Gynaecomastia

The benign enlargement of the breast in males that resembles the female growth pattern is named gynaecomastia. This enlargement may involve the ductal tissue, the surrounding fat and/or the skin.

There are three distinct types: pseudogynaecomastia is accredited to fat deposit due to obesity or to skin laxity after weight loss whereas true gynaecomastia involves the overgrowth of ductal tissue.

What are the causes?

Pseudogynecomastia which involves obesity and the rapid loss of weight needs no further screening and is directed for surgery. In true gynaecomastia there is an underlying hormonal imbalance that needs to be identified. In this case, the imbalance is treated and if the gynaecomastia persists, then a surgical solution can be sought.

This hormonal imbalance may arise normally because of a fluctuation in blood hormone levels. After birth, maternal estrogens circulating are transiently higher than normal but this usually resolves itself. In puberty, 66% of adolescent boys develop gynaecomastia due to a normal increase in hormones. Gynaecomastia in such cases is generally mild, its psychological impact negligible and in most cases is resolved on its own. In elderly males, when the testosterone levels are declining and the ratio between testosterone and estrogens tilts towards the estrogens, gynaecomastia can occur.
Other causes of gynaecomastia can be gland dysfunction or failure, tumors and drugs such as antiandrogens, cardiovascular drugs or even abused drugs (alcohol, heroin etc). In these cases, specific tests are necessary in order to identify the cause and course of treatment prior to any surgical intervention.

 

The operation

Depending on the case, general anesthesia or local anesthesia with mild intravenous sedation can be administered. When gland excision needs to be performed general anesthesia is favored.

The whole operation is performed through a tiny incision made in each breast and with the use of a power-assisted liposuction device, the fat is removed. The operation is safe, fast and leaves no scarring. After the operation, the patient needs to wear a pressure garment but can go home on the same day. The sutures are removed on the 8th day postsurgery, whereas any swelling and ecchymosis need 1 to 2 weeks to get absorbed. A rough estimate of the result of the operation can be made 30 days later.

When excess skin is present, a periareolar incision is indicated and then meticulous suturing ensures that no scarring will occur after all wounds are properly healed.

 

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