Most guys I see who are bodybuilders are not using anabolic steroids, but have taken “pro-hormones” or over-the-counter gym supplements. These products can aggressively stimulate the usually small male breast tissue to grow into a painful, large mass (Figure 1,2). While aromatase inhibitors may be helpful for anabolic steroids, they don’t help when gynecomastia results from pro-hormones or supplements.
Figure 1: “C-cup” breast shape from Pro-hormones overstimulating male breast tissue present for over 10 years. One year after gynecomastia treatment, chest is restored to masculine athletic shape. (32yr)
Figure 2: Gym supplements (pro-hormones) resulted in a painful round mass under the nipple. Gynecomastia treatment, complete glandular breast tissue removal, restored a normal chest shape for this 17 year old.
Gynecomastia is excess breast tissue in males. All guys have a very thin layer of breast tissue immediately under the nipple. The majority of guys have gynecomastia from hormone flux during puberty. Commonly, in a thin athletic male, gynecomastia presents as puffy or pointy nipples (Figure 3). This is corrected by removing the breast tissue under the nipple using a very small incision around the nipple area. The skin around the nipple shrinks or contracts, sometimes appearing darker.
Working out won’t make it better. Building chest muscle only makes the “breast-look” worse. Frustration and embarrassment take away your confidence. For competitive bodybuilders and men that dedicate themselves to incredibly high standards of muscle aesthetic, a round chest and pointy nipples looks and feels unnatural.
Figure 3: Pointy or puffy nipples are corrected by removing the excess breast tissue under the nipple. Scar is hidden. No skin is removed.
Despite a rigorous diet and exercise regime, competitive bodybuilders’ bodies are in a high testosterone state usually with pro-testosterone supplementation, anabolic steroids or a combination of both. When your body sees more testosterone than it can handle,“aromatase” converts excess androstenedione (male hormone) into estrogen and estrone, (very potent estrogens). Estrogen stimulates the usually very small amount of male breast tissue immediately under the nipple to grow into a painful mass- the size of a walnut or a golfball. You must stop the supplements immediately and might consider trying aromatase inhibitors such as anastrozole.
This patient is a 41 yr old personal trainer and bodybuilder had a complex type of gynecomastia (Grade 4). After a large weight loss there is a mis-match between the skin and the muscle. There is excess skin, inferiorly displaced nipples and excess breast tissue. This imbalance creates a distortion that gives the chest an unnatural appearance.
Figure 4: Pointy or puffy nipples are corrected by removing the excess breast tissue under the nipple. Scar is hidden. No skin is removed.
Before surgery, while standing, the correct position of the nipple on the lower lateral portion the pectorals muscle was selected. A skin pattern was drawn to remove the excess skin. The nipple remained attached, but was moved up to the new position on the pectorals muscle. The scars were placed around the areola (darker skin around the nipple), a short vertical scar to the chest crease and a curving scar that followed the underside of the lateral chest muscle definition. With the chest muscle having good anterior projection, the short vertical scar is hidden on the underside of the chest. The longer scar that runs along the side of the chest is hidden in the lateral chest muscle crease. To hide the scar and enhance the lateral chest definition, the ligaments under the skin are actually sewn to deeper structures. This “wraps” the skin around the lateral pectoral border. One year after the procedure, the right nipple has less sensation, but the left has normal sensation.
For Grade 1,2 or 3 Gynecomastia where there is excess breast tissue under the nipple but no skin excess, treatment is to remove the glandular tissue. There is usually minimal to no fat to remove.
For most bodybuilders with gynecomastia, a surgical procedure under local anesthesia is reasonable and comfortable. The chest is first infiltrated with a dilute numbing solution. You can remain awake, but will not feel the chest while the surgical procedure is taking place. After, there is a small scar within the areolar border, a special dressing is placed. A foam and compression dressing is placed on the chest to control immediate post-op swelling. You can then drive home. Most men return to work within 1-2 days or after the weekend. Pain medicine is rarely needed after day 2. Workouts are resumed the next week progressing to your full exercise within 2-3 weeks.
25 yr old young man after taking “gym supplements” to enhance his chest. Before and 6 months after gynecomastia treatment to remove the glandular tissue under the nipple. A normal chest shape is restored.
24 year old bodybuilder with gynecomastia presenting with puffy nipples from breast tissue under the nipple. After 1 month, the nipple is flat on the chest, the scar is hidden and the chest is restored to a masculine shape.
41 yr bodybuilder after large weight loss. The excess skin is removed and the nipple repositioned on the chest muscle.
41 yr personal trainer after weight loss. “It looked like I had sagging breasts”. Before and 8 months after gynecomastia treatment for bodybuilders
Browse before-and-after photos to see real results from real patients—each with their own goals, stories, and reasons for choosing cosmetic surgery.
