Male gynecomastia is a benign enlargement of the male breast, with an incidence rate of 32% to 65% in the general population. Most of the causes are congenital, and a small part is caused by endocrine dysfunction and drugs, or related to a certain syndrome (such as Klinefelter syndrome).
The cause of the feminization of bodybuilders' breasts is usually the intake of excessive steroids or hormonal drugs. In most cases, this breast enlargement is persistent, and this phenomenon persists even after stopping the steroid medication. For professional needs, they usually have to control the body fat ratio to within 9% before the game, which will make the breast look more obvious.
In addition, the body of a bodybuilder's patient appears to be more slack than the general population, the pain is more frequent, and there is also a nipple discharge. In recent years, due to aesthetic considerations, bodybuilders who require surgery to correct breasts have gradually increased. Dr. Blau from New York, USA, chose to completely remove the breast tissue under direct vision for satisfactory results. The study was published in Plastic and Reconstructive Surgery in February this year.
From 1980 to 2013, Dr. Blau performed surgical treatment on 1,574 bodybuilders with gynecomastia, and 1073 of them were followed up within 1 to 5 years after surgery. Patients ranged in age from 18 to 51 years. Most of the patients underwent subcutaneous resection of 95% of the breast tissue, and only a small number of patients were treated with liposuction.
Patient satisfaction survey results showed that 98% of the subjects were satisfied with the postoperative results. The total incidence of postoperative hematoma in the first 15 years and the following 15 years was 9% and 3%, respectively. No complications such as infection, appearance abnormalities and recurrence occurred.
List a 30-year-old bodybuilder, as shown in Figure 1. The left panel shows that the patient developed severe breast feminization after 4 years of taking prohormone and was resistant to estrogen resistance. The right panel shows a significant improvement in appearance eight months after mastectomy. 
Figure 1 Comparison before and after surgery
According to Dr. Blau, complete removal of breast tissue is the most appropriate method for bodybuilders, and incomplete resection often leads to recurrence. This is because due to professional needs, bodybuilders need to continue taking steroids, and residual breast tissue will continue to proliferate as a target organ for steroids.
The complete breast tissue consists of three parts. The mammary gland is located deep in the nipple-areola complex. The portion of the body that extends inwardly constitutes the head end of the breast. It extends into the middle of the chest and is usually short and round in appearance. The caudal end of the breast is usually narrow and extends outward to the underarm. See Figure 2 for details.
Figure 2 This is a specimen of breast tissue taken from the breast of a bodybuilder's patient, clearly showing the shape of the head, body and tail.
Liposuction often causes unnecessary damage to the pectoral fascia, destroys the fascia integrity and causes bleeding. Excessive hematoma promotes the formation of scars, which eventually leads to chest deformities and nipple retraction. In addition, bodybuilders have low levels of subcutaneous fat, so liposuction is not recommended in most cases.
In addition, because the bodybuilders' chest muscles are developed, the blood supply around them is more abundant than the general population, and the intake of large amounts of steroids and fatty acids can cause an increase in perioperative bleeding. Therefore, effective hemostasis during surgery is particularly important, and drainage measures should be taken when necessary.
In summary, direct removal of breast tissue by surgery is important for correcting male malformation of male bodybuilders, and it is recommended to completely remove breast tissue under direct vision to avoid appearance abnormalities caused by fragmentation and damage of the underlying pectoral fascia. No bleeding is necessary.
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