Abstract

In this narrative, I step into the shoes of someone who has lived with gynaecomastia — male breasts. Using the imaginary character of Aarav, I reflect on the themes of the stigma associated with body image, the courage to face it, and the role human relationships can play in fostering self-acceptance.

Keywords: gynaecomastia, stigma, remedial surgery, male breasts

At the age of 17, Aarav, a teenager assigned male at birth, began to realise that his chest had a protruding appearance, almost similar to a female breast. His friends would often tease him, which made him more conscious of this. He started wearing tight undershirts, as that would compress his chest a bit. A couple of his peers would mock him publicly. Whenever possible, he would avoid going out, fearing that people would notice and ridicule him. At times his peers would ask him, “Why do you have breasts?”, as if he is supposed to know and come back with a convincing answer. He lacked the courage to talk to anybody about it and began hiding from the world.

He would search the internet about his condition to discover the term “gynaecomastia”, “male breast syndrome”, “man boobs”, or “moobs”. Countless videos on the internet advised different exercises to shed breast fat. Aarav would try them all, but nothing worked. He asked his gym teacher for advice, and the teacher sold him some herbal pills to resolve his problem. Aarav bought the pills from his savings and completed the course with no significant result. As years went by, Aarav’s worry grew, as there was no change in the appearance of his chest.

Aarav feared that he would never find a partner. It was difficult for him to take off his shirt in public, particularly when he went clothes shopping in stores with no changing rooms. It was difficult for Aarav to live in a boys’ hostel during his undergraduate studies, as there was no privacy. Tight undershirts and loose T-shirts were the only tools Aarav could rely on to prevent himself from being embarrassed.

He finally started visiting medical professionals for advice: an endocrinologist, a plastic surgeon, a general physician, were all on the list. As an undergrad student, Aarav never had much money. Visiting each of these medical professionals came with a heavy consultation fee. One doctor prescribed testosterone-boosting pills, which didn’t help him at all and took a great toll on his savings. The estrogen/testosterone blood tests and the mammograms were all difficult for Aarav to procure, as he had not shared his condition with his parents, who were his only financial resource at that point. After visiting a series of doctors and undergoing various tests, it became evident that surgery was the only option.

Aarav did not like his breasts. He never liked what he saw in the mirror every time he would take off his shirt. Tight undershirts were too painful. He would end up getting skin rashes and fungal infections. He could not take it anymore and finally summoned the courage to talk to his conservative parents about this. His “coming out” was more out of helplessness than an autonomous choice. He discovered that his parents, like the rest of the world, had also noticed his gynaecomastia and were quite worried. Their worry, however, was only about the fact that their child may not be able to find a suitable match for himself. Aarav’s elder brother, who was also a physician, opposed the idea of surgery. He was of the view that things should be best left the way nature made them, and one should not meddle with it. His parents, however, agreed to sponsor a surgery.

His parents used their networks to find a doctor who would charge the least for the surgery. They found a general physician who, though had never done cosmetic surgery, had long experience of general surgeries. He quoted a sixth of the plastic surgeon’s quotation. Sadly, conditions like gynaecomastia may not be covered by health insurance policies as well. Aarav lacked the knowledge and skills to be able to distinguish whether a general physician was suited for this job in contrast to a plastic surgeon. His only concern was getting rid of the breasts and stopping the constant humiliation at the boys’ hostel; and, he was only too happy that his parents agreed to sponsor his surgery.

On the day of his surgery, Aarav knew that he would undergo full anaesthesia and be hospitalised for some time. He, however, showed no signs of stress or fear. He had been wanting this for a long time. Years of suffering in silence were now about to end. His mother was very worried about the complications of the surgery. She was also concerned about whether to talk about this surgery to her relatives and neighbours; Aarav requested her not to. She was also surprised to see her son without any fear of the surgery. For once, she felt her son was brave. She did not realise that he had been brave for many years, enduring taunts and resisting the badgering of those around him. He was also brave enough to speak to her about his condition.

Aarav remembers the effect of the anaesthesia fading during the surgery and feeling a sharp object being inserted on the edge of his right nipple. The next thing he knew was the doctor waking him up, saying that the surgery was over. The surgeon had extracted almost 500 grams of fat from Aarav’s breasts. For the next several days, Aarav was hospitalised and had a tube connected to collect fluids from inside the chest. As he recovered from the surgery, he could see depressions around the nipples. The chest looked asymmetrical and the shape of the nipples was distorted. He had also lost all sensation on the right side of his chest. He had no idea of the aftermath of this surgery. He thought his chest would begin to look like what he considered “normal”. The doctor, however, went on insisting that Aarav should give it some time and the necessary layers of fat would be restored and the depression would become barely noticeable. He believed the doctor. For months to come, he enjoyed going out around his hostel in a regular fitting vest. He lied to his hostel-mates that he has been exercising hard during his vacation to get rid of his breasts. Everyone believed him, and he seemed to have earned some respect from his hostel mates for appearing more manly.

After waiting for a year, he noticed that the depressions had not disappeared and though they were not visible when he had his shirt on, they were quite noticeable when he took it off. Once again, he started visiting a few surgeons. Some of them would appear repelled on seeing Aarav’s chest. He was once again told that secondary surgery was the only option. However, this time it was made clear that there was no guarantee that Aarav would get what he regarded as “normal”. He was also told that the loss of sensation in his right chest would never be restored.

By this time, Aarav was earning money and could afford the remedial surgery on his own. However, many things had changed in his life. He had friends in his life who appreciated him for who he was and did not bother about the appearance of his chest and nipples. His partner loved him and actually appreciated the asymmetrical appearance of his chest. Aarav, therefore, decided not to undergo remedial surgery. This time the people around him had changed something within him. He no longer felt like running away from the world and he would now see a man smiling back every time he looked in the mirror.

Acknowledgement: I acknowledge and thank Sayantan Datta for their input on this piece.