Real Patient Question: Do I Need an Ultrasound?

Earlier this month, a member of gynecomastia.org asked whether it’s a good idea to have an ultrasound examination of a case of gynecomastia to determine what kind of tissue is causing enlarged breasts (which he had done). We chimed in with two other gynecomastia specialists to give both short and more detailed answers.
The short answer we all agree upon is, NO! It’s not only unnecessary for the vast majority of guys with man boobs to have an ultrasound; the results can further confuse patients to boot. Reading the ultrasound report seems to add to patient concerns and spark discussions we have in our gynecomastia consulting room about “What’s really in there?” and “Why did this happen? ” These questions are interesting to consider, but mostly beside the point. Let us explain.

The Gynecomastia Diagnosis

Counterintuitive as it may seem, the actual makeup of enlarged male breasts is not the issue— a guy’s appearance is. Whether the patient is an ultra-lean bodybuilder with puffy nipples or an overweight guy with fatty looking breasts makes no difference: gynecomastia it is.
In addition, patients should know that all men have at least some breast tissue. The man who posted the question said his ultrasound report indicated “no evidence of any glandular breast tissue,” even though the man had taken finasteride. Perhaps the doctors saw no trace of “excess” glandular tissue; in any case, everyone has some breast gland and finasteride is a known trigger of growth. No wonder the gynecomastia.org member was perplexed.

Why Ultrasound is not Routine

As we advise our gynecomastia patients, the main reason imaging tests aren’t necessary for the majority of guys is that they don’t affect the treatment plan. In fact, one way to know you’ve found an experienced gynecomastia specialist is to hear them say they don’t know exactly what they’ll find under the skin but they’re prepared to deliver a good result no matter what. It’s when a cosmetic surgeon says they know precisely what the surgery strategy should be ahead of time that a patient should be concerned.
Contrary to what some patients think, breast gland can feel dense and lumpy or it can feel quite soft. The same is true for fat tissue. In fact, since fat tissue creates an environment that can trigger breast gland growth, and the two types of tissue are often quite intertwined, it’s imperative that the surgeon is ready for anything.

Our Approach to Tissue Removal

During our three decades of specializing in helping guys with man boobs, we’ve found that we almost always need to remove some measure of both fat and gland to give a guy the masculine shape he’s looking for. Even for bodybuilders with almost no extra fat, we realized long ago that we may need to re-sculpt tissues or at least re-drape skin to lie flat over the new contours underneath.
To minimize trauma and to give us maximum flexibility, we designed our own instruments that allow us to address whatever we encounter under the skin. We start with tiny incisions and minimal tissue disruption and move on to additional small incisions and more aggressive removal/repositioning as needed to achieve an optimal result.

Exceptions to the Rule

Of course, we do occasionally send a patient for an ultrasound, particularly if we suspect breast cancer. The incidence is admittedly low— just one in a thousand men will develop the disease— but it does happen. During consultations with gynecomastia patients, we look for symptoms like distinct lumps, nipple pain or discharge and more.
Be assured that we do perform thorough patient evaluations, both physical and psychological. Our consultations are extensive and detailed, partly so we can spot cases of body dysmorphic disorder or other issues that might indicate surgery is not a great idea. We send all our patients for blood work and have discovered a few cases of leukemia and bleeding disorders that were critical to find before proceeding. When patients are older we request additional tests as a precaution, and if medical conditions such as diabetes or HIV are present, we coordinate with the patient’s other physicians.
It’s not that we don’t believe thorough preparation for gynecomastia surgery is necessary, it’s just that ultrasound exams don’t usually need to be part of the drill.
If man boob surgery is on your mind, we hope you’ll reach out and talk over your case with us. Call 561-367-9101 and find out more about our practice and our approach.