An attractive, curvy bust line may be just what every woman desires. But for a man, large breasts are often a source of embarrassment and ridicule.
And although Kramer from "Seinfeld" invented the "manssière" -- a brazier for men -- that item of underwear still remains only in the imagination of show creator and writer Larry David.
So for Frank Costanza and the millions of other men who are unfortunately endowed with "man breasts," the remedy may just be plastic surgery.
The medical term for "man breasts"-- or "man boobs," as they are more commonly called today -- is gynecomastia, from the Greek words meaning "women-like breasts."
According to Dr Steven Copit, chief of the division of plastic surgery -- a specialist in breast-reduction surgery -- at the Albert Einstein Medical Center in Philadelphia, "all men have breast tissue, just as women do."
He explained that gynecomastia may affect either one breast or both: "When men develop excess chest tissue, it creates a contour of the chest wall that, aesthetically, is not what men want."
While the condition was rarely spoken about when he first began performing the procedure 13 years ago, Copit stated that today, "it's being talked about more and more."
In fact, according to the American Society of Aesthetic Plastic Surgery, the number of gynecomastia procedures since 1997 have increased by 112 percent, from just over 11,000 to more than 23,000 in 2006. And nearly 11 percent, or 2,575 of those surgeries, were performed on young men under the age of 18 last year.
'Never Goes Away'
Dr. Bruce E. Genter, a member of the plastic-surgery staff at Abington Memorial Hospital, confirmed that the number of teens being treated is on the increase.
"Pediatricians had been telling the parents of boys to wait until it goes away, but it never goes away. Now, pediatricians are aware that it will not go away, and we are treating it sooner as a result," explained Genter.
He added that the procedure results in no danger to boys under the age of 14. "Except if growth is not complete, there may be a reoccurrence," he pointed out.
Another reason that physicians are reluctant to operate on boys is "the tissue is hard under the areola and may require an excision. As boys get older, the tissue becomes softer and may be removed through liposuction."
Dr. Brian Buinewicz, chief of the division of plastic surgery at Abington Hospital, has been performing breast reductions for gynecomastia since 1992. "Over 50 percent of teens going through puberty will have breast-tissue enlargement, which is fairly normal going through puberty. For a majority of those teens, the breast tissue will start to reabsorb as they exit puberty," he explained.
In addition to the danger of having the tissue grow back, Buinewicz said, "there is also danger of scarring if the procedure is performed on boys under the age of 18."
There are a number of causes of gynecomastia, according to Copit. "It might be genetic. There are some drugs that can cause this condition, such as steroids and marijuana, plus many kinds of prescription drugs. Other causes are an excess of estrogen and tumors."
Because fat tissue forms along with breast tissue, he suggested that overweight men go on a diet program to see what effect that will have. However, he added, "for men who present with significant gynecomastia, weight loss will not help, because the breast tissue itself is not related to weight loss.
"The surgery for gynecomastia varies from a women's mastectomy, which is designed to remove all breast tissue, including the nipple and aureole. The gynecomastia surgery is more a contouring procedure. So what we are trying to accomplish is removing enough breast tissue to provide the proper contour, leaving the nipple and areola intact," the plastic surgeon noted.
The surgery is usually performed under general anesthesia on an out-patient basis and takes approximately two hours.
Unfortunately, "gynecomastia is not a condition covered by all insurance companies, but is taken on a case-by-case basis," noted Copit. "We will submit a photo of the patient and the patient's history to the insurance company to ascertain whether they will approve the surgery and pay for it. Frequently, they will not because they consider it a cosmetic procedure.
"As soon as other conditions causing gynecomastia are ruled out, such as breast cancer or a hormone producing tumor, it really is an elective procedure to make men more comfortable wearing shirts and bathing suits and things."