The Rock got breast reduction surgery and why that’s completely alright

Gynecomastia or male breast enlargement, loosely referred to as moobs, is a much more common occurrence than one might think. Dwayne Johnson would agree, as the actor and wrestler came into the spotlight recently for having undergone surgery earlier in his life for ‘aesthetic’ purposes. We talked to industry professionals to learn more about the lesser-known facts about the health issue.

Studies have shown that up to 70% of men in their lives have experienced gynecomastia, mostly in their adolescent years. While the enlargement of male breasts is shown to be a ‘benign/noncancerous condition,’ it is associated with a different health hazard. Depression and self-image issues is a recurring problem that plagues individuals who suffer from gynecomastia – be it caused by outer perception, bullying or even personal guilt. And while the hormonal condition tends to go away with time, at times, it also calls for surgery as it did in the case of  The Rock, who supposedly underwent a reduction procedure in 2005. Aesthetics being the main reason given – many men stricken with the issue refrain from showing their torsos, wear loose t’s, and can even lead to making lesser public appearances.  A beauty or aesthetic issue at first glance, the problem of male breasts lays deeper roots.

Decoding male breast reduction with industry experts: 

Dr Dhruv Chavan, M.B.B. S, M. S, M. Ch, Plastic and Aesthetic Surgeon at Clear Skin & Hair MD Clinics Pune along with Dr Karishma Kagodu a leading plastic & cosmetic surgeon as well as the Founder and Managing Director of Dr Karishma’s Aesthetics are two individuals who are no stranger to cosmetic surgeries, especially of aesthetics like the male breast reduction surgery.  The two shared their insights about Gynecomastia, its cause, reception, and solutions as we delve deeper into the issue.

Why is there a stigma around the topic of male breast reduction and why do you think it is necessary?

Dr Dhruv Chavan: The stigma around male breast reduction largely stems from the association with the word “breast,” typically linked to female anatomy. Terms like “man boobs” add to the negative perception, impacting a man’s self-esteem. The necessity for reduction depends on the severity of the condition and its impact on the individual. While physical symptoms like pain and nipple discharge are rare, the psychological effects, such as embarrassment, bullying, and social withdrawal, are significant. Addressing these issues can greatly improve a man’s quality of life.

Dr Karishma Kagodu: Gynecomastia or male breast enlargement (male boobs/ moobs) is usually a benign/ noncancerous condition, and the most common reasons include puberty, ageing, medications, and certain health conditions that affect hormones, i.e., the imbalance between the sex hormones testosterone and estrogen.

In the window of stigma/ embarrassment, since gynecomastia causes the development of female-like breasts in boys or men, surgical removal is necessary to restore one’s self-confidence. In addition, gynecomastia can also be a side effect of using illegal drugs, such as anabolic steroids, heroin, or marijuana; it is critical to cope with the condition. Thus, these factors may fuel the reason for taking it as a stigma. Discontinuing these drugs or certain medicines can help reduce the tenderness and softening of the glandular breast tissue, but this is not always the case.

In the context of surgical necessity, gynecomastia requires cosmetic attention if the problem does not resolve within a certain time frame during puberty or when people with gynecomastia report pain in their breasts. In many cases, the cause is not known, but surgical removal is necessary when it is tough to cope with the condition.

In the case of Dwayne Johnson, aka ‘The Rock,’ the surgery was conducted for aesthetic purposes. Please elaborate on the health reasons that may also lead to the surgery.

Dr Dhruv Chavan:  Just like Dwayne Johnson, aesthetic reasons are the most common and primary motivation for gynecomastia surgery, it can also address health concerns. Rarely, patients may experience pain (mastalgia) or nipple discharge, which require thorough evaluation. It’s crucial to understand that gynecomastia is a result of hormonal imbalance and not a disease itself. The underlying hormonal imbalance must be identified and treated before considering surgery. Additionally, there’s a myth that untreated gynecomastia can lead to breast cancer. However, the chances of developing breast cancer are the same for men with and without gynecomastia. This condition does not increase the risk of breast cancer, so the decision to treat gynecomastia should be based on physical and psychological symptoms rather than fear of cancer. Although rare, untreated gynecomastia can lead to persistent discomfort and psychological distress, making surgery necessary for some patients.

Dr Karishma Kagodu: Yes, gynecomastia has several medical benefits. Male breast reduction surgery improves posture, reduces back pain, and, along with restoring self-confidence, offers a more masculine figure.

Gynecomastia surgery is crucial to avoid certain health risks, i.e., breast cancer, as well as psychological or emotional problems, such as anxiety, depression, low self-esteem, and even eating disorders and body dysmorphia, it is advisable to consult a board-certified plastic surgeon. More severe cases of gynecomastia may require surgical tissue excision when a patient has stretched, sagging skin around the breasts, prominent breasts swelling, pain or tenderness, nipple discharge, a firm or hard lump, and dimpled skin on the breasts. One must note that certain risk factors, such as testicular damage, liver and kidney damage, hyperthyroidism, hypogonadism, and Klinefelter’s syndrome, need to be diagnosed to understand the condition better before making the surgical decision.

What techniques do you use for male breast reduction surgery, and how do you determine the best approach for each patient?

Dr Dhruv Chavan:  I perform the surgery with liposuction, gland excision and skin tightening techniques. Gynecomastia surgery addresses three types of tissues: skin, fat, and glandular tissue. The fat is first targeted using 4th Generation Ultrasonic Assisted Lipolysis (UAL), which effectively melts the fat and additionally heats the skin from the inside, aiding in effective skin contraction. Once UAL is done, I perform Power Assisted Liposuction (PAL) using the MicroAire device, the most advanced and preferred tool for liposuction. PAL effectively removes the fat and breaks the gland into fragments, allowing easier removal through a small incision. This comprehensive approach ensures minimal scarring(Imperceptible scar), effective skin contraction and optimal results. The best approach for each patient is determined by the extent of tissue enlargement, skin elasticity, and overall health.

Dr Karishma Kagodu: Treatment will be based on one’s problem status, age, and general health; however, in some cases, hormonal therapy may work. Still, surgery can be required if there is increased severity of gynaecomastia despite no underlying diseases to treat, and there has been no improvement in the last six months. The preferable, cutting-edge technique to treat gynecomastia at our clinic is high-definition, 4D VASER liposuction (less invasive, less blood loss, faster recovery, and better results) when a patient has mild to moderate excess fatty tissue deposition and glandular tissue without excess skin laxity. VASER does a great job of removing the fibrofatty tissue that is difficult to remove with conventional liposuction. Tissue-excision technique is preferred when the patient has moderate to severe gynecomastia and excess skin laxity.

What are the potential risks of this surgery, and how often do complications occur in your practice?

Dr Dhruv Chavan:  While risks associated with anaesthesia and surgery are generally low, some complications can occur. The most common are seroma (fluid accumulation) and hematoma (blood accumulation). Scar-related complications, such as keloid or hypertrophic scarring, can also occur, especially in individuals prone to these conditions. Rare but notable complications include contour deformities and “saucer deformity” due to aggressive liposuction. In my practice, complications are infrequent, thanks to meticulous surgical technique, extensive training and careful patient selection and management.

Dr Karishma Kagodu: About 20,000 people get this surgery every year. As far as complication rates are concerned, some minor complications do not significantly affect the result. Some side effects are common, such as bruising and scarring, swelling, infection, loss of sensation, or pain, which settle on their own, followed by prescription medication, or can be easily managed with the right post-op care. My practice has no cases of nipple-areola complex necrosis or areolar tethering. Follow your plastic surgeon’s advice about how to care for your incision when you go home. Call your clinic if complications are severe, such as bleeding or pus from the incision, severe pain, fever, or redness and swelling near the incision.

Source: Lifestyle Asia