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Microsoft word - male breast reduction march 2012.doc(Parkland Life/ Coconut Creek Life for March, 2012)
Often Overlooked: Male Breast Reduction
When the subject is breast reduction, the discussion is typical y about women, which we discussed in last month’s issue. However, excess breast tissue in one or both breasts occurs in an estimated 50% of the male population. Though the condition (gynecomastia) typical y does not cause the physical discomfort produced in women, it often creates significant social trauma, especial y for teens and younger men. Many wear heavy, loose-fitting shirts and steer clear of sports and the beach Both excess fatty tissue and excess glandular tissue can be the culprits, creating a "female" contour. Most commonly, gynecomastia is “idiopathic” (no known cause). However, it can be familial, and there are known associations with rare endocrine conditions resulting in hormonal imbalance. Of known causes, there are many popular exogenous “supplements” that can promote gynecomastia. These include, classical y, anabolic steroids but less known are various over the counter nutritional supplements. One of these is tribulus terrestris, a common herbal ingredient purported to enhance muscle building but as a side effect can lead to gynecomastia. While diet and exercise can help with generalized fat, as everywhere else, it cannot be directed to a specific area. Neither wil help reduce excess glandular tissue. Indeed, as chest muscle is built with exercise, the overlying fat and glandular tissue may be pushed further forward making the condition even more noticeable. Common in early puberty, the condition often resolves spontaneously by age 17-18. Surgical breast reduction should be delayed at least until age 15 or 16, or wel into puberty and after several years of persistence of the condition. Before proceeding with treatment, the patient should be relatively more mature, both physical y and emotional y. Although commonly treated in young men, If the enlargement is being caused by excess fatty tissue, liposuction alone may resolve the problem. If the problem is caused by excess glandular tissue, it may be necessary to directly remove the excess tissue through a small incision at the lower edge of the areola typical y in combination with liposuction. The area must be contoured careful y to create a smooth appearance. In rare cases with excess skin, incisions are made around and beneath the areola, as with a female breast lift or reduction, leaving longer scars. Results are permanent, although subsequent obesity or exposure to anabolic steroids, for example can cause recurrence. Patients typical y return to work in a few days unless the work is extremely strenuous. Scarring around the nipple is minimal. There can be minor post-operative bruising, swel ing, and occasional y fluid build-up. An elastic pressure garment is worn for 3 weeks and sun exposure is avoided for several months. Temporary numbness may persist for up to one year. Infrequent complications associated with any surgical procedure include bleeding, fluid col ection, infection, unsatisfactory scarring or contour irregularities. Post-operative asymmetry, while rare, is possible and may require a secondary procedure to remove additional tissue and create better balance. Post-recovery, the patient enjoys a firmer, flatter, more contoured chest which fits the standard “male profile”. Subsequent exercise to tone the chest muscles wil produce even greater David J. Levens, MD, PA, FACS, in practice in Coral Springs for 22 years, is a graduate of MIT and
Columbia University-Col ege of Physicians and Surgeons. Certified by the American Board of Plastic Surgery, he has been named a Top Doctor in Castle Connol y's national ratings for 2010 and 2011.
Clinical Chemistry 56:10 1528–1534 (2010) Clinical Chemistry Guide to Scientific Writing Bring Your Best to the Table Sometime in the past you were likely taught about thetext (e.g., mass transitions for 20 different drugs beingimportance of “bringing your best to the table”—inother words contributing your best ideas and results. A good table, although used for a purpose