The number of men having breast reduction operations in the UK is rising dramatically, but is this really the result of the media spotlighting the physical flaws of male celebrities?
By Finlo Rohrer
BBC News Magazine
This is an era when glossy magazines and tabloids delight in the most minor flaw of the female celebrity.
The actress with bags under her eyes, the singer with an untrimmed armpit, the model with a sweat patch, all are presented blinking in the paparazzo's flashbulb as their imperfections are chronicled.
All are highlighted with red circles and magnification. And the same process has been applied to male celebrities in recent years.
EXCESSIVE MALE BREASTS
Pubertal gynaecomastia, common in boys, sees breast tissue grow due to hormonal imbalance
In most boys it disappears by end of puberty
Breast growth can be side effect of drugs used to suppress prostate cancer
Can be caused by genetic condition like Klinefelter's Syndrome
Other causes include:
Anabolic steroid use
When both the then Prime Minister Tony Blair and leader of the opposition David Cameron were pictured enjoying the sun in the summer of 2006, newspapers from tabloid to broadsheet passed comment on their "moobs".
Every man has breast tissue, but some have excessive breasts. This ranges from classical cases of gynaecomastia, prompted by a range of causes, to breasts enlarged entirely by deposits of fat over the pectoral muscles. But whatever the cause British men seem to be increasingly concerned over the state of their chests.
The latest figures from the British Association of Aesthetic Plastic Surgeons (Baaps) seem to bear out this obsession.
Surgeons carried out 323 male breast reduction procedures in 2008, up a staggering 44% from 2007.
It would be easy to assume that the UK is a nation where men are rapidly becoming more obese, and they are taking a surgical shortcut to get rid of male breasts that are merely deposits of fat on top of their pectoral muscles.
Simon Cowell was mercilessly ribbed for his physique, but has since embarked on a fitness regime
But this is not the full picture says consultant plastic surgeon and Baaps member Dalia Nield.
She concedes that anything up to a third of the men seeking breast reductions are simply obese. But she says the rest of the rising numbers of operations are people who are suffering gynaecomastia - excessive breasts - caused by other factors, such as a hormonal imbalance.
Among these, a common type is pubertal gynaecomastia, where boys develop the excessive breast tissue during adolescence.
"Many of those young men if they don't have a very marked gynaecomastia they don't necessarily seek help," says Ms Nield. "But I see many of these pubertal cases later in life when they put on weight and it becomes more obvious."
Genetic disorders like Klinefelter's Syndrome - having an extra "X" chromosome - also account for some cases, and there are a rising number of men suffering from excessive breast tissue as a side effect of drugs prescribed for prostate cancer. Treatment of this type of cancer has improved in recent years, says Mrs Nield, leading to more cases.
But how can one explain the dramatic upwards trajectory for male breast reduction procedures? In 2005, only 22 were performed.
Mrs Nield suggests that much of the increase may be due to the media publicising the surgery option.
Many of those pieces mocking the imperfections of the middle-aged celebrity also contain a factbox that talks about non-obesity gynaecomastia and explains that surgery is an option.
MOOBS: THE ETYMOLOGY
Portmanteau word of "man" and "boobs"
First reference in UK newspaper in June 2004
Satirical website manboobs.co.uk domain name registered in January 2003
Term assumed to be of US origin
The effect, Mrs Nield suggests, is that men who might have been suffering in silence for years, realise they are not alone and are spurred on to seek out surgery.
"It is a cause of tremendous distress," says the surgeon.
And there is no doubting that the last few years have seen an increasing attention to this particular physical flaw.
A search of the LexisNexis newspaper databases suggests the word made its debut in a British newspaper in June 2004. Since then it has been used 161 times. There have been more than 350 references to "man boobs" over the same period. "Moobs" clocks up 281,000 hits on Google.
Kerri McPherson, a chartered health psychologist at Glasgow Caledonian University and a member of the men's health group, Scotland, is an expert on male body image.
"I would argue that what the media is really discussing is just representing the growing concerns of everyday men. This concern has always been there but they have not been able to articulate it."
And it could be argued that media mockery reinforces the negative body image of the excessive male breast sufferer, it also might free some from isolation and paranoia that they could have been burdened with a decade ago.
John McCririck was also mocked after appearing on Celebrity Big Brother
The presentation of "moobs" as something suffered by a slew of male celebrities might make life easier for the ordinary bloke sitting in a pub discussing his problem with his mates.
"More and more people are being given a language to talk about concerns about their body," says Dr McPherson.
"Particularly with what is a very feminine [characteristic] if a man was talking about [having] breasts [decades ago] they would have been a source of ridicule."
Paula Singleton, a researcher in the health faculty at Leeds Metropolitan University, is doing a PhD on the attitudes shown by men planning to have breast reduction surgery, entitled "Bruises heal but moobs last forever - men's account of cosmetic surgery for gynaecomastia."
"It seems like you can hardly turn on the telly and open a newspaper without it being mentioned," she says.
SHOWING SOME FRONT
Friends, 1997. Chandler tries to cancel his gym membership
Ross: Whoa-whoa-whoa, hey! Now remember what we talked about, you gotta be strong.
Chandler: Yes. (In a stronger voice) Yes!
Ross: One more time, "Hey, don't you want a washboard stomach and rock hard pecs?"
Chandler: No! I want a flabby gut and saggy man breasts!
Seinfeld, 1995. George is upset after seeing his dad's moobs
Jerry: So what? A lot of older men have that
Kramer: No, not these. These were real hooters.
George: I was throwing up all night. It was like my own personal Crying Game.
Kramer: Well, maybe you're gonna get 'em too, George.
George: Yeah, that's right. What if it's a genetic thing, like father like son?
"[Those planning surgery] described feelings of shame, anxiety and embarrassment. They had suffered everything from being shouted at from a bus to teasing from work colleagues… doctors smirking and laughing at them and saying 'get down the gym'."
Of course, it would be wrong to group men with excessive breasts into justifiable "moobs" - ie a hormonal, chemical or genetic cause - and unjustifiable "moobs" - those caused primarily by obesity.
Both sets of men may be suffering psychologically at a time when the male body is under increasing scrutiny.
In the academic world, most of the theorising about body image has traditionally been about women, but now researchers are starting to look at changing attitudes among men.
"Men are starting to feel those appearance pressures more and more," says Ms Singleton.
And this growing body consciousness could lead to more men making their way through the surgeon's doors.
Below is a selection of your comments.
I have pretty pronounced man-boobs, but I'm transgendered and I live that way most of the time. When I see the pain, cost and hassle that others go through to achieve a convincing cleavage, I count myself very lucky. Talk about a silver lining.
It is also linked to a certain kind of testicular cancer, as my brother unfortunately found out last year. He lost a testicle, and gained a little set of man-boobs. Oddly enough, he wasn't particularly impressed with the swap. Anyway, perhaps all this male self-image pressure will make some men a bit more sensitive about making stupid off-hand comments about women's bodies.
Laura, Albany, Australia
Many people suffering from this are on male hormone blocking treatment for prostate cancer, and some have to stay on it for life if they are in remission from a high grade cancer. There is one way of halting or slowing the breast tissue growth by zapping them with radiotherapy. I was left with two brown discs for months after I had this treatment. I don't know what was worst to explain at the gym.
Dave Young, Gloucestershire, UK
You really cannot begin to comprehend the overwhelming effect of gynaecomastia unless you've lived with it. I suffered in shame and silence for over 20 years before I even *heard* the term, believing myself a freak, and thinking I was alone. Staying home, wearing ill-fitting baggy clothes and walking stooped over to hide "them" - all common to men who suffer, and I do mean SUFFER, this condition. It has lead me to thoughts of self-mutilation and suicide many times. I am 38, and never had a relationship as I cannot bear to reveal the existence of "them" to anyone. Now, thanks to the indescribably shallow celebrity gossip journalists, the ridicule of the schoolyard has spread to the adult world. Think on this. The cry of rejoice from men who've had their condition "fixed" with surgery is one which would seem totally insignificant to most people, who might take it completely for granted. Is it "look at me, I'm a chiselled Greek god"? No, it is merely, "I can wear T-shirts".
The sad thing about these politicians is that their physique "issues" will affect the minds of a vapid electorate. These are middle-aged men we're talking about, not teenagers. They sit at desks all day pushing pens for a living, what do you expect? I'd rather they concentrate on that than doing buttock clenches.
I find it hard to believe that only 22 operations of this nature were performed in 2005. I had this surgery early in 2004 and there was a thriving community of men all posting on an internet support forum having the same kind of operations. My own surgeon had two more such operations to do that week.
Ian, Guildford, England
Feeling distressed and paranoid about your appearance? Unfairly judged solely on the basis of your body and face? Welcome to our world, gentlemen.
I like my moobs. They belong to me. I would not like to have them cut off with a scalpel. Ouch!
Simon Charles, Maidenhead
One cause which was not mentioned is alcohol use, specifically beer.
There is much mention of hormonal balance being involved in the generation of male breasts, but no reference to the pervasive use of hormones in meat and dairy production, or the presence of hormones in drinking water. These appear to be the most likely root cause of hormonal imbalance in men - and consequent moobs.
Gregory Sams, London
I'm under great pressure regarding my physical appearance. I used to exercise regularly but had a problem with my back and have not been able to train for the last three years. As I'm in my early 40s, my chest has drooped considerably to the point where I have to wear loose clothing and don't like to take my top off on holiday. I have contemplated surgery as it has really knocked my confidence.
Tony Davies, London, UK
Don't you think "moobs" is a truly ugly word compared with the elegant alternative "dadderies" (etymology obvious)?
Why do we find it socially acceptable to put a pair of "man boobs" online without any sort of censoring (or bikini top), but should the BBC ever grace its front page with a pair of female boobs, they'd get fined/in hot water? It's not fair.
James Druce, Tresco, Isles of Scilly