Prolactinoma is not a life threatening condition but can impair vision and cause other side effects unique to men and women.

For men, an increase of prolactin can cause:
• Decreased sexual interest
• Uncommonly enlarged breasts (gynecomastia)
• Decreased body hair
• Headache
• Vision changes
• Infertility
• Low bone density
• And more

Some men may not have any symptoms, and not everyone needs to have treatment. For those that need treatment, medication is successful for most. A few may need to have surgery if the tumor may damage vision.

The cause of these tumors remains unknown. Possible causes of overproduction of prolactin may be:
• Prescription drugs
•  Under active thyroid gland
• Injury to the chest
• Stress

While male breasts caused by Prolactinoma are fairly rare, Dr. Miguel Delgado reviews a patient’s medical history to determine possible causes for the gynecomastia breast and will refer the patient to an endocrinologist if he feels further evaluation is necessary before proceeding with male breast reduction surgery.

San Francisco Bay Area patients find valuable information and support at gynecomastia.org where there are forums available allowing members to interact with each other.

During the initial consultation, Marin County cosmetic surgeon, Dr. Miguel Delgado discusses all options with his Bay Area male breast reduction patients. He can tell if a patient may need the second stage surgery and informs them before any surgery has taken place.

Some patients are pleased with the results of their first surgery and do not choose to have the second stage, this is a personal decision and the satisfaction of the patient is most important. But for those that want the best possible outcome, the second stage can proceed after about four to six months of recovery from the first procedure, after the blood supply reestablishes itself underneath the nipple-areolar complex.

Some surgeons may opt to do a mastectomy type surgery to do everything in one stage, but Dr. Delgado feels the resulting scar is almost as obvious as the gynecomastia itself.

The procedure consists of an incision around the nipple-areolar complex doing what is referred to as a “Peri-areola donut mastopexy”, whereby you excise skin with a purse-string closure.

At the 2010 annual meeting of the American Society of Anesthesiologists in San Diego, a study was presented comparing over 82,000 smokers versus nonsmokers and the findings showed smokers were:
1. 50% more likely to develop pneumonia
2. 57% more likely to have cardiac arrest
3. 80% more likely to have a heart attack
4. 73% more likely to have a stroke

Smoking increases inflammation and inflammation increases the risk of complications. Also the risk of infection is far greater requiring the possible necessity of having to be put on mechanical ventilation. It has also been noted that patients who smoke have higher levels of pain after gynecomastia surgery. There is some evidence second hand smoke may also delay healing or cause problems.

Smoking interferes with special chemicals that allow the release of oxygen to the cells for healing. There are more complications stated in an article published by the Mayo Clinic in 2005. But newer studies show that contrary to what is stated in the article, the use of nicotine gum is not an alternative; the nicotine can interfere with healing in the same way as nicotine in cigarettes and it is imperative that one stops smoking at a minimum of two weeks prior to surgery.

For San Francisco Bay Area patients planning corrective surgery to get rid of man boobs, this is an exciting life changing event. All precautions are taken to ensure the safety of the patient. If you are a smoker and are considering surgery, you must stop smoking as soon as possible then reward your efforts with the surgery you desire.

Adolescent boys have a higher chance of getting coverage than do men, but it is still an uphill battle. There was a court case in 2007 where a father sued his insurance company for not covering his son’s surgery, it went all the way to the New York Supreme Court and ultimately the insurance company had to pay $5000 of the $7500 fee.  This did not however, set a precedent as hoped.

There is an excellent article on gynecomastia.org called “A Success Story-Start to Finish” written by a Mother about her son and everything they went through to get their insurance to cover his surgery. In the article she explains exactly what they did and how they did it to finally get approval. This is a long and difficult process and you can’t be sure of an outcome in your favor.

Dr. Delgado is always willing to submit a letter to insurance companies on behalf of any of his gynecomastia patients that he feels may have even a slight chance of getting coverage. Even though the surgery itself most likely will not be covered, there are expenses that under most policies will be covered, such as; required blood tests prior to surgery, pathology, and all prescriptions.

Many men discussing this issue on the popular website http://www.gynecomastia.org/ have stated that their girlfriends or wives do not find their extra breast tissue offensive at all.  Having the gynecomastia breast is a very personal issue and for some it can be the extreme feeling of self hatred. This is such a tragedy when sometimes just having a good support system can make a huge difference.
Some men tried to hide their condition all through their teen years from not only their friends but also their family. They were too embarrassed to even address the issue. It is unfortunate though as many discovered that once they were able to share with their parents the  humiliation it caused them, their parents only wanted to help them find a resolution. But then there are those that do not have the support and have to find their own way of coping. Sometimes therapy can make a difference, but for many the option of gynecomastia surgery can be a life changing event.
For those boys and men that do not find a good support system at home, Dr. Delgado recommends that they reach out to www.gynecomastia.org. This website has many different discussion boards with topics on all issues that men with breasts face.  Anyone can become a member at no cost, and the support one receives from other men facing similar situations can be invaluable.

When you work together for years it is not uncommon to see partners almost able to communicate without speaking, and such is the situation between Dr. Delgado and his Board Certified Anesthesiologist, Dr. Randy Gaynor. They have been doing surgery together since Marin Cosmetic Surgery Center opened in 2001, where Dr. Delgado treats his San Francisco Bay Area patients.

For Dr. Delgado, having his own private surgery center allows him the ability to pick his own superior surgical team for all his cosmetic procedures including surgery for the gynecomastia breast(moobs). Unlike performing surgery in a hospital where you may have a different team each time.

Dr. Delgado and Dr. Gaynor have traveled together to Guatemala as part of a “Faith in Practice” surgical team, donating their time and their surgical skills for much needed surgeries for burn victims and children with cleft lip/palates and birth defects.

There is no scientific evidence to support the claims of advertised pills or drugs  to reduce gynecomastia.  There is some thought that some of these products that have estrogen blocking agents may halt the continued development of the breast tissue but it cannot remove gland that has already formed.

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If an adolescent’s hormones are off balance, it is possible that an endocrinologist can possibly adjust them during the early developmental stages.  In some cases boys with gynecomastia, will find it will resolve itself once past puberty. Many surgeons will advise the patient and his parents to wait until the end of puberty before seeking surgery, unless it is a severe case or has significant psychological issues. However, once the gynecomastia is established, and the young man is past puberty and the teenage years, usually it does not resolve on its own without surgical intervention.

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Some men that have a milder case,  may have “pseudo-gynecomastia” which can be caused by fat alone and can be removed by liposuction or weight loss. And some men with genuine gynecomastia may have only a mild to moderate amount of glandular tissue and fat which means they might be a candidate for the “Light Procedure” that is much less invasive than the regular gynecomastia surgery.
For those men with moderate to severe gynecomastia, surgery is the only real option for “curing” this condition.  To get a well sculpted chest it is important that the surgeon uses a combination of liposuction for the fat removal, and surgical removal of most but not all of the breast tissue.

Many of my San Francisco, Bay Area patients ask what treatments are available as seen in this post on gynecomastia.org. You may need to become a member in order to read the posts but there is no charge and it is a great forum with many questions and answers posted by members and Board Certified Plastic Surgeons.

In many cases this condition will resolve on its own after puberty, however if it doesn’t, the treatment of the nipples is the same, it requires glandular excision in which an incision is made around the areola and the gland is dissected free from around the areola and the deeper tissue.  This removes the fullness in this location and allows the nipple areola to shrink and flatten.

Many patients feel that the Puffy Nipple Syndrome is improved when the nipple is cold or they are in water.  This is due to the contractual muscle that is in the areola that upon stimulation causes contraction, tightening, and flattening in that location.  Once the stimulation is removed the muscle relaxes and the puffiness is allowed to return.

The treatment of puffy nipples is very successful with  extremely high satisfaction rate and often times the Gynecomastia like procedure which I explained in my previous blogs about the male breast and on my website can be performed in this situation.

Recently there was an article in the BBC News pointing out the increase of breast reduction in men had jumped 80% from 2008. In a previous article,also in the BBC News from Sept. 2009, it states that “moob jobs” had risen 44% between 2007 and 2008. Nigel Mercer, the president of the British Association of Aesthetic Plastic Surgeons (BAAPS) stated, “The public’s interest in aesthetic surgery appears to remain strong and indeed growing quite considerably among UK males despite the economic downturn”.

The article goes on to state the numbers for men seeking gynecomastia surgery have shot up by 1000% over the past five years. Removal of the gynecomastia breast for men has become the fifth most popular plastic surgery procedure for men in Britain after; nose surgery, eye lifts, ear corrections and liposuction. This trend is the same in the United States as stated in an article by the American Society for Aesthetic Plastic Surgery (ASAPS), except hair transplants were in the top five instead of ear surgery.

Many men from England, Europe and all over the world travel to the United States and specifically Northern California’s San Francisco Bay Area to be treated by Dr. Miguel Delgado who has specialized in gynecomastia surgery since 1989.