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Visible trauma for young men

When he was 14 he developed small deposits of fat in

each breast.

"I didn't give much thought to it. It didn't seem any more weird to me than

anything else that was happening to my body at the time," he said.

"But one day in the locker room in the eighth grade, they were making fun

of a kid for having a large chest. I didn't understand why they were making fun

of him, and then they started making fun of me. That summer I went to baseball

camp, and it was a nightmare. They called me Mini-nips," a nickname the young

man was to hear time and again, it being common teenage banter to describe boys

with overdeveloped breasts.

"I basically didn't take my shirt off in public from that time until I was

27."

It was then that he finally underwent surgery to have the excess tissue

removed. By his own account almost two years later, he now looks "awesome."

The young man agreed to speak about his years of suffering with what is

known as gynecomastia, a term derived from the Greek "gyne" meaning "woman" and

"mastos" meaning "breast," only on the condition of anonymity, which is

understandable considering the embarrassment it causes those who are afflicted.

Gynecomastia is nothing new. Studies of King Tut's mummy have shown Egypt's

boy king had enlarged breast tissue back in the 18th Dynasty, according to Dr.

Elliot W. Jacobs, a Manhattan plastic surgeon. Jacobs has done hundreds of

modified liposuction procedures over the past 25 years to permanently correct

gynecomastia.

Watch and wait

He said about one-third of American males show signs of gynecomastia at

some time in their lives. Most cases occur at puberty, when boys undergo an

increase in hormones and produce some estrogen, which can cause the breast

tissue to grow disproportionately.

Puberty-induced gynecomastia usually resolves spontaneously as boys reach

14 or 15, so doctors generally prefer to watch and wait for a couple of years

to determine if surgery is advisable. The condition can affect one or both

breasts.

As Jacobs points out, however, occasionally the family doctor or

pediatrician will "pat the kid on the back and say, 'Don't worry, son, it will

go away.' They wait and wait, and there go all their precious teenage years

when they are teased and embarrassed."

He said some boys will not take their shirts off at the beach or in the

gym, and some go to the extremes of wrapping their chests in Ace bandages to

appear flatter, or deliberately gaining weight, "so their belly is bigger than

their chest, and they don't look so disproportionate."

Lifting weights or working out at the gym will do nothing to alleviate the

problem.

Jacobs performs outpatient liposuction in his office after an

anesthesiologist puts the patient into a light sleep, or "sedation anesthesia."

He first injects fluid into the tissue to soften it. Then a semi-sharp cannula

or tube of his own design is inserted through a tiny nick in the skin and

moved to and fro to loosen and isolate pieces of breast tissue and fat. These

loose pieces are then suctioned out of the body with a high-powered suction

machine.

If there are areas where excess tissue is particularly dense and cannot be

penetrated with the cannula, Jacobs makes a small half-circle cut around the

edge of the nipple and uses that incision to surgically remove the solid

tissues. The cut is closed with dissolving sutures under the skin.

Small cuts, little scarring

Dr. Thomas Lee, a pediatric surgeon at Stony Brook University Hospital,

does not do liposuction for gynecomastia. He performs a subcutaneous mastectomy

to remove the excess tissue, making the incision in the area around the

nipple. His method is done on an outpatient basis, with general anesthesia, at

an ambulatory center connected with University Hospital.

According to both doctors, the modified liposuction and the subcutaneous

mastectomy procedures result in very little scarring. Any incisions are made in

the brown area surrounding the nipple, where scars are not noticeable. There

is usually minimal postoperative discomfort, and the result is a whole new

outlook on life.

"These kids are ecstatic; it really is a life-changing type of operation

for them," Lee said.

The same procedures can, of course, be done on adults, and while Lee, a

pediatric surgeon, usually only sees patients through their late teens, Jacobs

treats patients of all ages. "I can even help older men with pendulous breasts,

but I tell them they're not going to look like a 20-year-old, with a chest as

tight as a drumhead," Jacobs said.

Gynecomastia can run in families, according to Jacobs, and while older,

obese men can have enlarged breasts as a result of their weight, in a teenager

the cause is not usually weight-related.

Although most cases of gynecomastia are attributable to puberty, excess

breast tissue can be associated with chronic liver disease, certain endocrine

diseases and some cancers. Jacobs said 1 percent of all breast cancers in the

U.S. occur in males, but gynecomastia does not predispose a man to breast

cancer. Some medications cause gynecomastia, and marijuana use is thought to be

a possible cause. Enlarged breasts are also seen in some body builders who

take certain steroids.

Lee said patients must be evaluated to rule out any disease-related causes.

If no cause but puberty is found, he determines just how significant the

gynecomastia actually is. Some teens, he said, are unrealistic about how they

should actually look.

Often not covered

Most gynecomastia procedures run between $4,500 and $8,500. The majority of

health insurance companies say it is cosmetic and elective and will not cover

the cost. "Insurance companies don't often recognize the psychological effect

on children," Lee said.

The young man we spoke of earlier first consulted a surgeon when he was 16,

but his family could not afford the cost so he kept his shirt on in public. He

went on to college, met a girl and married her. By 2004 they were divorced.

His lifestyle changed to "sex and the single guy" living and working in

Manhattan with a career in publishing.

"It was overwhelming. I just didn't want my chest to be an issue anymore,"

he said.

At age 27, he researched gynecomastia on the Internet. He liked Jacobs'

credentials, contacted him, went for a consultation and had the procedure. "I

look great," he said.

LONG ISLAND FAMILY�S CASE FOR COVERAGE

In 2004, a Long Island family filed suit against the health insurer GHI on

behalf of their 17- year-old son, who suffered from gynecomastia. According to

court papers, the teenager was ridiculed by his peers and never went to the

beach or engaged in activities that would expose his enlarged breasts. His

family said he was so distraught about his condition that although he had been

accepted at an out-of-state university, he decided against attending for fear

of being taunted in the dorm.

GHI contended that corrective surgery was not covered by insurance because

it would be elective, cosmetic and not medically necessary.

Civil Court Judge Barbara Jaffe ruled that the young man's functioning as a

normal adolescent was impaired as a result of his condition. She ordered that

the family, which had already gone ahead with the breast reduction surgery at a

cost of $7,500, be reimbursed in the amount of $5,000.

GHI has appealed the ruling. There has been no decision as yet. - ELLEN

MITCHELL

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