Medications and Drugs That Can Lead to Enlarged Male Breasts (Gynecomastia)

Gynecomastia, which is the enlargement of breasts in a male is relatively common and is a frequent cause of embarrassment and insecurity. I have indicated elsewhere that the underlying cause of gynecomastia is related to the absolute and relative levels of the sex hormones testosterone and estrogen. Their levels are significantly affected by puberty, aging, alcohol, and a variety of medications, illicit and street drugs, and diseases.

Listed below are several broad categories of medications with some specific examples that are associated with male breast enlargement:

1. Anti-androgens used to treat prostate enlargement or cancer: finasteride (Proscar, Propecia), dutasteride (Avodart), flutamide (Eulexin); cyproterone (Androcur)
2. Anti-anxiety medications: diazepam (Valium)
3. Tricyclic antidepressants: amitriptyline (Elavil), doxepin (Sinequan) and imipramine (Tofranil)
4. Antibiotics such as ketoconazole (Nizoral) and isoniazid
5. Ulcer medications such as cimetidine (Tagamet)
6. Certain chemotherapy agents used in the treatment of cancer.
7. Cardiac medications such as digitalis (Digoxin) and calcium channel blockers such as amlodipine (Norvasc), diltiazem (Cardizem) and nifedipine (Procardia)
8. Certain AIDS medications especially Efavirenz
9. Products that contain tea tree oil or lavender oil
10. Miscellaneous medications such as estrogen, spironolactone (Aldactone), and HCG (human chorionic gonadotropin)

The following includes street and illicit drugs that have been found to cause gynecomastia:

1. Marijuana
2. Cocaine
3. Anabolic steroids
4. Methadone
5. Heroin
6. Amphetamines

If you have developed gynecomastia that is not related to puberty, alcohol or certain diseases and may be on one of the agents listed above or a similar medication or drug, it would be wise to investigate the situation further. You may want to discuss the situation with your primary care doctor or the appropriate prescribing physician if relevant.

To later cosmetically address the enlargement of the breasts (if appropriate), male breast reduction surgery can be considered. This procedure may involve ultrasonic assisted liposuction of the breasts with or without directly removing the enlarged glandular tissue.

If you would like more information on male breast reduction surgery for the treatment of gynecomastia such as with ultrasonic assisted liposuction or information on any other cosmetic surgery procedure, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Though radiation therapy is important in many situations for the treatment of breast cancer, it does present a challenge for breast reconstruction. Its permanent effects on the tissues of the chest can be significant and will have some impact on the reconstructive results.

The ionizing radiation injures and destroys healthy cells leading to scarring, thickening and rigidity of the tissues often with some associated change of color and texture. The outcome is skin and underlying tissues that feel firm, somewhat rigid and more resistant to stretching which is required for breast reconstruction using tissue expansion. In addition, nutritional blood flow to the area exposed to the radiation is significantly decreased due to permanently injured blood vessels. The consequences of this are an increased risk of infection, prolonged healing times from surgery and injury and greater susceptibility to trauma.

Because of these manifestations of radiation, it is not uncommon to be unable to stretch the tissue out to the predetermined volume and it definitely requires more time and patience. Infections are more common as is the incidence of capsular contracture, the formation of additional restricting scar tissue that further limits expansion. Incisions take much longer to heal and may reopen during the expansion. The tissue expanders not infrequently erode through the skin requiring an immediate surgical response.

Breast reconstruction employing tissue expanders in previously irradiated tissue can be successful but the risks and challenges should be understood as well as other options that may be available.

If you would like additional information on breast reconstruction or any other surgical procedure or to schedule a consultation, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Hematomas, which are undesirable accumulations of blood, are an inherent risk of most surgical procedures. They are relatively uncommon following a breast augmentation, occurring in about 1 to 4 percent of patients. Simple precautions can be taken to help minimize the incidence.

Medications and other substances that interfere with the ability of blood to clot normally will increase the risk for the development of a hematoma following surgery. Commonly used medications that are known to have this side-effect include aspirin, ibuprofen, Motrin and Aleve. There are also ones specifically used as blood thinning agents to prevent clots such as Coumadin, Warfarin and Plavix. Many herbal supplement as well as Vitamin E and fish oils also have blood thinning effects.

My patients are provided with a thorough list of medicines, supplements and herbs that should be avoided for a specific period of time. Most of these medications, Vitamin E and herbal supplements should not be taken starting two weeks preoperatively and continuing until two weeks postoperatively. Therapeutic blood thinners like Coumadin and Warfarin are typically stopped two to three days before surgery and restarted again around two to three days postoperatively. Clearance from your physician to temporarily discontinue these medications is mandatory.

Vigorous activities that involve considerable exertion, heavy lifting or repetitive upper extremity movements can increase the risk of hematomas. My patients are instructed to avoid sports, aerobics, jogging, and similar activities for around three weeks after surgery. For those women who have a fairly physical or strenuous job such as hairdressers, nurses and waitresses, some restrictions are recommended during this period of time.

A few simple steps taken can keep your risk low for developing a hematoma following a breast enlargement and therefore avoid the undesirable consequences.

If you would like additional information on breast augmentation, breast implants or other cosmetic procedures, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Breast reductions are most commonly performed for functional reasons, that is, to alleviate symptoms such as neck, back and shoulder pains, headaches and rashes. Even in these situations, there is an aesthetic effect as the smaller breasts will also be lifted and rejuvenated in appearance.

What are some of the reasons to undergo a breast reduction for cosmetic reasons? These can involve situations where the breasts are large but not so gigantic that they would be associated with discomfort but they are bigger than the woman desires or attract unwanted attention or comments. By reducing their size they will be more to the woman’s sought after body image and would be less conspicuous.

Another reason to pursue a breast reduction for aesthetic reasons is where the breasts are both droopy (ptotic) and larger than desired. In this scenario, they are not large enough to cause symptoms or to qualify for insurance coverage. By decreasing their size, tightening the skin envelope and lifting the tissue, smaller, perkier and more youthful appearing breasts can result.

This last scenario can possibly be considered also to be a breast lift (mastopexy) with a small reduction. There can be confusion at times as to what constitutes a breast reduction of which a lift is usually an intrinsic component versus a breast lift with a small reduction. Both procedures usually involve the same incisions. The difference lies in the amount of breast tissue that is removed. Though there is no specific amount that distinguishes between the two, some consider removal of less than 300 grams per side to warrant being called a lift with a small reduction.

Either way, the results are smaller, lifted and perkier breasts.

For additional information on breast reduction surgery, breast lifts or other breast procedure or to schedule a consultation, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

In our society, there is a strong emphasis on breasts and breast size. From magazines, television, movies and even advertisements, there is a preponderance of voluptuous well-endowed women that are seen as the ideal. Their presence seemingly everywhere can be quite stressful for the adolescent girl experiencing considerable hormonal and emotional fluctuations and physical changes along with a fragile body image.

When an adolescent girl realizes that her breasts are not and will never be the size that she would like them to be, what is the youngest age that it would be reasonable for her to pursue breast augmentation surgery? Taking physical, emotional, and intellectual issues and maturation into consideration, my recommendation is for her to wait until at least 18 years of age before undergoing a breast enlargement.

As with many things, there are some exceptions. If a girl has breasts of such significantly different sizes that is difficult to hide with normal clothing or if there is either severe underdevelopment or absence of one breast (which is often congenital in nature), proceeding with surgery at an earlier age may be more prudent. Surgery in these situations may even be considered to be reconstructive.

If you would like additional information on breast augmentation, breast implants or other cosmetic procedures, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona