These are the things men commonly tell Michael Zarrabi, an L.A. plastic surgeon who specializes in treating gynecomastia (also known as “man boobs,” “moobs” and “bitch tits”), during their initial consultation with him:
- “My breasts have become cone shape.”
- “They’re tender to touch, and my nipples stick out whenever it gets cold.”
- “I look like my 13-year-old daughter.”
Upon Zarrabi’s examination of my moobs, a reflexive chill shoots through my groin as he delicately caresses and pinches my left areola. He’s probing for dense breast tissue hidden beneath the nipple, a clear indicator of gynecomastia. “It would feel more like a golf ball,” he tells me, his finger briefly pausing below my nipple. There could be something right here, he explains, but it’s not significant enough to warrant surgery. He suggests hitting the treadmill and easing off the Double-Double cheeseburgers. (Honestly, I’d rather have bitch tits.) “Someone like you carrying a little extra fat in their chest would be an ideal candidate for liposuction,” he explains.
Most of Zarrabi’s male breast-reduction patients — 80 percent in all, he estimates — say they developed the condition during puberty and that it’s gradually gotten worse over the years. A smaller percentage is made up of chronic marijuana smokers (a known cause of gynecomastia); bodybuilders who’ve abused anabolic steroids (likewise); men who have adverse reactions to certain medications that can develop breast tissue; and rare cases of men with abnormal estrogen production.
Usually, though, a guy walks into Zarrabi’s office, points to his chest and says, “I’ve had these since I was a teenager.” Typically, the man’s mom took him to his pediatrician when he was young, who rightly advised that breast lumps in boys are perfectly normal and will eventually go away.
For some men, though, they never do.
Sal, a 24-year-old Pacific Northwesterner I meet in the gynecomastia subreddit, says he developed gynecomastia at age 10. He was a fat kid who slimmed down during puberty, which left him with bitch tits and puffy nipples. Finding concealing clothes has been his biggest struggle, he says. He usually wears a wife beater under T-shirts and tight white undershirts under button-downs, pulled down and harnessed with a belt. Fortunately, intimacy hasn’t been an issue. “When my nipples relax, I’ll hide them or pinch them to make them harden and shrink,” he explains.
He’s hardly an outlier. Nearly one in three men will struggle with enlarged breasts over their lifetime according to a 2014 study. It’s not surprising then that recently released statistics from the American Society of Plastic Surgeons show a 30-percent increase in male breast-reduction surgeries over the past five years — nearly 28,000 were performed in 2016 alone.
Many of these patients were bodybuilders, since steroids are converted by the body into estrogen, resulting in unwanted breast tissue. Dr. Joseph T. Cruise in Orange County says about 50 percent of his gynecomastia patients have hormone-induced gynecomastia. “It’s unfortunate that men who are very fitness-minded don’t realize that once you develop enlarged breasts, surgery is the only viable option for correcting it, ” he explains. There are, of course, plenty of estrogen blockers on the market, which Cruise says many bodybuilders use to keep gynecomastia at bay, only to be disappointed when the products don’t deliver on their promise.
Because visible breasts are typically considered a female trait, some researchers believe that having gynecomastia can result in feelings of “spoiled identity” in some men. A 2009 study went a step further, likening the shame and stigma associated with gynecomastia to the objectification of women’s bodies since having visible breasts can “marginalize and subordinate” men within gender hierarchies.
For his part, Sal says having female breasts is hopeless. “The adage ‘it gets better’ doesn’t apply to guys like us,” he tells me. “Guys with gynecomastia are the butt of every joke. Clothing isn’t designed for us, and people stare at even the slightest hint of breasts on a man.” He adds people don’t appreciate the toll this condition takes on a man’s psyche and that he “constantly feels emasculated” by his “moobs,” which have led to severe body dysmorphia. “We aren’t taken seriously as men. There are no exercises, diets or clothes that can change this. Only surgery.”
David Stoker, a board-certified plastic surgeon in Marina del Rey and expert in treating gynecomastia, has made a name for himself on shows like The Biggest Loser and Extreme Makeover: Weight Loss Edition, where he’s often tasked with eliminating breasts on guys after they’ve lost more than 200 pounds. “Weight loss is the most common reason for breast reduction surgery among older male patients,” Stoker explains. In fact, he just finished one before hopping on the phone with me. Gynecomastia patients all want the same thing, he adds: To be able to take their shirt off — whether it’s at the beach, playing pickup basketball or while having sex.
As for the procedure itself, Stoker does it under local anesthesia. (Zarrabi, meanwhile, prefers to knock out patients completely.) First, he uses power-assisted liposuction by inserting a thin hollow tube through several small incisions and moves it back and forth to loosen the excess fat, which is then sucked from the body by a vacuum. In cases where glandular breast tissue must be removed — that golf ball Zarrabi was looking for — he does so through a tiny areola incision. For prominent nipples, Stoker removes a portion to make them less pointy and visible through shirts. “I’m consistently impressed by how enormous the positive effect of the surgery is on male patients who are bothered by prominent breasts or nipples,” he says.
One such grateful patient — 47-year-old Jacob — had breast reduction surgery in 2015 and tells me it’s hard to convey the psychological relief it’s brought him. “I looked like a woman,” he explains. “There are a lot of times a man is expected to take off his shirt, and I obsessively avoided those times.” You can hide your stomach, ass or size of your penis, he notes. But your chest is right next to your face, so people will always see it. When he wore button-down shirts, his nipples would stick out, so he’d always crouch forward attempting to conceal them. Most of all, he lacked confidence when playing sports, talking to women or taking meetings as a general contractor because he was “deeply embarrassed.”
Cost-wise, Stoker says male breast reduction can range from $5,000 to $15,000, depending on the scope of the procedure. Zarrabi says his average is around $8,000, which includes excision and liposuction.
Such a four/five-figure expense has proven to be a hindrance for Sal, who has waited years for surgery but can’t afford it presently. He’s hoping that if he loses a little more weight, the price will come down, too. “I was quoted $6,500 for the procedure when I weighed almost 200 pounds. I don’t make enough to save for surgery. My only hope is to lose weight to get the cost down, then somehow finance the rest.”
Jacob financed his $10,000 procedure entirely with Credit Care, a healthcare financing credit card, and paid it off over three years at $350 a month. “You can’t put a price tag on peace of mind for the rest of your life,” he says. “In my eyes, this is a surgery that’s way more about improving your psychological state. Suddenly, you can go to the pool. You can go to the beach. You can take a shower at the gym. It’ll change your personality. It’ll change your confidence. And most of all, it’ll change your life.”