This group composes a large part of my gynecomastia practice. My patients include prominent professional and amateur body builders and athletes. Gynecomastia can be a result of anabolic steroid intake, however it is not the only reason for this condition. For this group treatment is more aggressive to prevent recurrence and to enhance the end result. All specimens removed are sent to Pathology.

Jason Arntz Ironman Pro Invitational - 8th Place - 2002 PC National Championships - Heavyweight, 1st - 1998 USA Championships - Heavyweight, 1st - 1998 www.bodybuilders.com/arntz

Dave Palumbo (Editor-in-Chief of RX MUSCLE Magazine) NPC USA - Super Heavyweight, 6th - 2004 NPC Nationals - Super Heavyweight, 6th - 2003 NPC USA - Super Heavyweight, 3rd - 2002 www.davepalumbo.com | www.rxmuscle.com

Geno Sylvain (Well known New York based personal trainer) NPC New Jersey - Master's over 35, 1st - 2001 NPC East Coast - Light Heavyweight, 2nd - 2001 NPC NY Metropolitan - Overall, 1st - 2001 www.genosylvain.com | www.geneticsbygeno.com

Greg Kovacs Arnold Schwarzenegger Classic - Heavyweight, 13th - 2003 IFBB Ironman Pro Invitational - Heavyweight - 16th - 1998 NPC Canadian Championships - Heavyweight, 1st - 1996 www.gkovacs.com

Derek Anthony NPC Collegiate Nationals - Heavyweight, 3rd - 2002 NPC New York Grand Prix Amateur - Overall Teen, 1st - 2000 Bev Francis NPC Eastern Classic - Overall Teen, 1st - 1999 www.derekanthony.com

Colette Nelson (Post Breast Augmentation) World Universe - Heavyweight & Overall, 1st - 2004 IFBB North American - Light Heavyweight, 1st - 2004 NPC Team Universe - Heavyweight, 1st - 2004 www.colettenelson.com

Concern with body image in the 21st Century is no longer limited to women. A man’s physique is not only important to the athlete and body builder, but to all men. One of the reasons why women refer to men as, “the opposite sex,” is because a male’s flat physique (as opposed to any female curvature) is aesthetically more pleasing. Women in general see the flat chested man as more masculine, attractive and sexy. Gynecomastia (enlarged or flabby breasts) can affect the patient psychologically and become a social stigma.

For the athlete/bodybuilder, his physique is important and not just for appearance only. His chances of performing better and winning competitions increase.

In order to increase muscle bulk, some athletes resort to anabolic steroid use. Side effects depend upon the particular substance used and the cycle (frequency of ingestion). Studies have shown that high dose steroid usage as well as frequency are directly proportional to the probable development of gynecomastia.

The lack of regulation and real knowledge of anabolic steroids by most users is a significant problem. Some of these steroids are actually converted by the body to estrogen; others stimulate production of estrogen. This may cause enlargement of the male breast.

Unlike a woman’s breast, gynecomastia very rarely becomes cancerous (1 to 3 of 100,000 men). It usually occurs in men over the age of 60 years, and is frequently found under the nipple-areola. Forty percent of patients have a family history of gynecomastia. In general, while male breast tumors are rare, their location may present difficulty in distinguishing them from enlarged male breast tissue. Therefore in all cases, biopsies are essential.

Bodybuilders, as opposed to overweight persons, have real breast tissue. To prevent recurrence (10% in the literature) of gynecomastia, most of the breast tissue should be removed. In some cases when not enough breast tissue is removed, recurrence is more likely. In many cases, this “so-called recurrence” is actually the lack of adequate excision.

If not stopped prior to surgery, dietary supplements can be a problem for athletes. These supplements are not regulated, and some of them increase the risk of extensive bleeding during the surgery. In this scenario, incomplete excision of the gynecomastia tissue is more common. After the surgery, these blood thinners may also cause hematomas or seromas (bleeding and fluid accumulation) which significantly swells the breast tissue. In this case, surgical exploration may be warranted. To ensure that this does not occur, it is essential to completely stop the use of all dietary supplements two weeks prior to and two weeks after surgery.

In my opinion, successful surgery is when 90% or more of the real breast tissue is removed. This requires a surgeon who is experienced with this type of surgery.

In the vast majority, the incision site should be periareolar (the lower part of the nipple areola), and when possible, should not exceed 1 to 1_ inches. To minimize scarring, it is essential that the experienced plastic surgeon use the proper light source and instruments. Based on personal experience, I have found that in an overwhelming number of patients, I am able diminish the size of the scar which is of paramount importance to the bodybuilder.

The less fat tissue the person has, the more gynecomastia tissue can be removed without leaving a depression or deformity. In those patients, the skin will drape directly on a developed pectoralis muscle. Therefore the male chest will look more masculine and attractive.

Liposuction alone cannot correct this problem in athletes. Only comprehensive excision of the gynecomastia tissue by a highly experienced surgeon can bring about the desired effects and results.

As with any surgery, you should consult your surgeon regarding any questions or concerns you may have. If your expectations are realistic, chances are good that you will be pleased with your new look.