Gynecomastia

Gynecomastia

Gynecomastia (male breast reduction)

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Gynecomastia, a condition of over-developed or enlarged breasts in men, is common in men of any age. It can be the result of hormonal changes, heredity conditions, disease or the use of certain drugs.

Gynecomastia can cause emotional discomfort and impair your self confidence. Some men may even avoid certain physical activities and intimacy simply to hide their condition.

Gynecomastia is characterized by:

•   Excess localized fat
•   Excess glandular tissue development
•   A combination of both excess fat and glandular tissue
•   Gynecomastia may be present unilaterally (one breast) or bilaterally (both breasts)

Gynecomastia surgery is a highly individualized procedure and you should do it for yourself, not to fulfil someone else’s desires or to try to fit any sort of ideal image.

This procedure is a good option for you if:

•   You are physically healthy and of relatively normal weight
•   You have realistic expectations
•   Your breast development has stabilized
•   You are bothered by the feeling that your breasts are too large

Surgical correction of Gynecomastia is best performed on:

•   Men whose condition cannot be corrected through alternative medical treatments
•   Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing
•   Non-smokers and non-drug users
•   Men with a positive outlook and specific goals in mind for improving the physical symptoms of Gynecomastia

What Causes Gynecomastia?

The condition is normally from abundant growth in glandular and fatty tissue in the male breast, giving the appearance of small to medium breasts and occurs in roughly 40 to 60% of men.  The causes can range from hereditary factors, hormonal imbalances, obesity, steroid use, marijuana use, benign or malignant breast tumors, fibrosis, genetic disorders, Klinefelter Syndrome, testicular atrophy and/or failure, supplemental hormones and other medications, and lastly, liver disease.

Gynecomastia may be present at birth, occur during the onset of puberty, throughout life due to any of the above reasons or from something as simple as the normal aging process toward the end of our lives.

Do You Have Gynecomastia?

Although gynecomastia can and does occur in persons of normal weight or body fat composition, it may occur simply from being overweight.  If this is the case, you may wish to follow a sensible diet and exercise program to see if this corrects the problem.  If you presently adhere to a good diet and healthy exercise regimen and you still feel as though you have fatty breasts, you may have gynecomastia.  If you suffer from any of the causative factors in section 2 (What Causes Gynecomastia?), and feel as though your breasts are larger than they should be, it is quite possible you may have gynecomastia.

Gynecomastia is divided into four grades: grade I: small enlargement, no skin excess; grade IIA: moderate enlargement, no skin excess; grade IIB: moderate enlargement with extra skin; and grade III: marked enlargement with extra skin. Grades IIB and III require some skin excision. Letterman and Schuster simplified the classification into three types of gynecomastia based on the required correction: (1) intra-areolar incision with no excess skin; (2) intra-areolar incision with mild skin redundancy corrected with excision of skin through a superior periareolar scar only; and (3) excision of chest skin with or without shifting the nipple.One can reduce the gland through a periareolar incision and perform a skin correction at a later date if necessary.

For surgical planning, there are three classifications of gynecomastia.

Grade I: A localized button of tissue that is concentrated around the areola. These buttons are usually easy to remove; the chest is not fatty, and there is no skin excess.

Grade II: Diffuse gynecomastia on a fatty chest where the edges of the tissue are indistinct. This tissue is difficult to taper. Dishing was common before the addition of suction lipectomy.

Grade III: Diffuse gynecomastia with excessive skin. These patients require external (outside the areola) skin excisions or nipple repositioning, or both." (Source: Yale Medical Core Curriculum)

Pre operative/Consultation

The success and safety of your gynecomastia procedure depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.

Be prepared to discuss:

•   Why you want the surgery, your expectations and desired outcome
•   Medical conditions, drug allergies and medical treatments
•   Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs including steroids
•   Previous surgeries

Your surgeon may also:

•   Evaluate your general health status and any pre-existing health conditions or risk factors
•   Perform diagnostic testing to determine the underlying cause of gynecomastia; this may include testing of your endocrine function
•   Examine your breasts and may take detailed measurements of their size and shape, skin quality, placement of your nipples and areolas
•   Take photographs for your medical record
•   Discuss your options and recommend a course of treatment
•   Discuss the likely outcomes of gynecomastia correction and any risks or potential complications
•   Discuss the use of anaesthesia during your breast reduction

Prior to surgery, you may be asked to:

•   Get lab testing or a medical evaluation
•   Take certain medications or adjust your current medications
•   Stop smoking well in advance of surgery
•   Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

Special instructions you receive will cover:

•   What to do on the day of surgery
•   Post-operative care and follow-up

The Physical Examination

You will be asked to remove your shirt and possibly told you may cover yourself with a gown.  After you are finished your surgeon and a nurse will come in to examine your skin condition, type, thinness and elasticity. 

Your surgeon may possibly take measurements.  He may pinch or tug on your skin gently to test your laxity, and determine the density of fat or breast tissue accumulation.  You may feel uncomfortable during this time so prepare yourself for it.

You will also be given (or should be given) a list of medications that you must cease or avoid taking.  These medications will mostly be aspirin-containing products and supplements that may inhibit clot formation or cause problems with anaesthesia.  However medications which may cause clotting (such as Vitamin K) may be prohibited, do ask your surgeon. 

The Operation

Plastic surgery to correct Gynecomastia is technically called reduction Mammaplasty, and reduces breast size, flattening and enhancing the chest contours.

In severe cases of Gynecomastia, the weight of excess breast tissue may cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple). In these cases the position and size of the areola can be surgically improved and excess skin may be reduced.

Anaesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anaesthesia. Your doctor will recommend the best choice for you.

Liposuction: In cases where Gynecomastia is primarily the result of excess fatty tissue, liposuction techniques alone may be used.
This requires insertion of a cannula, a thin hollow tube, through several small incisions. The cannula is moved back and forth in a controlled motion to loosen the excess fat, which is then removed from the body by vacuum suction.

There are various liposuction techniques that may be used; the technique most appropriate in your case will be defined prior to your procedure.

              
Excision:

Excision techniques are recommended where glandular breast tissue or excess skin must be removed to correct gynecomastia.

Excision also is necessary if the areola will be reduced, or the nipple repositioned to a more natural male contour. Incision patterns vary depending on the specific conditions and surgical preference.

Sometimes Gynecomastia is treated with both liposuction & excision

                  
Will there be scars?

Any surgical treatment to correct Gynecomastia will require incisions. While most incision lines are concealed within natural contours, some may be visible and are a necessary result of breast reduction surgery.

Important facts about the safety and risks of Gynecomastia surgery
The decision to have Gynecomastia surgery is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable.

Your plastic surgeon and/or staff will explain in detail the risks associated with surgery.
You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks or potential complications.

The risks include:

•   Unfavourable scarring
•   Bleeding (hematoma)
•   Blood clots
•   Infection
•   Poor wound healing
•   Changes in nipple or breast sensation may be temporary or permanent
•   If liposuction is used, additional risks include uneven contours, rippling or loose skin, irregular pigmentation, excessive fluid loss or fluid accumulation

Anaesthesia risks

•   Breast contour and shape irregularities
•   Skin discoloration, permanent pigmentation changes, swelling and bruising
•   Damage to deeper structures – such as nerves, blood vessels, muscles, and lungs – can occur and may be temporary or permanent
•   Allergies to tape, suture materials, glues, blood products, topical preparations or injected agents
•   Breast asymmetry
•   Fatty tissue found deep in the skin might die (fat necrosis)
•   Fluid accumulation
•   Deep vein thrombosis, cardiac and pulmonary complications
•   Pain, which may persist
•   Possibility of revisional surgery

Post Operatively

After surgery, dressings or bandages will be applied to your incisions and an elastic bandage or support garment may be used to minimize swelling and support your new chest contour as it heals.

A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid that may collect.

You will be given specific instructions that may include: How to care for your surgical site(s) following surgery, medications to apply or take orally to aid healing and reduce the risk of infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with your plastic surgeon.

Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.

•   Where will I be taken after my surgery is complete?
•   What medication will I be given or prescribed after surgery?
•   Will I have dressings/bandages after surgery? When will they be removed?
•   Are stitches removed? When?
•   When can I resume normal activity and exercise?
•   When do I return for follow-up care?

The final results of breast reduction in men are permanent in many cases. However, if Gynecomastia resulted from the use of certain prescription medications, drugs including steroids or weight gain you must be fully free from these substances and remain at a stable weight in order to maintain your results. Please discuss this with your physician before making changes to your prescription medications.

All scars are permanent, even though some scars may be concealed in the natural contours of the breast. Your improved upper body will likely enhance your self-image and confidence, whether in a shirt and tie, a t-shirt, or baring your chest at the beach.