Barb: Wanna spend a couple minutes now on a story about something that I guess it still carries a lot of stigma, it’s a problem that men have called gynecomastia. It’s the issue with the overdeveloped breasts in men. And a lot of them who have this, it affects them for the entire lives. And the solution, there’s a pretty quick fix, it’s a male breast reduction surgery. More and more men are looking into this, having it done. So of course, we wanted to talk to the expert, Dr. Stephen Mulholland, founder of SpaMedica, one of Canada’s top cosmetic plastic surgeons. Dr. Mulholland, welcome back to the show.
Dr. Mulholland: Thank you for having me, Barb.
Barb: Is this something that you are seeing an increase in men inquiring about this or having this type of surgery done?
Dr. Mulholland: I think that it’s been very common for a long time, and we’ve got the baby boomers getting a little older in their 50s and 60s now. And so a male with gynecomastia with a 50-year-old booby is very common. The problem was in the past, no one wanted a scar around the areola. With the new energy devices like BodyTite and SmartLipo and Vaser, plastic surgeons can make tiny little incisions, liquefy the gland and any fatty tissue, and really flatten out the chest without the scars that typically would’ve been associated with this procedure in the past and made men a little bit self conscious. But now, quite a simple procedure to do under local anesthesia.
Barb: What is it like, and I guess if you’ve heard from patients, what is it like for men to go through life with this problem and not have it dealt with?
Dr. Mulholland: Well there’s two sort of segments that we see as plastic surgeons. The first [inaudible 00:01:50] segment is the young fellow who has a little bit of glandular breast bud development in his 13th, 14th year, very, very embarrassing. You can imagine, it’s tough enough to be a teenager without having the dreaded man boobs. And then of course, they’re embarrassed to go to the pool. You’re embarrassed in the summer to take your shirt off. You can’t wear tight shirts. It really affects you at many, many, many levels and of course you know how ruthless young kids can be with their classmates. And so it really does make young men very, very self conscious and they can live their whole life like that.
Dr. Mulholland: ‘Cause in the past, if it was glandular, it was very, very firm, you’d have to have breast reduction scars, which are deforming as well. And again, this young group has been helped enormously by the new energy devices, little probes you can stick into the gland, liquefy the glandular tissue, almost like it was fatty, and then aspirate it without having to make big cuts. So a scarless way to reduce male gynecomastia for the younger set has been huge for them. It really has. It’s been a life changing sort of surgery.
Barb: Is there ever a case where a young boy/young man will have this issue, or any people ever outgrow them?
Dr. Mulholland: Yes. So sometimes you get a little breast bud development, like the areola’s a little more prominent, 12, 13, 14, and then there’s a sudden growth spurt, the chest stretches out. You develop pectoralis major, you know, your pec muscles, and it all goes away. But unfortunately, for a significant number of young males, there is that genetic risk. It’s not related to a lack of hormones. You can have normal testosterone levels. You know you have [inaudible 00:03:39]. You have a normal erectile function. It’s just that you have that little bit of breast glandular tissue that you got from grandma or great grandma, and it’s a curse, because it doesn’t matter how much you work out or exercise, you have that little breast bud.
Dr. Mulholland: And then there’s the older fellow, you know, 50, 55, 60. He was a body builder. He was a hockey player. He was a football player, and he was muscular. Puts on a little weight and he gets some fatty deposition on top of the pec major that’s now saggy. And then you’ve got the 50-year-old male booby, which is generally fatty. The problem has been if we didn’t cut away the skin and you just did lipo, it would sag.
Dr. Mulholland: Now with the modern technologies, when we heat the fat in the gland, not just the fat, the skin tightens, and again we can avoid big scars. And that’s the secret. Get a flat chest without the telltale signs of a breast reduction surgery, which would be unacceptable unto themselves. So now we have a scarless way for older men and younger men to have that lean, flat chest, the Ryan Gosling chest basically.
Barb: Ah yes. How long does the procedure take and how invasive is it?
Dr. Mulholland: It takes about an hour to an hour and twenty minutes. It’s done under local anesthesia where we, a couple of happy pills under your tongue and some freezing in the chest tissue, much like you’re getting your wisdom teeth removed. It’s very similar to that. Some men are very, very nervous, much more nervous than female clients. They might even want a little IV sedation like you could have on your colonoscopy. But you do not have to be right asleep. You don’t need a general anesthetic.
Dr. Mulholland: Once the local anesthetic is infiltrated into the chest tissue, you feel nothing. And then there’s about 10 minutes per side of heating to liquefy the fat or the gland and then that will allow the skin to tighten and then we remove the liquefied tissue to complete the procedure.
Barb: What’s the recovery like?
Dr. Mulholland: There is a bit of recovery. You have to wear a special sort of … it’s a garment that looks like a tank top that has some compressive component to it. And we put a little bit of foam over the chest and you need to wear that for about three weeks. So it’s not the best thing you do in the middle of August. But you do it in the winter and you’re ready for the spring and the summer and ready to go south and ready to go shirtless in the summer. So give yourself about six weeks to recover and don’t do it in the middle of summer.
Barb: What’s the typical cost of this procedure?
Dr. Mulholland: It depends who’s doing it. But the devices themselves are quite expensive. So, it’s gonna cost the men 6, 7, $8,000.00. But most guys would say it’s money well spent.
Barb: Somebody texted, and this is actually a really good question, why does OHIP pay for women to have breast reduction surgery but not for men, and they’re saying especially young men are often severely psychologically affected by this condition?
Dr. Mulholland: Well first, OHIP doesn’t pay for all breast reductions. It has to be a very large reduction over a certain amount of grams of resected tissue, otherwise it is cosmetic. With young boys, if they’re 13, 14, 15, and they have a hormonal imbalance, you do some blood tests and the hormones are unbalanced, then yes, OHIP will cover it.
Dr. Mulholland: But if there is no hormonal imbalance, and it is a hereditary trait like love handles or like a double chin, then the managed care system will not pay for it.
Barb: In this story that we saw today about this, I was really surprised to see something. I had never heard this before and I wanted to get your opinion on it. This story claims that the most common reason for gynecomastia among 18 to 35-year-olds is frequent use of marijuana.
Dr. Mulholland: Well there is a known link between the cannabinoids, the chemicals inside marijuana and stimulation of glandular tissue in males for sure and decreased testosterone levels. So we’re talking a large consumption, however, so the odd weekend marijuana user or come July casual recreational use, we’re not gonna be sprouting breasts all over Canada. It has to be heavy, heavy marijuana use.
Barb: Okay. We’re talking serious smokers. It’s just something that I thought was really unusual. I hadn’t heard that and I don’t know if people know that.
Dr. Mulholland: You do need to be very cautious as a young man or woman with a lot of marijuana at a young age. It has been shown to affect cognitive skills, and that’s one of the concerns as we legalize that young kids are gonna have access to it and it’s really gonna affect their cognitive capacity and development let alone gynecomastia. We’ll have a bunch of underperforming academic guys with boobs. And so we really gotta be very careful how we roll out the legalization of marijuana, the least of which is breast tissue.
Barb: Look, we’re laughing, but there are so many guys out there who have this issue, and it can be crippling.
Dr. Mulholland: Oh, devastating.
Barb: What has some of the feedback been like from the people that have had this procedure done with you? How has it changed their life?
Dr. Mulholland: Oh, it’s really life changing. They’ll come back, big smiles. They’ll come back for their six or eight week with a tight t-shirt on and say, “Doc, I haven’t been able to wear this really since I was 9-years-old.” So really it is life changing. Imagine never being able to take your shirt off when you go south or on the beach or in the summer.
Barb: Or being intimate with somebody.
Dr. Mulholland: Yeah, intimate. Well candle lights and dimmers are not just for women. Male gynecomastia. All guys look good with gynecomastia when they’re lying down. Now to stand up and actually be feeling very sexy and attractive. So it really does change things. To have that feminine stigma of breasts, it’s just not cool and it’s sort of like a woman with hirsutism who has a goatee and beard. It’s just culturally not cool.
Barb: Sure. Dr. Stephen Mulholland, as always, thank you very much for this.
Dr. Mulholland: Thank you very much, Barb.
Barb: All right. We’ll talk to you soon.
Dr. Mulholland: Take care.
Barb: Dr. Stephen Mulholland, founder of SpaMedica, one of Canada’s top cosmetic surgeons.