Breast reduction surgery can achieve good aesthetic outcomes in bodybuilders with gynecomastia, but special considerations are required in this group of patients according to a report in the February issue of Plastic and Reconstructive Surgery®.
For example, bodybuilders usually don’t need removal of excess fat or skin, but they do need special attention to prevent bleeding and scarring.
Steroids and unregulated supplements, including protein shakes, vitamins, and fish oils, may also increase bleeding risk.
Mordcai Blau, MD, a plastic surgeon in private practice in White Plains, NY, has performed gynecomastia surgery in nearly 1,600 bodybuilders and other patients with good physique. The new report focuses on 1,073 such patients, followed up for 1 to 5 years.
The men ranged in age from 18 to 51 years; 15% were competitive bodybuilders. All men were free of hormonal or other diseases that can cause gynecomastia. In some cases, gynecomastia developing in adolescence became permanent after the patient started using steroids or hormone-containing supplements.
Bodybuilders are perfectionists with regard to their physique and chest aesthetics; hence their level of expectations is higher, Dr Blau writes. He performs the procedure through a 1-inch incision, made on the underside of the areola. He highlights the need for complete removal of all breast gland tissue. After surgery, pathology reports usually show hypertrophy of the gland tissue, although a few patients had precancerous cells.
Most patients are “extremely satisfied” with their surgical results, he reports. The “vast majority” of patients continued to use anabolic steroids. Because the gland was completely removed, there were no problems with recurrent gynecomastia.
Complications were uncommon and generally minor. There was a 6% rate of hematomas. This problem became less common after he began providing stricter instructions regarding preoperative and postoperative care: stopping all use of steroids and supplements before surgery, and resuming exercise gradually after surgery. Steroids and unregulated supplements, including protein shakes, vitamins, and fish oils, may also increase bleeding risk.