The metamorphosis
Like many kids in middle school, Alameda resident Merle Yost had a nickname. But it wasn’t one of those nicknames that kids like, the ones that describe a child’s prowess such as "Sport" or "Champ" or "Slugger."
No, Yost’s nickname described a physical feature he grew into as a young man. His nickname was "Tits."
By junior high, the skinny kid from Missouri had pronounced breasts. Yost began what would be a lifetime struggle with what’s medically known as gynecomastia, or casually referred to by many as "man boobs."
"The girls would offer me their bras, and the guys would attack my chest," says Yost, now a 47-year-old licensed marriage and family therapist whose practice is based in Oakland.
Yost invited a journalist to follow him as he had a second surgery to reshape his chest. He says he did this because he wants to publicize the issue and educate others. Maybe, he says, men young and old troubled by this condition can learn how to overcome their shame and live normal lives.
"I want there to be a conversation about this," he says. "There is so much shame in this, and the way out of shame is to put light on it."
According to Yost’s self-published book, "Demystifying Gynecomastia: Men with Breasts," ($19.95), up to 70 percent of men experience some degree of gynecomastia during their adolescence as the result of surges of testosterone and estrogen during puberty. For most, breast and nipple swelling goes away as the body adjusts to the new hormone levels. But for about 30 percent of men, gynecomastia is a permanent condition.
Yost says the condition is hard to define. Although people don’t think this way, he says, men’s chests vary physically as much as women’s chests.
"Just go to the beach and look at different men and you’ll see all kinds of different shapes," he says. Any enlargement of the chest tissue, particularly the breast tissue, and accumulation of fat in and around the nipples is probably gynecomastia, he says.
And as hard as the condition is to distinguish from man to man, it is even harder to know why men get gynecomastia. The condition is idiopathic, which means it occurs without a known cause. It could occur from natural hormones, weight gain, certain medications such as antipsychotics and drugs that treat prostate diseases, alcohol use and so on.
Regardless, for many young men living with gynecomastia, the embarrassment is unbearable. Boys avoid taking off their shirts in front of others. They avoid participating on swim teams or other sports of any kind. Yost says for most young men with the condition, as for anyone with a noticeable physical abnormality, gynecomastia has a strong impact on a boy’s sense of self.
Yost acknowledges that some men don’t mind their breasts and make no moves to hide or remove them. But for most, having gynecomastia means participating in a game of hiding the chest every day. Some men wear three or more T-shirts to cover their chests, while others buy binding garments that are specially designed to flatten the breasts. Others choose to have surgery to remove the fatty tissue around the breasts.
Seeking medical help
The first time Yost went to a doctor about his condition he was a teenager. Back then little was known about gynecomastia, and his doctor told him that the breasts could be removed, but Yost wouldn’t grow any taller. That was the last time he talked to a doctor about the problem until he was an adult.
In 1993 he talked to a plastic surgeon. The doctor ended up removing much of Yost’s breasts, but fatty tissue was left under his arms, which made Yost feel as if he had a more feminine body shape.
When we first met him, he was preparing for his second surgery by another plastic surgeon.
"It is really for me," he says. "I want to look the best I can look and be the best that I can be. It is a literal re-creation of me."
Yost, who is gay, is ready to date again. He’s single after the end of a 19-year loving, committed relationship.
He has been spending his free time working out with a personal trainer at Emerson Sport Training and Fitness in Oakland. He has changed his diet. He has been through therapy. He feels good, and he feels ready to meet someone.
Yost acknowledges that plastic surgery will not result in a miracle — he’s not going to look like Brad Pitt afterward. He will, however, look more masculine. And that, he says, will make him feel better about himself and his body.
"I can’t do anything about being 5-foot-8, but I can do something about the shape of my body," he says.
Preparing for surgery
It is just past 11 a.m. in the Novato offices of Dr. Miguel Delgado, a plastic surgeon who has built a cottage industry around treating men with gynecomastia. Under the bright lights of Delgado’s exam room, Yost takes off his pink shirt and smiles somewhat shyly.
"Just let it all hang out," Delgado tells Yost.
With gloved hands, Delgado squeezes the right side of Yost’s chest, then the left. He pokes at Yost’s nipples and looks at his underarms, where Yost believes his gynecomastia looks the worst.
They talk about what sort of chest Yost would like to have and what can reasonably be done under the surgeon’s guidance and knife.
Delgado performs surgery on 80 to 90 men with gynecomastia a year, along with traditional plastic surgery such as breast augmentation and tummy tucks.
Yost is here for his last pre-surgery appointment. Delgado takes pictures of Yost’s chest, and they discuss everything from pre-surgery diet and exercise to postoperative care.
The surgery is no lark. It will take hours and will cost Yost $9,000 — gynecomastia surgery is rarely covered by insurance because it’s not medically necessary.
After researching gynecomastia, Yost talked about the issue on a link on his personal Web page. At the time, there were very few Web pages outside of plastic surgeons’ Web sites that addressed the issue, and Yost’s link became a hot spot for Internet traffic on gynecomastia.
In 2001, he developed www.gynecomastia.org, a comprehensive site that includes stories of men who are living with the condition, information about gynecomastia and treatment options. The site has received 1.5 million hits this year. Interestingly, Yost had to create five different types of chat rooms to accommodate the varying perspectives of men with gynecomastia, including that of men who have no desire to change their condition.
Yost says he does not promote surgery and says his decision is a personal one.
"There are as many responses to this as there are guys," he says. "For a lot of guys (surgery) is the right answer. For a lot it simply is not."
Time for surgery
On Aug. 31, Yost arrives at the doctor’s Novato office at 11 a.m., accompanied by friends who will drive him home. He cracks jokes as he is put under anesthesia, and if he has any fear, he hides it well. The procedure lasts eight hours, as Yost has elected to also have some liposuction done to his waist. The surgery on his chest takes about three hours, total. Everything goes smoothly, and he goes home the same day.
A few days later, back at the doctor’s for his post-op appointment, nurse Colleen Ferrari asks Yost how he’s feeling.
Yost is sitting in the exam room looking uncomfortable. He is wearing four pieces of foam covered by two compression garments, one for his waist and one for his chest. Three surgical drains are taking excess fluids from his incisions. He hasn’t showered in five days.
"That’s the thing I am most looking forward to," Yost tells Ferrari as Ferrari and Delgado inspect him for signs of bleeding or any other complications.
"You’re healing beautifully," Delgado says.
Yost doesn’t complain of pain or discomfort, though he says he wishes he didn’t have to wear the compression garments, which help squeeze body fluids back toward tissues to prevent swelling and promote healing.
Although the garments help, Yost is still so swollen it’s hard to tell how well the surgery has reduced his chest tissue. It will take about eight weeks for 80 percent of the swelling to go down and about six months before he’ll be fully healed.
Here in the doctor’s office, Yost is reflective about the surgery, his job and how he feels about himself.
"All psychology is about is coming to terms with the things we can’t change and changing the things we can," Yost says. "If you can do something about changing yourself, why wouldn’t you?"
A few weeks later, back at Yost’s Oakland office, Yost has a bit of a sparkle in his eyes. It is obvious he is happy with the results.
"My clients tell me I look so much younger," he says.
Yost says he has not felt much pain, and each day there is less discomfort in his chest as he heals.
The best part, he says, is his chest is flat and his underarms no longer give a womanly shape to his body. Even with compression garments still on and the swelling still not completely gone, Yost’s chest looks significantly more masculine. Yost also seems more comfortable in his body.
"My chest is radically different than it was before," he says. "It has been quite a metamorphosis."