Gynecomastia Q&A with Dr. Shenker

Dr. Robert Shenker of the Cosmetic Surgery Clinic London Ontario talks about gynecomastia or male chest reduction surgery.Male breast reduction surgery in London, ON

Many of our patients know Dr. Shenker as the founder, principal surgeon, and driving force of our clinic. But not everyone knows that he has personal experience as plastic surgery patient. The procedure in question? Gynecomastia, a.k.a. male breast reduction. Having enjoyed the benefits of this surgery, and the resulting improved body image himself, Dr. Shenker has a unique perspective on this particular patient experience. Knowing first-hand how impactful this procedure can be, he is committed to educating prospective male patients about this surgical option to improve the appearance of their chest.

“I have personally experienced how profoundly cosmetic surgery affects people. It gives men and women confidence and makes them feel more at home in their own skins. Most people aren’t even aware of the possibilities plastic surgery offers. They ponder and think and deliberate for months and years, and, with every operation I do, I inevitably hear ‘I wish I had done this years ago’.” – Dr. Robert Shenker.

Dr. Shenker answers a few of our patients most common questions about gynecomastia.

Q: Gynecomastia is the swelling of breast tissue in males. How common is this condition and what causes it?

A: Asymptomatic gynecomastia is very common and occurs in three age groups: neonates (newborns), teenagers and older men. Asymptomatic gynecomastia has a prevalence of 60-90% in neonates, 50-60% in adolescents and 70% in men 50-69 years old.
The cause of gynecomastia is often multi-factorial, however, the unifying pathophysiology lies in an imbalance of the hormones; estrogen and androgen. Lower androgen levels increase the growth of breast glands, and higher estrogen levels will stimulate their growth.

Q: What are the causes of gynecomastia?

A:  The majority of cases of gynecomastia actually have no identifiable cause. In other cases, we do find an underlying cause.  The known causes of gynecomastia include:

  • Physiologic gynecomastia: the normal enlargement of the male breast during infancy and puberty. This will present as a temporary enlargement on both sides that is smooth, firm and symmetrical. This will usually resolve in 6 months to 2 years.
  • Persistent pubertal gynecomastia
  • Idiopathic gynecomastia (idiopathic means no identifiable cause)
  • Underlying health conditions such as chronic kidney disease, liver cirrhosis, feminizing adrenocortical tumour, hyperthyroidism and hypogonadism.
  • Testicular tumours.
  • Drugs of many types

Q: Are there different levels of severity of gynecomastia?

A: There are two systems of grading gynecomastia. These systems can help guide the choice of surgical procedure.
The Simon grading system categorizes gynecomastia as:

Grade I: small enlargement without excess skin
Grade IIa: moderate enlargement without excess skin
Grade IIb: moderate enlargement with minor excess skin
Grade III: marked enlargement with excess skin and ptosis (drooping)

Rohrich et al’s system for grading gynecomastia is as follows:
Grade I: Minimal hypertrophy (<250 g) without ptosis
Grade II: Moderate hypertrophy (250-500 g) without ptosis
Grade III: Severe hypertrophy (>500 g) with grade I ptosis
Grade IV: severe hypertrophy with grade II or III ptosis

Q: What is the difference between gynecomastia and pseudogynecomastia?

A: Gynecomastia is a benign (enlargement) of glandular tissue in males. In contrast, pseudogynecomastia is increased breast fat with no glandular enlargement.  In my experience, the overwhelming majority of cases combine both glandular and fatty excess.

Q: What are the best treatments for this condition?  What is the recovery time and is it a life-long solution?

A: If there is an inciting drug or an underlying condition, the first step is to stop the drug and treat the underlying condition.  The gynecomastia may or may not resolve after these causes are managed.

For cases where no known cause exists (the majority of cases), or when treating the underlying condition does not reverse the breast growth,  gynecomastia, a surgical procedure is the only consistently effective treatment with long-lasting, life-long results. The surgery involves removing the excess breast tissue along with liposuction of the fatty component of the breast.

After surgery, patients will have to wear a compression garment for a few weeks. The garment helps to reduce swelling and optimizes tissue recovery. To reduce soreness, pain medications can be taken. Normally, patients will be able to return to work within 1 week of surgery and exercise within 3 weeks. Each patient heals differently so it is crucial to attend follow-ups with the cosmetic surgeon.

Next Steps

If you’re ready to enjoy a firmer, sculpted, masculine-looking chest – opting for gynecomastia is the answer! Contact us to arrange a surgical consultation with Dr. Shenker today.


Meet Our Surgeons

The talented, experienced plastic surgeons at our Kitchener-Waterloo clinic have the advanced training to create exceptional, natural-looking results that meet the individual needs of our patients. The collaborative nature of our practice benefits patients in many ways.

Dr. Robert Shenker Dr. Stephanie Ma
The Cosmetic Surgery Clinic