CredentialsPositions
Board Certifications
Education and Training
- Clinical Assistant Professor, Hansjorg Wyss Department of Plastic Surgery at NYU Grossman School of Medicine
Board Certifications
- American Board of Plastic Surgery - Plastic Surgery, 2014
Education and Training
- Fellowship, NYU Grossman School of Medicine, Microsurgery, 2013
- Fellowship, NYU Grossman School of Medicine, Plastic Surgery, 2012
- Residency, NYU Grossman School of Medicine, Surgery, 2009
- MD from University Of Rochester, 2006
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
The following is a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed.
Speaker 2 (00:09):
The following program is brought to you by NYU Land
Gone Health. It's CATS's Corner with doctor Aaron Katz. You're
trusted expert in men's health, providing straight talk on a
wide range of men's health topics and advice on how
to live your healthiest life. Now on seven to ten WOOR.
It's the Chairman of Urology at NYU Land Gone Hospital,
(00:32):
Long Island. Here is doctor Aaron Katz.
Speaker 3 (00:36):
Well, good morning everyone, and welcome again to CATS's Corner
here on wr iHeartRadio. So glad you could join us today.
We have a wonderful show for you. And in light
of this October being Breast Cancer Awareness Month, we have
an interesting show today which we'll be talking about breast cancer,
but not specifically for women, but for men and this
(00:58):
is certainly a clinical situation that does come up. We're
going to be talking with doctor Lawrence Draper, who is
Clinical Associate Assistant Professor in the Department of Plastic Surgery
here at the NYU Grossman School of medicine, and he
did complete a residency in plastic surgery at NYU and
also a fellowship in microsurgery the following year, also at NYU,
(01:23):
and his clinical interests are quite diverse. They do include
breast reconstruction and the treatment of a condition that we're
going to talk about this morning for men known as
gaina komastia, and we're going to talk about how that occurs,
what about breast cancer and men, and what about some
of the surgical treatments and reconstruction that can occur following
(01:47):
skin cancer and breast cancer treatment. And he does practice
here on Long Island. And in the middle of the show,
I'll announce for those listeners that would like to share
this with a loved one his phone number for his office.
Doctor Lawrence Draper is here this morning. Good Lawrence, and
thank you so much for coming on to Kats's corner.
Speaker 4 (02:08):
Good morning, how are you.
Speaker 3 (02:09):
I'm doing very well and appreciate the time. And let's
maybe we can just start, Lawrence, if you could just
tell the listeners about you know, the I guess breast enlargement, gynochomastia,
breast cancer. How common is that in the population. Certainly
we see, you know, pink and breast cancer awareness. We
(02:31):
think about women with breast cancer, but what about men?
Is that something that you see quite a bit of.
Speaker 4 (02:38):
Well, breast cancer in men is a rare condition. So
in women, the incidents of breast cancer is about one
in eight lifetime risk. For men, it's about one in
eight hundred, so it is significantly less in terms of incidents. However,
(03:00):
men that have been diagnosed with breast cancer don't tend
to do as well stage for stage relative to women
with breast cancer, and that's thought to be from a
variety of things. One of the most important factors may
be lack of awareness and that they present later than
(03:21):
women do with breast cancer. So breast cancer in men
is certainly not as common as in women, but it
is a real entity. It happens. There have been various
celebrities that have come out, you know, and detailed their
struggle with breast cancer, coming to mind as I Montel Williams,
(03:42):
I think, was very public about his battle with breast cancer.
So it's out there and it's important for men to
know that it is an entity and how they can
pick up on the signs and symptoms of breast cancer
and get themselves checked out.
Speaker 3 (03:59):
Yeah, and when you talk signs and symptoms, and certainly
for women, you know there's mammograms, and there's recommendations based
upon risk factors if you have it in your family,
or if you're from Eastern Europe, or you have a
certain type of a gene and maybe doing even self
breast exams and going for yearly mammograms. What is the
(04:22):
recommendation or if there are, maybe there aren't any for
men to screen for a breast cancer.
Speaker 4 (04:30):
You know, the recommendations are not as clear as they
are for women. But the best way to think about
it is to extrapolate from what we know about breast
cancer and women. So self exams are critical. So men
tend to have less breast tissue than women do. So
if you feel something that's abnormal, you feel a pea
(04:53):
sized tumor or a firm area that hasn't been there before,
whether it's tender or not, that's something to bring up
with your primary care physician. Just like women, men can
get mammograms and pick up on disease early. You can
have an ultrasound in some cases, you can have an
MRI to look in more detail. At the chest and
(05:17):
breast area. In terms of risk factors, age is a
risk factor. If you're older than sixty, you're at a
higher you're at a greater risk of developing breast cancer. Certainly,
if you have a first or second degree relative with
breast cancer, whether it be a woman or a man,
(05:38):
you're at a four times greater risk of developing breast
cancer as a man. If you have any genetic mutations
that are associated with breast cancer, your listeners may have
heard of the BRCA one BRCA two genes which can
predispose patients to breast cancer. Somewhere between four and sixteen
(06:00):
percent of male breast cancers do have that mutation, so
that is an important component. Genetic syndromes like Klin Filter syndromes,
which is when you're born with an extra X chromosome,
so your carrier type would be why XX can certainly
increase your risk of male breast cancer by twenty to
(06:23):
fifty times, and that is thought to be caused by
the high levels of estrogen that cliin Filter's syndrome patients have.
Obesity tends to disrupt the balance between testosterone and estrogen,
and being obese is certainly a risk factor as well,
and less common things such as radiation exposure. Exposure if
(06:45):
you underwent mantle radiation for lymphoma, for example, that can
also put you at risk for breast cancer.
Speaker 3 (06:52):
Yeah, certainly a lot of a lot of different things.
But yet, like you said, I guess the good news
in all of this is that with for men, it's
not that common. You said, I think it was one
in eight hundred, right, So that's that's somewhat reassuring, but
certainly something that we need to be aware of. And
then there's another condition that I think is probably more
common in men. I certainly see it quite a bit
(07:15):
in my practice, which is breast in larger or ginochomastia.
And perhaps you can tell us a little bit about that.
Speaker 4 (07:22):
Yes, gina coomastia is very common, very common. We see
a lot of it in our practice. Just to start
with defining some terms, kin of coomastia is a benign condition.
It's not cancer, and it is defined as abnormal growth
of breast glandular tissue in males, and it can affect
(07:45):
a person at many different stages of life. It can
happen at any time, but it tends to happen during
changes in the hormonal miliu. So for newborn males baby boys,
the vast majority baby boys have some type of breast
bud that you can palpay, and that is thought to
be due to placential estrogens that are still in that
(08:08):
child's bloodstream. Another spike happens and that tends to resolve
on its own almost almost all the time, after the
child metabolizes the mother's estrogen. Later in life, in early
adolescents thirteen to fourteen years of age, as kids start
to enter puberty, there can be an increase in estrogen
(08:33):
as well as testosterone, and it's thought that the arise
in estrogen can come before the surgeon testosterone, and then
that may be a cause. But it's very very common.
Something in the range of fifty to sixty five percent
of adolescent boys will have some degree of gynecomastia. Typically
(08:54):
that goes away on its own and around two to
three years. Most of the case are what are called idiopathic,
meaning that a cause is not known, but there are
other causes that we know from certain medications, certain substances.
So I always ask patients when they come in if
(09:16):
they smoke marijuana, certainly, marijuana or alcohol can cause ganicomastia.
Medications such as antipsychotics can cause ganicomastia as well, so
usually after you stop a medication, the ganicomastia will resolve. However,
there are some circumstances where it can cause irreversible ganicomastia,
(09:40):
such as the use of anabolic steroids. The use of
the exogenous distosterone can sometimes or will suppress your own
production of distosterone and disrupt that balance between estrogen and
testosterone and cause ganicomastia, But most of the cases by
far are of this un known ideology or cause. Where
(10:02):
it happens, the thought processes that it's from a hormonal
imbalance and it goes away on its own. Later in life,
when men are over fifty, there is another change that
frequently occurs in men, where their testosterone they're a free
testosterone may decrease over time and men are as you
get older. More men are frequently on some type of
(10:24):
medication for high blood pressure for a cardiac issue, and
it's thought that that can also contribute to the incidents
of gynecomastia. Common medications that people can be on they
may not even know that they're at risk for ganicomastia.
I think crestor or statins are linked to gynocomastia. Medications
(10:46):
that can be used for high blood pressure, like sprono lactone,
is linked to the formation of ganiccomastia. Antipsychotics as I
mentioned earlier, like Holdall or a respert All, are also
linked to ganicomastia as well. And again marijuana alcohol can
also contribute to the development of ganico.
Speaker 3 (11:09):
Mask you yeah, and thanks for that explanation. That was great,
And it's certainly again lots of causes of it. It's benign,
like you said, but Ken, I would think in God,
let's specifically we'll talk. We'll limit our discussion today for
men that are over fifty with this breast enlargement or
breasts that are too large. It's certainly you say, it's benign,
(11:32):
it's not malignant, but it can cause I would think
lots of in some cases some psychological effect. You know,
maybe you don't want to go to the beach, you
don't want to take your shirt off. Maybe if you're
in a relationship, you don't want to take your shirt off.
Maybe you don't feel right about yourself having in large breasts,
and I think I thought that maybe it was more
(11:52):
due to people that gained weight, that just that gained weight,
and but maybe that's not Maybe that's not right. Is
that not true just just being overweight?
Speaker 4 (12:04):
Because I think, well, obesity certainly can cause gynocomastia. It's
thought that with obesity, it may disrupt the balance of
testosterone estrogen, it may be more of an estage and
rich milieu, and that that can certainly cause this benign
(12:25):
breast growth. Is thinking on the matter, Well, what can
also happen is that you can develop a pseudo gyiniccomastia.
And what that means is that you have proliferation of
fat that happens to be in the area of the
breast and towards the side of the breast into the
axilla area. That you just have hypertrophy of those fat
(12:47):
cells as you gain weight. And so that can be
treated in a slightly different way. But yes, obesity in
and of itself can predispose you to developing ganiccomastia. And certainly, yeah,
go ahead.
Speaker 3 (13:02):
Now, I was gonna say, if you have this right
and you're concerned about it and maybe you want to
do something about it, is there a way to distinguish
between the gin of commastia and let's say breast cancer.
I mean, do you need you need a mammogram? First?
You should? Should you? Should you get a mammogram just
to check and make sure that there's no underlying cancer
(13:23):
there in the breast or is that?
Speaker 4 (13:26):
Yes? First and foremost you would take you know your
standard history and physical Are there any medications the patients
taking the predispose them to this war They placed on
oldactone or bernal actone recently, and that's could be a source.
So after doing that, if you roll out everything else
that could be a problem, you would want it. You
(13:47):
would want to test for any hormonal imbalance, and then
you should also get some imaging. So if you have
a mammogram, you can differentiate, you can certainly pick up
on signs of malignancy, and certainly if you have any
evidence of a malignancy, you would go down that path
(14:09):
of getting worked up for a breast malignancy, which could
involve a core biopsy, maybe more specific imaging like an MRI.
Is certain it's certainly something that your breast surgeon wouldn't recommend.
But first, as you may have been suggesting, it's important
(14:31):
to rule out more sinister diagnoses like breast cancer over
gani coomastia, if.
Speaker 3 (14:39):
You're just wake it up in the morning. Here on
Katz's corner, we're talking with doctor Lawrence Draper, who holds
a title of Clinical Assistant Professor in the Department of
Plastic Surgery here at NYU A Grossman School of Medicine.
He does see patients here on Long Island in Garden City.
I believe I'm going to give you the number, and
(14:59):
I'll I'll announce it a couple of times at the
end of the show. Uh, it's five to one six
seven five eight eight five five five. That number again
is five to one six seven five eight eight five
five five. And doctor Draper is a plastic surgeon. He's
not an oncologist. As we've been talking today and this morning,
(15:20):
and what i'd like to talk about now, Lawrence, if
you will, is you know, for men that have breast enlargement,
it's not cancer, it is enlarging. And let's say they're
they're uncomfortable, they'd like to do something about it. How
do you how do you if someone wants to seek treatment,
how do you evaluate them? And how do you, how
(15:40):
do you go about treating that and managing that great question.
Speaker 4 (15:45):
So it is benign, meaning that it's not cancerous, but
it can cause pain. Men come in with breast pain.
Usually one side is more painful than the other. Usually
the pain is retrorealer or behind the nipple area. Not
everybody has pain, but some patients do for sure, and
most patients do have some sort of psychosocial stress associated
(16:09):
with it. Not everybody, but certainly it's a select group
that seeks out to be seen by a plastic surgeon
to review their options. So there is some degree of
bias in the patients that I see. What can be
done about it? Once you confirm that you're not missing
something like a tumor or a testicular tumor or a
(16:30):
pituitary tumor that could be causing it, you want to
move on to what are the potential therapies, and certainly surgery.
As a plastic surgeon, surgery is an option, and really
that depends on the burden of the disease. What is
your anatomy like do you have a lot of loose skin,
(16:51):
do your breast troop? Do you have a small amount
of breast tissue? And good skin quality and really minimal
loose skin that would move me down a different path.
There are basically two different approaches. You can use liposuction,
where you basically inject medication to numb the area and
(17:16):
to constrict the blood vessels in the area, and that
is followed by insertion of relatively small canulas, which are
these metal instruments that are hollow on the inside with
a cutting tip, and you can basically disrupt the fat
and in some cases breast tissue and basically suck it
out through a relatively small incision. That is a very
(17:39):
powerful technique to use, especially in pseudoganicomastia where it's more
just fat in the area than breast tissue. Breast tissue
tends to be fibrous, and so while liposuction can be
a good adjunct or an additional therapy for direct decision,
typically if you have true ganicomastia, you need to physically
(18:00):
cut the tissue out, and that can be done in
a couple different ways. If you have a minimal burden
of disease, let's say you just have some disease around
the nipplein arela complex and adjacent to that area, you
can make an incision next to the pigmented part of
the niplin arella complex called the arella, so it's well hidden,
(18:23):
raise up some skin flaps, and develop a dissection plane
where you can remove the breast tissue evenly so that
you don't create any kind of deformity as you're removing
the breast tissue. And then at the end of the procedure,
usually I leave a drain and you're left with an
incision just confined to that area between the arella and
(18:47):
normal skin that is reserved for patients that have good
skin quality and don't have a lot of skin laxity,
and have a pretty well localized burden of this gnigomastia
just in the region of the nipple and a real
complex and the area around it.
Speaker 3 (19:04):
Interrupt is intrupt? Is that done under anesthesia or is that?
Is that a local or is that like in a
doctor's office that procedure or is that in an operating room?
Speaker 4 (19:13):
In my practice, this is done in the operating room.
I think it's too much intervention to be comfortably done
in a procedure room or in an office type setting.
Speaker 3 (19:23):
What about the liposuction? Is that done under anesthesia too?
Or is that local?
Speaker 4 (19:27):
It depends on which practice you go to, but I
always do the liposuction under at least sedation, if not
general anesthesia.
Speaker 3 (19:36):
Gotcha, And then there was one more you were going
to talk about, right, A larger type of man have
much larger breasts. Is that.
Speaker 4 (19:43):
Yes, So if there's someone that has a lot of
redundant skin or a breast that's large or has, for
lack of a better term, has some drooping breast morphology,
then usually you have to ressect some skin in addition
to the breast tissue. So usually you remove the skin
(20:03):
at the lower part of the breast. You remove the
nipple and arela remove all of the breast tissue with
the goal of making them as flat as possible and
accentuating their pectoralis muscle, the muscle on their chest. And
then after the wound is closed, you put the nipple
in a reella complex back on in the location of
(20:25):
the ideal mal nipple, which is a little bit of
a more involved procedure, but is very reliable and tends
to give very good results.
Speaker 3 (20:33):
Yeah, what would you say is the patient's satisfaction rate
with doing something like this? I'm almost thinking also a
lot some women need a breast reduction. I think, is
it a similar type of surgery that you do for
women that require a breast reduction, or is it a
completely different type of thing.
Speaker 4 (20:49):
It's similar, it's related. For women, you try to avoid
taking the nipple off and using it as a graft,
But in a breast reduction, for a woman, it serves
to functions Aesthetically, you're trying to make a breast that
looks good, esthetically pleasing, but is smaller and it's more
comfortable for the patient. In this operation, the esthetic goals
(21:14):
are to make the patient as flat as possible typically
and accentuate that peck muscle. The indications are different, but
there are some similarities.
Speaker 3 (21:24):
And so the overall satisfaction for these is pretty high.
Speaker 4 (21:28):
Would you say yes, It's up to me when patients
come in to give them realistic expectations. So they have
to be okay with the burden of scars, where the
scars are located, some of the problems that can be
encountered during the procedure, such as a contour, deformity, or
abnormal scarring. After I explain all that clearly and I
(21:51):
understand their goals and they understand the limits of the
procedure and if they choose to move forward, then those
patients tend to be very happy at the end of
the day.
Speaker 3 (22:00):
Wonderful. And you know, I need to just ask you
one final question about this, and of course, if you're
just tuning in where we've been talking with doctor Lawrence Draper,
who's a plastic surgeon at NYU and specializes in reconstruction
of breast both for men and women. And today we're
talking about breast cancer. We've been talking about the incidents
and who's affected by it, as well as this benign
(22:22):
condition of guinoclemastia which is much more common in men,
and some of the surgical options and reconstruction following in
managing patients with gynocomasty. If you'd like to reach doctor Draper,
his number is five to one six seven five eight
eight five five five. The number again is five to
one six seven five eight eight five five five. What
(22:46):
about insurance? Will will insurance cover this? It's a medical condition?
Maybe is patients like you said, I've been on medications
or may have some underlying condition and leading to breast enlargement.
How does that work?
Speaker 4 (23:02):
That's a that's a great question, and it can be
a sticking point during a consultation. So it depends on
why someone is presenting to see me. If they come
in and they're complaining of pain, and in the note,
I have their exam thoroughly documented and the purpose of
the operation is to treat pain, that is more likely
(23:24):
to get approved than someone that comes in and says
they just don't like the way that they look. If
they have if they've been on anti retroviral therapy and
they have gonakomastia secondary to a medication use, I have
a good history of getting that approved by insurance. But
unless there is a medical diagnosis that is that you're
(23:48):
treating with this, it can be misconstrued as just a
cosmetic operation, and that's where it can be difficult getting
insurances to cover this.
Speaker 3 (23:58):
Procedures understood for those patients that do present with pain.
Are you able to relieve the pain in a good
number of.
Speaker 4 (24:08):
Patients, Yes, If the source of the pain is this
abnormal breast tissue and you remove it, then usually that
goes away. Wow, with the excision of the tissue, hopefully
in the most cosmetically appropriate fashion as possible, then yes
it does.
Speaker 3 (24:26):
I mean, here you are living with pain every day
with breast enlargement and also having the psychological effects. And
you're basically taking care of two things for patients and
really probably improving their overall quality of life and may
making them feel better, they look better, look at themselves
in the mirror and I don't know, in the beach
or wherever. And also relieve daily pain. I mean that
(24:50):
to live with daily pain like that from this just
remarkable jobs. So thank you so much for all you do,
Lawrence Draper. Thank you and for also for educating all
of us about this.
Speaker 4 (25:02):
Certainly thank you for having me on. Yeah.
Speaker 3 (25:05):
And it's it's something that you see pretty commonly, is it.
I mean, as you see if kind of commancity, you
do see that quite a bit.
Speaker 2 (25:10):
Huh, very common, very common.
Speaker 4 (25:13):
Yeah, on a weekly basis, we see several houses. Yes.
Speaker 3 (25:17):
Wow. Okay, Well, if you've been listening to doctor Draper
and uh you yourself, you know, thinking about this, you've
had this pain or rest enlargement and thinking about ways
to to to remove the excess tissue, and certainly have
an evaluation to make sure that there's nothing underlying that's
even more concerning. As doctor Draper pointed out, please give
(25:39):
him a call. Your practice is here in Garden City, doctor,
or is it in Minneola? Where do you practice?
Speaker 4 (25:48):
It's here in Garden City. It is in garden City. Yes,
one one one Franklin Avenue, Garden City is the NYU
Lingo and Ambulatory Care Center and our clinic is.
Speaker 3 (25:59):
There beautiful, Yes, downtown garden City actually a beautiful center.
And if you'd like to give him a call, that
number again is five one six seven five eight eight
five five five. Thank you so much, doctor Lawrence Draper
here on Katz's Corner educating us and all the listeners
about kind of commastia and breast cancer on this Sunday
(26:19):
in October, which is Breast Cancer Awareness Month. Thank you again, Laurence,
really appreciate you coming on. Thank you for having Well,
let's go endo the show. Everyone, Thanks for tuning in.
We'll be back next week with a great show here
on Katz's Corner. Tune in every Sunday. This is doctor
Aaron Katz.
Speaker 2 (26:34):
You've been listening to Katzer's Corner. Come back every week
to hear more straight talk on a wide range of
men's health topics and advice on how to live your
healthiest life.
Speaker 1 (26:45):
The proceeding was a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed
The following is a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed.
Speaker 2 (00:09):
The following program is brought to you by NYU Land
Gone Health. It's CATS's Corner with doctor Aaron Katz. You're
trusted expert in men's health, providing straight talk on a
wide range of men's health topics and advice on how
to live your healthiest life. Now on seven to ten WOOR.
It's the Chairman of Urology at NYU Land Gone Hospital,
(00:32):
Long Island. Here is doctor Aaron Katz.
Speaker 3 (00:36):
Well, good morning everyone, and welcome again to CATS's Corner
here on wr iHeartRadio. So glad you could join us today.
We have a wonderful show for you. And in light
of this October being Breast Cancer Awareness Month, we have
an interesting show today which we'll be talking about breast cancer,
but not specifically for women, but for men and this
(00:58):
is certainly a clinical situation that does come up. We're
going to be talking with doctor Lawrence Draper, who is
Clinical Associate Assistant Professor in the Department of Plastic Surgery
here at the NYU Grossman School of medicine, and he
did complete a residency in plastic surgery at NYU and
also a fellowship in microsurgery the following year, also at NYU,
(01:23):
and his clinical interests are quite diverse. They do include
breast reconstruction and the treatment of a condition that we're
going to talk about this morning for men known as
gaina komastia, and we're going to talk about how that occurs,
what about breast cancer and men, and what about some
of the surgical treatments and reconstruction that can occur following
(01:47):
skin cancer and breast cancer treatment. And he does practice
here on Long Island. And in the middle of the show,
I'll announce for those listeners that would like to share
this with a loved one his phone number for his office.
Doctor Lawrence Draper is here this morning. Good Lawrence, and
thank you so much for coming on to Kats's corner.
Speaker 4 (02:08):
Good morning, how are you.
Speaker 3 (02:09):
I'm doing very well and appreciate the time. And let's
maybe we can just start, Lawrence, if you could just
tell the listeners about you know, the I guess breast enlargement, gynochomastia,
breast cancer. How common is that in the population. Certainly
we see, you know, pink and breast cancer awareness. We
(02:31):
think about women with breast cancer, but what about men?
Is that something that you see quite a bit of.
Speaker 4 (02:38):
Well, breast cancer in men is a rare condition. So
in women, the incidents of breast cancer is about one
in eight lifetime risk. For men, it's about one in
eight hundred, so it is significantly less in terms of incidents. However,
(03:00):
men that have been diagnosed with breast cancer don't tend
to do as well stage for stage relative to women
with breast cancer, and that's thought to be from a
variety of things. One of the most important factors may
be lack of awareness and that they present later than
(03:21):
women do with breast cancer. So breast cancer in men
is certainly not as common as in women, but it
is a real entity. It happens. There have been various
celebrities that have come out, you know, and detailed their
struggle with breast cancer, coming to mind as I Montel Williams,
(03:42):
I think, was very public about his battle with breast cancer.
So it's out there and it's important for men to
know that it is an entity and how they can
pick up on the signs and symptoms of breast cancer
and get themselves checked out.
Speaker 3 (03:59):
Yeah, and when you talk signs and symptoms, and certainly
for women, you know there's mammograms, and there's recommendations based
upon risk factors if you have it in your family,
or if you're from Eastern Europe, or you have a
certain type of a gene and maybe doing even self
breast exams and going for yearly mammograms. What is the
(04:22):
recommendation or if there are, maybe there aren't any for
men to screen for a breast cancer.
Speaker 4 (04:30):
You know, the recommendations are not as clear as they
are for women. But the best way to think about
it is to extrapolate from what we know about breast
cancer and women. So self exams are critical. So men
tend to have less breast tissue than women do. So
if you feel something that's abnormal, you feel a pea
(04:53):
sized tumor or a firm area that hasn't been there before,
whether it's tender or not, that's something to bring up
with your primary care physician. Just like women, men can
get mammograms and pick up on disease early. You can
have an ultrasound in some cases, you can have an
MRI to look in more detail. At the chest and
(05:17):
breast area. In terms of risk factors, age is a
risk factor. If you're older than sixty, you're at a
higher you're at a greater risk of developing breast cancer. Certainly,
if you have a first or second degree relative with
breast cancer, whether it be a woman or a man,
(05:38):
you're at a four times greater risk of developing breast
cancer as a man. If you have any genetic mutations
that are associated with breast cancer, your listeners may have
heard of the BRCA one BRCA two genes which can
predispose patients to breast cancer. Somewhere between four and sixteen
(06:00):
percent of male breast cancers do have that mutation, so
that is an important component. Genetic syndromes like Klin Filter syndromes,
which is when you're born with an extra X chromosome,
so your carrier type would be why XX can certainly
increase your risk of male breast cancer by twenty to
(06:23):
fifty times, and that is thought to be caused by
the high levels of estrogen that cliin Filter's syndrome patients have.
Obesity tends to disrupt the balance between testosterone and estrogen,
and being obese is certainly a risk factor as well,
and less common things such as radiation exposure. Exposure if
(06:45):
you underwent mantle radiation for lymphoma, for example, that can
also put you at risk for breast cancer.
Speaker 3 (06:52):
Yeah, certainly a lot of a lot of different things.
But yet, like you said, I guess the good news
in all of this is that with for men, it's
not that common. You said, I think it was one
in eight hundred, right, So that's that's somewhat reassuring, but
certainly something that we need to be aware of. And
then there's another condition that I think is probably more
common in men. I certainly see it quite a bit
(07:15):
in my practice, which is breast in larger or ginochomastia.
And perhaps you can tell us a little bit about that.
Speaker 4 (07:22):
Yes, gina coomastia is very common, very common. We see
a lot of it in our practice. Just to start
with defining some terms, kin of coomastia is a benign condition.
It's not cancer, and it is defined as abnormal growth
of breast glandular tissue in males, and it can affect
(07:45):
a person at many different stages of life. It can
happen at any time, but it tends to happen during
changes in the hormonal miliu. So for newborn males baby boys,
the vast majority baby boys have some type of breast
bud that you can palpay, and that is thought to
be due to placential estrogens that are still in that
(08:08):
child's bloodstream. Another spike happens and that tends to resolve
on its own almost almost all the time, after the
child metabolizes the mother's estrogen. Later in life, in early
adolescents thirteen to fourteen years of age, as kids start
to enter puberty, there can be an increase in estrogen
(08:33):
as well as testosterone, and it's thought that the arise
in estrogen can come before the surgeon testosterone, and then
that may be a cause. But it's very very common.
Something in the range of fifty to sixty five percent
of adolescent boys will have some degree of gynecomastia. Typically
(08:54):
that goes away on its own and around two to
three years. Most of the case are what are called idiopathic,
meaning that a cause is not known, but there are
other causes that we know from certain medications, certain substances.
So I always ask patients when they come in if
(09:16):
they smoke marijuana, certainly, marijuana or alcohol can cause ganicomastia.
Medications such as antipsychotics can cause ganicomastia as well, so
usually after you stop a medication, the ganicomastia will resolve. However,
there are some circumstances where it can cause irreversible ganicomastia,
(09:40):
such as the use of anabolic steroids. The use of
the exogenous distosterone can sometimes or will suppress your own
production of distosterone and disrupt that balance between estrogen and
testosterone and cause ganicomastia, But most of the cases by
far are of this un known ideology or cause. Where
(10:02):
it happens, the thought processes that it's from a hormonal
imbalance and it goes away on its own. Later in life,
when men are over fifty, there is another change that
frequently occurs in men, where their testosterone they're a free
testosterone may decrease over time and men are as you
get older. More men are frequently on some type of
(10:24):
medication for high blood pressure for a cardiac issue, and
it's thought that that can also contribute to the incidents
of gynecomastia. Common medications that people can be on they
may not even know that they're at risk for ganicomastia.
I think crestor or statins are linked to gynocomastia. Medications
(10:46):
that can be used for high blood pressure, like sprono lactone,
is linked to the formation of ganiccomastia. Antipsychotics as I
mentioned earlier, like Holdall or a respert All, are also
linked to ganicomastia as well. And again marijuana alcohol can
also contribute to the development of ganico.
Speaker 3 (11:09):
Mask you yeah, and thanks for that explanation. That was great,
And it's certainly again lots of causes of it. It's benign,
like you said, but Ken, I would think in God,
let's specifically we'll talk. We'll limit our discussion today for
men that are over fifty with this breast enlargement or
breasts that are too large. It's certainly you say, it's benign,
(11:32):
it's not malignant, but it can cause I would think
lots of in some cases some psychological effect. You know,
maybe you don't want to go to the beach, you
don't want to take your shirt off. Maybe if you're
in a relationship, you don't want to take your shirt off.
Maybe you don't feel right about yourself having in large breasts,
and I think I thought that maybe it was more
(11:52):
due to people that gained weight, that just that gained weight,
and but maybe that's not Maybe that's not right. Is
that not true just just being overweight?
Speaker 4 (12:04):
Because I think, well, obesity certainly can cause gynocomastia. It's
thought that with obesity, it may disrupt the balance of
testosterone estrogen, it may be more of an estage and
rich milieu, and that that can certainly cause this benign
(12:25):
breast growth. Is thinking on the matter, Well, what can
also happen is that you can develop a pseudo gyiniccomastia.
And what that means is that you have proliferation of
fat that happens to be in the area of the
breast and towards the side of the breast into the
axilla area. That you just have hypertrophy of those fat
(12:47):
cells as you gain weight. And so that can be
treated in a slightly different way. But yes, obesity in
and of itself can predispose you to developing ganiccomastia. And certainly, yeah,
go ahead.
Speaker 3 (13:02):
Now, I was gonna say, if you have this right
and you're concerned about it and maybe you want to
do something about it, is there a way to distinguish
between the gin of commastia and let's say breast cancer.
I mean, do you need you need a mammogram? First?
You should? Should you? Should you get a mammogram just
to check and make sure that there's no underlying cancer
(13:23):
there in the breast or is that?
Speaker 4 (13:26):
Yes? First and foremost you would take you know your
standard history and physical Are there any medications the patients
taking the predispose them to this war They placed on
oldactone or bernal actone recently, and that's could be a source.
So after doing that, if you roll out everything else
that could be a problem, you would want it. You
(13:47):
would want to test for any hormonal imbalance, and then
you should also get some imaging. So if you have
a mammogram, you can differentiate, you can certainly pick up
on signs of malignancy, and certainly if you have any
evidence of a malignancy, you would go down that path
(14:09):
of getting worked up for a breast malignancy, which could
involve a core biopsy, maybe more specific imaging like an MRI.
Is certain it's certainly something that your breast surgeon wouldn't recommend.
But first, as you may have been suggesting, it's important
(14:31):
to rule out more sinister diagnoses like breast cancer over
gani coomastia, if.
Speaker 3 (14:39):
You're just wake it up in the morning. Here on
Katz's corner, we're talking with doctor Lawrence Draper, who holds
a title of Clinical Assistant Professor in the Department of
Plastic Surgery here at NYU A Grossman School of Medicine.
He does see patients here on Long Island in Garden City.
I believe I'm going to give you the number, and
(14:59):
I'll I'll announce it a couple of times at the
end of the show. Uh, it's five to one six
seven five eight eight five five five. That number again
is five to one six seven five eight eight five
five five. And doctor Draper is a plastic surgeon. He's
not an oncologist. As we've been talking today and this morning,
(15:20):
and what i'd like to talk about now, Lawrence, if
you will, is you know, for men that have breast enlargement,
it's not cancer, it is enlarging. And let's say they're
they're uncomfortable, they'd like to do something about it. How
do you how do you if someone wants to seek treatment,
how do you evaluate them? And how do you, how
(15:40):
do you go about treating that and managing that great question.
Speaker 4 (15:45):
So it is benign, meaning that it's not cancerous, but
it can cause pain. Men come in with breast pain.
Usually one side is more painful than the other. Usually
the pain is retrorealer or behind the nipple area. Not
everybody has pain, but some patients do for sure, and
most patients do have some sort of psychosocial stress associated
(16:09):
with it. Not everybody, but certainly it's a select group
that seeks out to be seen by a plastic surgeon
to review their options. So there is some degree of
bias in the patients that I see. What can be
done about it? Once you confirm that you're not missing
something like a tumor or a testicular tumor or a
(16:30):
pituitary tumor that could be causing it, you want to
move on to what are the potential therapies, and certainly surgery.
As a plastic surgeon, surgery is an option, and really
that depends on the burden of the disease. What is
your anatomy like do you have a lot of loose skin,
(16:51):
do your breast troop? Do you have a small amount
of breast tissue? And good skin quality and really minimal
loose skin that would move me down a different path.
There are basically two different approaches. You can use liposuction,
where you basically inject medication to numb the area and
(17:16):
to constrict the blood vessels in the area, and that
is followed by insertion of relatively small canulas, which are
these metal instruments that are hollow on the inside with
a cutting tip, and you can basically disrupt the fat
and in some cases breast tissue and basically suck it
out through a relatively small incision. That is a very
(17:39):
powerful technique to use, especially in pseudoganicomastia where it's more
just fat in the area than breast tissue. Breast tissue
tends to be fibrous, and so while liposuction can be
a good adjunct or an additional therapy for direct decision,
typically if you have true ganicomastia, you need to physically
(18:00):
cut the tissue out, and that can be done in
a couple different ways. If you have a minimal burden
of disease, let's say you just have some disease around
the nipplein arela complex and adjacent to that area, you
can make an incision next to the pigmented part of
the niplin arella complex called the arella, so it's well hidden,
(18:23):
raise up some skin flaps, and develop a dissection plane
where you can remove the breast tissue evenly so that
you don't create any kind of deformity as you're removing
the breast tissue. And then at the end of the procedure,
usually I leave a drain and you're left with an
incision just confined to that area between the arella and
(18:47):
normal skin that is reserved for patients that have good
skin quality and don't have a lot of skin laxity,
and have a pretty well localized burden of this gnigomastia
just in the region of the nipple and a real
complex and the area around it.
Speaker 3 (19:04):
Interrupt is intrupt? Is that done under anesthesia or is that?
Is that a local or is that like in a
doctor's office that procedure or is that in an operating room?
Speaker 4 (19:13):
In my practice, this is done in the operating room.
I think it's too much intervention to be comfortably done
in a procedure room or in an office type setting.
Speaker 3 (19:23):
What about the liposuction? Is that done under anesthesia too?
Or is that local?
Speaker 4 (19:27):
It depends on which practice you go to, but I
always do the liposuction under at least sedation, if not
general anesthesia.
Speaker 3 (19:36):
Gotcha, And then there was one more you were going
to talk about, right, A larger type of man have
much larger breasts. Is that.
Speaker 4 (19:43):
Yes, So if there's someone that has a lot of
redundant skin or a breast that's large or has, for
lack of a better term, has some drooping breast morphology,
then usually you have to ressect some skin in addition
to the breast tissue. So usually you remove the skin
(20:03):
at the lower part of the breast. You remove the
nipple and arela remove all of the breast tissue with
the goal of making them as flat as possible and
accentuating their pectoralis muscle, the muscle on their chest. And
then after the wound is closed, you put the nipple
in a reella complex back on in the location of
(20:25):
the ideal mal nipple, which is a little bit of
a more involved procedure, but is very reliable and tends
to give very good results.
Speaker 3 (20:33):
Yeah, what would you say is the patient's satisfaction rate
with doing something like this? I'm almost thinking also a
lot some women need a breast reduction. I think, is
it a similar type of surgery that you do for
women that require a breast reduction, or is it a
completely different type of thing.
Speaker 4 (20:49):
It's similar, it's related. For women, you try to avoid
taking the nipple off and using it as a graft,
But in a breast reduction, for a woman, it serves
to functions Aesthetically, you're trying to make a breast that
looks good, esthetically pleasing, but is smaller and it's more
comfortable for the patient. In this operation, the esthetic goals
(21:14):
are to make the patient as flat as possible typically
and accentuate that peck muscle. The indications are different, but
there are some similarities.
Speaker 3 (21:24):
And so the overall satisfaction for these is pretty high.
Speaker 4 (21:28):
Would you say yes, It's up to me when patients
come in to give them realistic expectations. So they have
to be okay with the burden of scars, where the
scars are located, some of the problems that can be
encountered during the procedure, such as a contour, deformity, or
abnormal scarring. After I explain all that clearly and I
(21:51):
understand their goals and they understand the limits of the
procedure and if they choose to move forward, then those
patients tend to be very happy at the end of
the day.
Speaker 3 (22:00):
Wonderful. And you know, I need to just ask you
one final question about this, and of course, if you're
just tuning in where we've been talking with doctor Lawrence Draper,
who's a plastic surgeon at NYU and specializes in reconstruction
of breast both for men and women. And today we're
talking about breast cancer. We've been talking about the incidents
and who's affected by it, as well as this benign
(22:22):
condition of guinoclemastia which is much more common in men,
and some of the surgical options and reconstruction following in
managing patients with gynocomasty. If you'd like to reach doctor Draper,
his number is five to one six seven five eight
eight five five five. The number again is five to
one six seven five eight eight five five five. What
(22:46):
about insurance? Will will insurance cover this? It's a medical condition?
Maybe is patients like you said, I've been on medications
or may have some underlying condition and leading to breast enlargement.
How does that work?
Speaker 4 (23:02):
That's a that's a great question, and it can be
a sticking point during a consultation. So it depends on
why someone is presenting to see me. If they come
in and they're complaining of pain, and in the note,
I have their exam thoroughly documented and the purpose of
the operation is to treat pain, that is more likely
(23:24):
to get approved than someone that comes in and says
they just don't like the way that they look. If
they have if they've been on anti retroviral therapy and
they have gonakomastia secondary to a medication use, I have
a good history of getting that approved by insurance. But
unless there is a medical diagnosis that is that you're
(23:48):
treating with this, it can be misconstrued as just a
cosmetic operation, and that's where it can be difficult getting
insurances to cover this.
Speaker 3 (23:58):
Procedures understood for those patients that do present with pain.
Are you able to relieve the pain in a good
number of.
Speaker 4 (24:08):
Patients, Yes, If the source of the pain is this
abnormal breast tissue and you remove it, then usually that
goes away. Wow, with the excision of the tissue, hopefully
in the most cosmetically appropriate fashion as possible, then yes
it does.
Speaker 3 (24:26):
I mean, here you are living with pain every day
with breast enlargement and also having the psychological effects. And
you're basically taking care of two things for patients and
really probably improving their overall quality of life and may
making them feel better, they look better, look at themselves
in the mirror and I don't know, in the beach
or wherever. And also relieve daily pain. I mean that
(24:50):
to live with daily pain like that from this just
remarkable jobs. So thank you so much for all you do,
Lawrence Draper. Thank you and for also for educating all
of us about this.
Speaker 4 (25:02):
Certainly thank you for having me on. Yeah.
Speaker 3 (25:05):
And it's it's something that you see pretty commonly, is it.
I mean, as you see if kind of commancity, you
do see that quite a bit.
Speaker 2 (25:10):
Huh, very common, very common.
Speaker 4 (25:13):
Yeah, on a weekly basis, we see several houses. Yes.
Speaker 3 (25:17):
Wow. Okay, Well, if you've been listening to doctor Draper
and uh you yourself, you know, thinking about this, you've
had this pain or rest enlargement and thinking about ways
to to to remove the excess tissue, and certainly have
an evaluation to make sure that there's nothing underlying that's
even more concerning. As doctor Draper pointed out, please give
(25:39):
him a call. Your practice is here in Garden City, doctor,
or is it in Minneola? Where do you practice?
Speaker 4 (25:48):
It's here in Garden City. It is in garden City. Yes,
one one one Franklin Avenue, Garden City is the NYU
Lingo and Ambulatory Care Center and our clinic is.
Speaker 3 (25:59):
There beautiful, Yes, downtown garden City actually a beautiful center.
And if you'd like to give him a call, that
number again is five one six seven five eight eight
five five five. Thank you so much, doctor Lawrence Draper
here on Katz's Corner educating us and all the listeners
about kind of commastia and breast cancer on this Sunday
(26:19):
in October, which is Breast Cancer Awareness Month. Thank you again, Laurence,
really appreciate you coming on. Thank you for having Well,
let's go endo the show. Everyone, Thanks for tuning in.
We'll be back next week with a great show here
on Katz's Corner. Tune in every Sunday. This is doctor
Aaron Katz.
Speaker 2 (26:34):
You've been listening to Katzer's Corner. Come back every week
to hear more straight talk on a wide range of
men's health topics and advice on how to live your
healthiest life.
Speaker 1 (26:45):
The proceeding was a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed
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