Why do men have nipples? Practical answer: For practice. Scientific answer: Because men start out as women. During the first five weeks in the womb the sex of the fetus is unknown, like Lady Gaga. By week six a fetus with a Y chromosome begins growing man parts, which the young male will explore for the next eight months, establishing a pattern he will repeat for life. (Not much to do in there. Not much to do anywhere.)

Breasts and nipples take root before the male fetus produces the testosterone that will shape his manhood. Evolution tends to eliminate that which humans do not need, but in the case of the male breasts and nipples – no harm, no foul. Male breasts do not impede survival or reproduction, so evolution looks the other way. Like the 1970s-era pink bathroom tile forever insulting the dignity of the commode in your apartment, male breasts and nipples remain as a permanent reminder that we live in our chromosomes and not the other way around.

Thus the biological table is set for gynecomastia. Gynecomastia is the development of abnormally large breasts in males. Causes range from an imbalance of hormones during puberty, to reaction to steroids, to tumors, to heroin or marijuana use. (You read that correctly, Captain Kush. Weed causes moobs.) Both overweight men and skinny men can develop gynecomastia, which is Greek for “woman’s breast.” Large breasts on women are called gigantomastia, which I trust you can translate on your own. Soleil Moon Frye (TV’s Punky Brewster) suffered from gigantomastia as a teenager. Frye said her large breasts affected her mental health and relationships. She had breast reduction surgery, a common procedure for women, but not for men. Not until relatively recently.

Male breast reduction surgery is now an option for men who have the means (approximately $7,000 to $12,000) to pay for cosmetic surgery. While news reports might lead you to believe that male breast reduction surgery is exploding in popularity, it is not. Some 17,902 American men had breast reduction surgery in 2008, the last year that records were kept. That number represents a 16 percent decrease since 2007 and a 12 percent decrease since 2000. Bear in mind, there are more than 11 million American men between the ages of 15 and 19 alone. Less than 20,000 out of 11 million is a very small number. Gynecomastia made headlines recently when the British Association of Aesthetic Plastic Surgeons reported an 80 percent increase in male breast reduction surgeries. The number of British men who elected to have the surgery in 2009? A whopping 581, up from 323 the year before.

Moob madness hysteria is laughable. Consultant plastic surgeon Rajiv Grover said that male fretting over “man boobs” or “moobs” is caused by the media. Grover told the media, “Many men are feeling the pressure from men’s magazines that weren’t even being published five or six years ago.” According to Grover, some percentage of 581 men in a nation of more than 61 million Brits is influenced by men’s magazines. I wanted to dispute that claim, but given the poor state of men’s magazine publishing, that number sounds about right.

Still, the increase in men who receive male cosmetic surgery is a relatively new trend and gynecomastia is the fourth-most popular surgical procedure among males, behind nose reshaping, eyelid surgery and liposuction. It is a popular option for the statistically tiny number of men who undergo plastic surgery.

According to Dr. Lloyd Krieger of Rodeo Drive Plastic Surgery in Beverly Hills, Calif., men with gynecomastia who receive breast reduction surgery tend to fall into one of three categories. Some are physically fit individuals who exercise regularly, are in good shape and want to look sculpted. Some used medicines, possibly steroids, that caused their chests to overdevelop. Some are simply average-sized men who have overdeveloped breasts. The typical patient, said Krieger, went through his teen years with large breasts, which were a result of hormonal development during puberty and fat caused by overeating. His body is slim but his chest is out of proportion. Dr. Krieger said that his patients tend to be 20 or 21 by the time they enter his office. Those numbers differ from the national norm. According to the American Society of Plastic Surgeons, 79 percent of all male breast reduction patients in 2008 were between the ages of 13 and 19.

Krieger said that men should wait until puberty is complete before undergoing surgery.

“Every man has breast tissue, just like we have nipples,” Krieger said. “With puberty some of our hormones stimulate that breast tissue to develop. It can stay somewhat overdeveloped or shrink down. Most of the times it is some combination of a small amount of breast tissue that developed and then fat tissue that sat there beside it, both of which stayed kind of large after puberty.”

A male with overgrown breasts can expect to undergo any number of a series of indignities: teasing, failure to find clothes that fit properly, the need to wear a constricting undershirt under work or school clothes, embarrassment over removing a shirt in public and lovers who only concentrate on their breasts during foreplay. (Kidding. Probably.)

Male breast reduction surgery comes in three forms. The first is liposuction, which is minimally invasive. It creates the smallest scars and has the shortest recovery time. A quarter-inch incision is made on the side of the chest and through that incision a fluid is pumped into the fat. The fat expands and separates from the surrounding tissues. A medicine tightens blood vessels to prevent bleeding. With a local anesthetic administered, the surgeon uses a vacuum tube and suctions the fat. Liposuction is the most common form of gynecomastia, which is a catch-all term used for any male breast reduction procedure.

A second procedure involves removing heavier tissue from behind the nipple, tissue that might not come out as completely or as evenly with liposuction. A half-moon incision is made below the areola and the denser tissue is removed. Liposuction is also used. There is a risk with this procedure that the man could lose feeling in his nipples.

The third type of surgery is a true breast reduction, comparable to what a woman receives. It is used rarely. A man who is slim, with the equivalent of a C-cup, might want this option. A surgeon cuts out a pie-wedge of skin and tissue from the bottom third of the breast or chest area, pulls the chest back together and reassembles. Liposuction takes about an hour. The breast reduction can take four hours. It is rarely performed because it creates visible scarring. The scarring extends around the areola, down like a lollipop, with an anchor at the bottom. Much of the scarring is hidden on women by the shape of the breast. Men have flat chests, exposing the scarring, and many men who receive this surgery never remove their shirts in public again. This is the most expensive option. Liposuction is the least expensive. Rates vary nationwide, but patients can expect to pay between $7,000 and $12,000 for one of these procedures at Rodeo Drive Plastic Surgery.

Surgery is followed by a series of appointments with the doctor. It takes about a year to see the total effects. By the time a patient gets home he looks no better than before surgery because of swelling. After a week his chest begins to change shape. At about six weeks men see about 80 percent of the results. The last 20 percent of the change is subtle and takes the rest of the year. A patient who has received a liposuction can expect to wear a pressure garment that keeps the skin tight and resolves swelling. The garment usually is worn for several weeks.

None of Krieger’s patients, as far as he knows, has ever worn a “bro” or a “manzier.” Under Armour garments appear to be the boob flattener of choice among men with gynecomastia.

For more info about gynecomastia go to: MedlinePlus