Breast development can occur during adolescence and may appear as a small lump just under the areola. Gynecomastia commonly occurs during puberty, and it may affect up to 40 percent of adolescent boys during puberty, usually by the age of 14. The excess breast tissue disappears without treatment in two years in 75 percent of these children, and within three years in 90 percent of them.

Men with gynecomastia often avoid normal activities such as swimming, exercise, and sex to avoid exposing their condition. Unfortunately for aging men, no exercise program or diet can resolve gynecomastia. However, there is a plastic surgery procedure that can remove excess breast tissue.

Gynecomastia can be a side effect of some medications and drugs. The most common medication that causes breast development is estrogen. Other medications linked with gynecomastia include certain antidepressants, drugs used to treat high blood pressure and tuberculosis, some chemotherapy agents, and anabolic steroids. Drinking alcohol in excess or smoking marijuana are other possible contributors. Some diseases can cause gynecomastia too, including certain endocrine disorders, tumors, and chronic diseases.

Surgery to correct gynecomastia may be performed on healthy, emotionally stable men of any age, providing the breast is fully developed. The best candidates for surgery have firm, elastic skin that will reshape to the body's new contours.

Surgery may be discouraged if you are obese, or if you are overweight and have not first attempted to lose the fat around the breast area with exercise or weight loss. If you use drugs that may cause the condition (excessive alcoholic beverages, marijuana, anabolic steroids, etc.), you would not be considered a good candidate. Your doctor would first direct you to stop the use of these drugs to see if the breast fullness will diminish before he would consider surgery as an option.

If your gynecomastia consists primarily of excessive fatty tissue, your surgeon may use liposuction. If excess glandular tissue is the primary cause, the tissue may be cut out with a scalpel. The excision may be performed alone or in conjunction with liposuction. In extreme cases where large amounts of fat or glandular tissue have been removed, skin may not adjust well to the new smaller breast contour. In these cases, excess skin may have to be removed to allow the skin to firmly re-adjust.

Breast reduction surgery for gynecomastia is most often performed as an outpatient procedure, but in extreme cases, or those where other medical conditions are cause for concern, an overnight hospital stay may be recommended. Time in surgery is typically an hour and a half. More extensive procedures may take longer.

Be sure to arrange to have someone drive you after surgery and to help you at home for a day or two if needed. Whether you've had liposuction or excision with a scalpel, you will feel discomfort for a few days after surgery. Pain can be managed with a prescription from your doctor.

To help reduce swelling, you'll probably be instructed to wear an elastic pressure garment continuously for a week or two, and for a few weeks longer at night. Although the worst of the swelling will subside in the first few weeks, it may be three months or more before the final results of your surgery are apparent.

You'll be encouraged to begin walking around on the day of surgery, and to return to work when you feel well enough -- which could be as early as a couple of days later. Stitches are generally removed one to two weeks after the procedure.

Your surgeon may advise you to avoid sexual activity for a week or two, and heavy exercise for about three weeks. You will be told to stay away from any sport or job that risks a blow to the chest area for at least four weeks. Your activities should be back to normal after about a month.

Avoid exposing surgical scars to the sun for at least six months. Sunlight can permanently affect the skin's pigmentation, causing the scar to turn dark. If sun exposure is unavoidable, use a strong sunblock.

The procedure alone combines three costs: anesthesia fees, facility fees, and surgeon's fees. Since the doctor performing tumescent liposuction will not know what is required until the consultation, only an estimate can be made. Total fees could range from $3,600 to $6,000. For financing options and tips, please read our article on patient financing.

1. Check references. References may be obtained through friends, your doctor, the American Society of Plastic Surgeons, and the American Society for Aesthetic Plastic Surgery.

2. Review credentials, the type of training, and the length of the training for the procedure.

3. Inquire how many times the procedure has been performed by the surgeon.

4. View the doctor's before-and-after photos of individuals who received the procedure, to help set reasonable expectations.

5. Inquire about the type of equipment to be used, where the procedure will be performed, and the extent of the procedure.

6. Review possible side effects of the procedure with your doctor.

Before you decide to have surgery, think carefully about your expectations, and discuss them frankly with your plastic surgeon. The results of the procedure are significant and permanent.

It's important to choose a board-certified plastic surgeon from the American Board of Plastic Surgery with extensive experience in male breast reduction procedures. Board certification may not always guarantee the best results; however, board certification does require specific and rigorous surgical education and training that improve the odds for a successful outcome.