Ultra Repair Hydra-Firm Sleeping Cream](https://www.sephora.com/product/ultra-repair-hydra-firm-sleeping-cream-P393076).

### __6. Alpha and Beta Hydroxy Acids__
Exfoliation is key to every skincare routine, but if you suffer from breakouts and acne, using an acid instead of a scrub to exfoliate can make all the difference. Alpha hydroxy acids (think: glycolic acid or lactic acid) help to break the bonds between dead skin cells and gently slough them away from the surface of the skin. Beta hydroxy acids (like salicylic acid), meanwhile, get down into the pores and dissolves built-up oil and debris inside. Depending on your skin type, you may want to incorporate one or both. Using an exfoliating toner, like [Glossier Solution](https://www.glossier.com/products/solution), a few times a week will help get rid of dead skin cells and leave skin clear and fresh.

### __7. Ceramides__
One of the most important components of your complexion is the skin barrier, a microscopic layer of lipids that helps to keep moisture inside your skin but also keep environmental pollution out. When products are too aggressive, or you exfoliate your face too much, the skin barrier can become compromised and inflammation can occur. That can lead to redness, dry skin, and even acne. “Ceramides are great in moisturizers to replace the skin’s barrier,” says Dr. Shelton. Ceramides are lipids (the same kind that make up the natural skin barrier) and using a product that can replenish them can help maintain a healthy barrier. Look for a moisturizer like [Paula’s Choice Ceramide Enriched Firming Moisturizer](https://www.paulaschoice.com/clinical-ceramide-enriched-firming-moisturizer/212.html) that contains ceramides and use it morning and night.

### __8. Charcoal__
You may have noticed that lots of men’s products contain charcoal, but it’s not just a marketing ploy. Activated charcoal has been used for thousands of years to absorb toxins. When it comes to your skin, Dr. Shelton says “charcoal can help absorb over-produced amounts of oil.” If you have oily skin, using a cleanser (like [Odacite Black Mint Cleanser](https://odacite.com/products/black-mint-cleanser) or [Clinique For Men Charcoal Face Wash](https://www.clinique.com/product/1611/34923/mens/3-step-mens/cleanse/clinique-for-mentm-charcoal-face-wash)) that contains charcoal can help curb the production of oil and help cut down on blackheads and breakouts. It should be noted, however, that charcoal may be too harsh for people with sensitive skin, so don’t use it every day when you first start out.

## __One Ingredient to Avoid__
“If you have sensitive skin, avoid alcohol-based products as they tend to be drying,” says Dr. Shelton. Traditionally, alcohol has been included in skincare products to help dry skin and make it less oily — at least in the short term. Long term, it can actually disrupt the skin barrier by stripping away too much oil. This is particularly a problem for people with sensitive skin, who depend on a healthy skin barrier to keep inflammation in check — but everyone should be wary of how much alcohol they’re putting on their skin. Look for products that say ‘alcohol-free’ on the label instead.

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From hydrating hyaluronic acid to detoxifying charcoal, The AEDITION rounds up the skincare ingredients that should be in every guy’s grooming routine.

Best Skincare And Grooming Ingredients For Men

8 Ingredients That Should Be In Every Guy’s Skincare Routine

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Ask any parent and they’ll likely tell you that having kids can do a number on your physique — and we’re not just talking about pregnancy, childbirth, and breastfeeding. The lifestyle changes and demands of childrearing can have a dramatic impact on dads, too. 

As the conversation surrounding male plastic surgery continues to evolve, more and more fathers are considering a collection of cosmetic procedures that have become known as the ‘daddy do-over.’ “The stigma against men having plastic surgery is falling, so men are more likely to get what they want,” says Nashville-based plastic surgeon [Jacob Unger, MD](https://aedit.com/provider/jacob-unger-md-2649). 

Similar to its counterpart — the so-called [mommy makeover](https://aedit.com/aedition/the-mommy-makeover-how-to-bounce-back-after-a-baby) — a daddy do-over typically consists of surgical body contouring (think: liposuction, tummy tucks, and male breast reduction). Some men take advantage of their OR time to tack on facial procedures ranging from [blepharoplasty](https://aedit.com/procedure/blepharoplasty-eyelid-surgery) (i.e. eyelid surgery) and [neck lifts](https://aedit.com/procedure/neck-lift-lower-rhytidectomy) to [hair transplants](https://aedit.com/procedure/hair-transplant) and [CO2 laser resurfacing](https://aedit.com/procedure/ablative-co2-laser).

## __Male Plastic Surgery Trends__

According to the American Society of Plastic Surgeons, [more than 1.3 million cosmetic procedures were performed on men in 2018](https://www.plasticsurgery.org/news/press-releases/more-men-undergo-plastic-surgery-as-the-daddy-do-over-trend-rises-in-popularity) (up nearly 30 percent since 2000) and liposuction was the second most popular surgical procedure for guys with some 30,000 treatments performed. 

“I think men are realizing they feel the same way as women do about not wanting to age,” says Scottsdale, Arizona-based plastic surgeon [Richard J. Brown, MD](https://aedit.com/provider/richard-brown-md-4646). “With society’s emphasis on being healthy and in shape, men want their faces and bodies to match how they feel inside.”

As men age, fat tends to accumulate around the midsection. With less time to exercise and eat right, many guys — dads including — find it nearly impossible to reduce that stubborn bulge and are turning to surgery to reach their goals. 

Dr. Unger, for example, has seen an increasing number of dads coming in for liposuction of the abdomen, flanks, and back, as well as high-def lipo sculpting procedures that utilize laser and radiofrequency energy to target specific areas of fat and create the illusion of a more chiseled physique — especially in the ab area. “Fitness is so en vogue, and this is an extension of that trend,” he says.

## __The Best Candidates for a Daddy Do-Over__

According to both surgeons, the best candidates for these types of contouring procedures are men who are already in relatively good shape. “Fit people with isolated issues that can be treated effectively,” says Dr. Unger. And, as with any procedure, prospective patients must be healthy enough for surgery. 

“Patients need to have a body mass index (BMI) that is sufficient to support having surgery safely and to give them the best result,” Dr. Brown explains. Plastic surgery [should not be used an alternative to weight loss surgery](https://aedit.com/aedition/why-you-should-lose-weight-before-plastic-surgery), and patients who already have a healthy lifestyle in place — including a nutritious diet and regular exercise routine that allows them to maintain a healthy weight — are more likely to experience the benefits of just about any form of cosmetic surgery.

Seeing the sculpting results of a daddy do-over may even inspire patients to amp up those already positive lifestyle choices. Dr. Unger’s patient Jack* says that getting liposuction on his abdomen and flanks “jump started” his road to getting back in shape. The 34-year-old father of two elementary school-aged kids followed up his surgery with “a good, healthy meal plan” and “better lifestyle choices,” which, he says, got him in the best shape of his life.

It should be noted that while combining cosmetic procedures is generally more cost effective than having separate surgeries, a daddy do-over can set patients back between $10,000 and $20,000, depending on the treatment plan. The trade-off, however, is that patients will only have one period of downtime, as opposed to separate recoveries, if the surgeries were spaced out.

## __Most Popular Daddy Do-Over Procedures__

So, for dads (or, really, any man looking for a bit of fine tuning) what are the best face and body procedures to combine? The AEDITION asked the experts. 

### __1. Liposuction__

As mentioned, some 30,000 [liposuction](https://aedit.com/procedure/liposuction) procedures were performed on American men in 2018 alone. Dr. Brown says the sculpting techniques used during a daddy do-over do differ from those employed on mommy makeover patients. “For male body contouring, the way we shape the torso is different because the hip to waist ratios are different,” he explains. “Women tend to desire an hourglass appearance while men do not.”

### __2. Gynecomastia Surgery (a.k.a. Male Breast Reduction)__

As men age, their likelihood of experiencing [gynecomastia](https://aedit.com/procedure/male-breast-reduction) (colloquially referred to as ‘man boobs’) increases. This excess of breast tissue and fat in the chest — as a result of an imbalance between testosterone and estrogen — can be exacerbated by certain medications and lifestyle choices. The [American Society for Aesthetic Plastic Surgery (ASAPS) reports](https://www.surgery.org/sites/default/files/ASAPS-Stats2018_0.pdf) that male breast reduction surgery rose nearly 50 percent between 2014 and 2018, making it the second most frequently performed cosmetic procedure among men.

### __3. Abdominoplasty (i.e. Tummy Tuck)__

While they’re a staple of the mommy makeover, the [ASAPS found](https://www.surgery.org/sites/default/files/ASAPS-Stats2018_0.pdf) only about 5,000 male tummy tucks were performed in 2018. Because of the significant stretching of both the skin and underlying muscle that occurs during pregnancy, women tend to seek out [abdominoplasty](https://aedit.com/procedure/abdominoplasty) more often than men. But that’s not to say they don’t have benefits for guys as well.

In cases of extreme weight loss, a tummy tuck — which tightens the abdominal muscles and removes loose skin — may be the best and only solution to meet a patient’s goals. Joe, a father of two, lost a significant amount of weight through diet and exercise and found himself unhappy with the sagging skin left around his midsection. He opted with a tummy tuck with Dr. Brown that had a big impact on his sense of self. “I feel more self confident and less apprehensive about going shirtless,” he shares.

### __4. Facial Rejuvenation__

Not only seeking to undo their ‘dad bods,’ surveys show that men are also turning to cosmetic surgeons to help them look younger and maintain a competitive edge in the workplace. Both surgical and non-surgical facial rejuvenation procedures, especially [eyelid surgery](https://aedit.com/procedure/blepharoplasty-eyelid-surgery) and [Brotox](https://aedit.com/aedition/the-rise-of-brotox-injections) — ahem, Botox® — are on the rise. 

[Botulinum toxin type A injections](https://aedit.com/aedition/comparing-neurotoxin-botulinum-type-a-injections-botox-dysport-jeuveau-xeomin) (like Botox®, Dysport®, Jeuveau®, and Xeomin®) and soft tissue fillers rank first and second, respectively, on the [ASAPS’ annual list](https://www.surgery.org/sites/default/files/ASAPS-Stats2018_0.pdf) of the most popular minimally invasive procedures for men. In his practice, Dr. Brown has seen an increase in the number of dads requesting these tweakments. “They see their wives looking rejuvenated, and they want to keep up,” he says.

Alex*, a busy father of three, started getting Botox® when he felt his facial lines were making him look older. “I didn’t like looking like I was frowning all the time, but I didn’t want that frozen look either,” he confides. “When Dr. Brown explained that I would still be able to make expressions and that it keeps wrinkles from getting worse, I thought, ‘Why not try it?’”

## __The Takeaway__

Much like the mommy makeover, the results and impact of a daddy do-over typically run deeper than the physical aspect alone. In addition to restoring a patient’s physique, many report an overall improvement in their self confidence as well.  

“I’ve got twin boys, so I get it. I don’t know anyone — dads included — who doesn’t want to look and feel their best,” says Dr. Brown, who practices what he preaches. “I do have filler in my face and some neurotoxin, and it has made a huge change in the way I look. That translates into how I feel. Upkeep is no longer taboo. It’s the norm for everyone, and why the heck not?”

*Patient names have been changed

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