Gynecomastia, the growth of breast tissue in men, can be a shame for teens, but it can end a career for professional bodybuilders. Two plastic surgeons said the culprit was steroid use and the best treatment was surgery, not liposuction.

Gynecomastia, the growth of breast tissue in men, can be embarrassing for teens, but it can mean the end of a career for professional bodybuilders. His sport features competitive events where competitors cannot have more than 9% body fat, which further improves their glandular tissue.

Mordcai Blau, MD and Ron Hazani, MD write in a plastic and reconstructive surgery journal that there is a solution for plastic surgery. However, when the disease is treated with liposuction, and not surgical excision, it can lead to relapse, bleeding, and other side effects, they wrote.

The authors practice surgeons (respectively) in White Plains, NY and Beverly Hills, CA.

This condition occurs in many adolescents (estimated at 35% to 65%) and usually goes away. But it can be permanent when it comes to bodybuilders. This usually happens with anabolic steroids or over the counter hormones sold in sports and nutrition stores.

Between 1980 and 2013, surgeons treated 1,574 bodybuilders with gynecomastia. Of these, 1,073 were followed for 1 to 5 years. Only 2% of men were candidates for liposuction; the rest had too much unwanted breast tissue and needed surgery.

Subtotal excision in the form of subcutaneous mastectomy was used, which in 98% of cases gave “pleasing aesthetic results,” the doctors wrote. “There was no infection, contour deformation or relapse.”

Surgery works best, but there are also challenges: There is an increase in mammary vessels due to their hypertrophic pectoral muscles and the intake of various omega fatty acids, a condition that threatens them with bleeding.

All glandular tissue must also be removed otherwise it will grow. And before surgery, patients should be evaluated to make sure the disease is not caused by endocrine problems or testicular cancer.

“Experience has shown that almost complete excision of the glandular problem is the most appropriate treatment for gynecomastia in bodybuilders, while suction-assisted lipectomy should rarely be used,” Blau wrote. He added that although he had no personal experience with ultrasound liposuction, he treated patients for whom the procedure had not worked.

The surgery is sometimes covered by insurance, but “gynecomastia surgery is considered cosmetic by many payers,” the article states.