Men are becoming much more open about plastic surgery these days. It’s no longer the taboo, hush-hush subject it was in the past, and social media has largely helped in breaking that wide open. When men come into my Houston office, they are consistent about what they want to achieve. One of the most common requests, without fail, is the correction of gynecomastia.
Most men call it "man boobs," but regardless of the name, the frustration is the same. They’ve spent years in the gym, hitting the bench press and logging hours of cardio, only to find that the soft appearance of their chest hasn't changed. If you’ve reached a point where your effort doesn’t match your results, it’s important to understand the anatomy of why the gym isn't always the answer for breast enlargement.
The reason fitness often fails to resolve this issue is that gynecomastia isn't always a fat problem; it’s an architecture problem. True gynecomastia is the growth of actual glandular breast tissue, the firm, rubbery material behind the nipple.
"You can't exercise away a gland," Dr. Fortes notes. "I see men all the time who think they just need more discipline. But if you have glandular tissue, building the pectoral muscle underneath can actually push that tissue out further, making the chest appear more projected rather than flatter."
This is a biological reality. Glandular tissue responds to hormone changes, not calorie deficits. When you have enlarged breasts, the machine of your body is responding to a different set of internal instructions.
While weight gain can contribute to a softer breast, true growth of male breasts usually boils down to hormonal changes that have nothing to do with your workout routine. Hormone fluctuations are the primary cause of gynecomastia, specifically an imbalance between estrogen and testosterone.
The primary driver is a shift in the ratio of the hormones estrogen and testosterone. Every man has both, but when estrogen levels rise or testosterone levels dip, the breast tissue reacts.
"As we get older, Mother Nature begins to change our hormonal chemistry," says Dr. Fortes. "This natural decline in testosterone can lead to a softer profile even in older men who remain very active. It’s a physiological change, not a lack of effort."
This hormonal imbalance can be triggered by several factors:
We also see a faster rise in cases linked to certain medications. From hair loss treatments to taking medications for prostate cancer, the side effects often involve breast enlargement.
"Men need to be aware of what they are putting into their systems," Dr. Fortes warns. "Sometimes the very things intended to help you in the gym, like anabolic steroids or even certain illegal drugs, are exactly what cause you to develop gynecomastia."
When you see a healthcare provider for a physical examination, they will assess the degree of enlargement. Gynecomastia can affect one or both breasts. In a systematic review or literature review of clinical features, plastic surgeons often use a grading scale:
During a physical exam, your doctor will also check for symptoms like nipple discharge or unusual lumps to rule out male breast cancer. While breast cancer in men is rare, any localized change deserves a thorough physical examination and potentially liver function tests to ensure the prognosis for gynecomastia is purely aesthetic.
In recent years, there has been a significant trend toward more conservative, athletic results. Men aren't looking for over-the-top changes. They want the slender, fit appearance that their genetics might currently be hiding. Low self-esteem often stems from feeling that your body doesn't reflect your masculine identity.
"The goal today is 'less is more,'" says Dr. Fortes. "Men are coming in at a younger age than they used to because they want to stave off that dramatic change that happens as they get older. They want a well-defined point to the chest that doesn't appear to wrap around the back."
To treat gynecomastia effectively, the focus is on male chest contouring. This involves surgical treatment of two distinct components: the fatty tissue and the gland.
We often use liposuction to thin the fatty layer not just on the chest, but in the axilla—the area in front of the armpit. However, to truly prevent gynecomastia from returning, we must address the glandular tissue.
Gynecomastia surgery involves a small incision at the border of the areola to physically remove the firm tissue. This is a precision-based surgical intervention. Simply "liposucking" the area won't work on firm glands; they have to be excised to ensure a truly flat, masculine contour.
One of the biggest hurdles for men considering surgery is the fear of a "traumatic" recovery. There is a lingering misconception that you will be sidelined for weeks. However, surgical treatment has evolved.
"We’ve moved away from the old way of doing things," Dr. Fortes explains. "We no longer rely just on oral medications that cause dizziness, nausea, or constipation. Today, we use long-acting local anesthetics like Exparel that give a numbing effect for about 72 hours. This was unheard of in the past."
By using advanced numbing techniques and focusing on a smooth treatment plan, the goal is to get men back on their feet faster. Most men find they can return to light work within a few days, finally seeing the results of the gym-ready chest they’ve been working toward for years.
Beyond the physical, the correction of enlarged breasts provides massive relief for mental health. Many men spent their lives "shirting" themselves at the pool. Self-esteem is often tied to how we feel the world perceives us.
"The shift in confidence is often the most rewarding part," says Dr. Fortes. "When you no longer have to worry about how your shirt fits, it changes how you carry yourself. It’s about no longer feeling like you have to hide."
Whether it's newborn babies (where male babies get a temporary boost of maternal estrogen) or older adults facing hormone declines, gynecomastia caused by biology shouldn't be a source of shame. As noted in the European Journal of Plastic Surgery, the prognosis for gynecomastia patients following surgery is overwhelmingly positive when it comes to quality of life.
If the gym hasn't fixed your chest, it isn't a failure of your willpower; it’s a matter of anatomy. Whether your condition is caused by a specific condition or simply the hormone changes of aging, there is a path forward.
"I don't have a one-size-fits-all approach to the male body," Dr. Fortes says. "We look at your specific anatomy. Whether we are doing a male breast reduction or refreshing your profile, the goal is to help you look great and feel confident."
Breaking the stigma of the past is the first step. By understanding the underlying causes of gynecomastia, you can start planning for a result that reflects your hard work.
