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What is Gynecomastia?

Gynecomastia is enlargement of breast tissue in men. There may be enlargement of one or both breasts. There are several medical problems that may cause Gynecomastia however, in most cases there is no known organic cause of breast tissue enlargement in men

Gynaecomastia is a common condition producing generalised enlargement of the male breast tissue

This condition often occurs during puberty and in many occasions resolves spontaneously

It can also occur in old age in which case it is unlikely to resolve but rarely requires treatment, and often runs in families

What causes Gynecomastia?

Some of the common causes of Gynecomastia include:

Physiologic Gynecomastia is seen in newborn infants, pubescent adolescents, and elderly individuals.

Aging

Obesity

Chronic liver disease

Steroid or Marijuana abuse

Some medications

Drugs that enhance estrogen synthesis such as gonadotropins, clomiphene, phenytoin, and exogenous testosterone

Drugs that inhibit production or action of testosterone such as ketoconazole, metronidazole, alkylating agents, cisplatin, spironolactone, cimetidine, flutamide, finasteride, and etomidate

Drugs that act by unknown mechanisms such as isonicotinic acid hydrazide, methyldopa, busulfan, tricyclic antidepressants, diazepam, penicillamine, omeprazole, phenothiazines, calcium cha nnel blockers, ACE inhibitors, alcohol, marijuana, and heroin

Familial Gynecomastia

Gilbert's Syndrome - Gilbert's Syndrome is a relatively common and benign congenital (probably hereditary) liver disorder, found more frequently in males

Klinefelter's Syndrome - This is a genetic disorder characterized by abnormal enlargement of one or both breasts in men; hard tiny testicles that never grow, infertility, incomplete masculine body build, height, (6 ft. or more), may not be particularly athletic or co-ordinated.

What happens in Gynecomastia?

Gynecomastia occurs when glandular tissue of the breast swells, usually in response to an excess of the female hormone estrogen or a lack of testosterone, a male hormone.

Who is an ideal candidate for surgical correction for Gynecomastia?

Any physically fit male who has significant breasts large enough to embarrass him is a candidate for surgical correction. Male breasts could be mild, moderate or severe. Mild breasts usually have a glandular structure under the skin, made up of fat and fibrous tissue. There is usually no excess of skin. In moderate breasts, along with the gland, there is some excess of skin, which can contract after the gland is removed. In severe gynaecomastia, the excess skin may have to be removed as well.

What does the surgical correction for Gynecomastia involve?

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The surgical procedure for correction of Gynecomastia involves Liposuction or Power Assisted Liposculpture (PAL) and Breast Reduction. The procedure is performed under general anesthesia in a hospital. The surgical correction for Gynecomastia is a procedure similar to Breast Reduction which is performed in women. An incision is made around the areola, excess glandular tissue is excised out, fatty tissue is removed (either surgically or with Liposuction), excess skin may be removed to re-adjust to the new breast contour. If there is only excess fatty tissue in the breast that needs to be removed, your surgeon may just make one or two small incisions, insert a cannula through it, moving it in different directions to break and suction out the fat. The entire procedure for the surgical correction of Gynecomastia may take about 2 hours.

Treatment : Liposuction And Excision

When gynaecomastia is severe; when it is the cause of abnormal behavior and loss of body image; when it persists, and in those cases where there is a suspicion of malignancy surgical treatment is indicated. The incision for this operation is placed just inside the areolar border (dark area of the breast) where it is less likely to be conspicuous. The glandular tissue must be removed. This firm fibrous tissue extends from the nipple areolar complex down to the surface of the pectoral muscles beneath. At Hande Hospital we always use liposuction to remove the fatty tissue, which surrounds the ductal tissue. Without liposuction, patients would have a “doughnut” or a “volcano” shaped defect after removal of the ductal tissue and the patients are unhappy with the inferior results. Liposuction is a procedure where fat is sucked out from under the skin with a blunt needle. Between three and four liters of fat can be sucked out in one sitting. Liposuction of the abdomen and hips may also be performed simultaneously along with correction of gynaecomastia. Several of our patients have opted for this.

Stay in hospital is usually for a period of about three days. A drainage tube is placed to prevent any haematoma (collection of blood) under the skin, which is removed at the end of three days. The patient after discharge can perform light work straight away. Strenuous exercise and going to gym etc may have to wait for a period of up to fifteen days


Bilateral Gynecomastia Pre-Operative Photograph	Bilateral Gynecomastia Post-Operative Photograph Combination Of Liposuction And Excision Of The Gland


Before	After

How do I prepare for the surgical correction for Gynecomastia?

All the routine screening tests including blood and urine examination x-ray of chest will be preformed before surgical correction for Gynecomastia. Make sure you discuss in detail all the aspects of the procedure i.e. description of the procedure, scars from the incision, risks involved, chances of post-operative complications, before and after photographs, all the prescription and non-prescription medications that you take including vitamin and herbal supplements. These discussions will help you to make an informed decision and be comfortable with your decision to undergo Gynecomastia correction. You will be advised to eat a healthy diet and stop smoking at least 2 weeks prior to surgery. You will also be advised to refrain from eating or drinking anything at least 12 hours prior to Gynecomastia correction surgery.

What to expect during the recovery period following surgical correction for Gynecomastia?

After the surgical correction of Gynecomastia, your breast will be covered with a gauze dressing. You will be instructed to wear a pressure garment to minimize swelling and bruising. A drainage tube will be inserted to collect blood and fluid which will be removed after couple of days following surgery. You may be hospitalized overnight and allowed to go home the next morning. It is common to experience some pain and tenderness for the first few weeks after surgical correction of Gynecomastia which will eventually subside. There may also be some degree of swelling or bruising. Your dressing will be removed in about 2 - 4 days however, your stitches will be removed after about 3 weeks following the surgery. You will be advised to avoid lifting anything heavy or pushing for the next several weeks although you can resume you non-strenuous daily activities with caution within a week after surgical correction for Gynecomastia. Complete healing generally takes about 3 months after surgery.

What is the outcome of surgical correction for Gynecomastia?

Surgical correction of Gynecomastia has good results and men undergoing this procedure are quite pleased with the results. The changes produced by this procedure are significant and permanent. It is important that you have realistic expectations and discuss them openly with your cosmetic surgeon.

Benefits of surgical correction for Gynecomastia

Gynecomastia can make you self conscious and as a result you may avoid gym classes, athletic activities, and swimming or beach activities and may resort to hiding your abnormal body image with clothes. Surgical correction for Gynecomastia will improve your body image, will boost your self confidence and self esteem and you will be able to enjoy the freedom of participating in sports and activities that expose your chest without being self conscious or embarrassed.

Risks of surgical correction for Gynecomastia

Bleeding

Infection and poor healing

Allergic reaction to anesthesia

Sores around the nipple that can be treated by antibiotic cream

Scars from surgery which fade away as time goes by.

Permanent loss of feeling in the nipple area.

Slight asymmetry in the size of breasts and unevenly positioned nipples.

Formation of scar tissue internally

Complications

The most common complication following surgical removal of the ductal tissue is haematoma. To prevent this complication we take meticulous care in securing haemostasis and also routinely place a suction drain that is removed at the end of three days. Bleeding and haematoma formation is more common in patients with bleeding disorders and those taking drugs like aspirin. If a patient is taking any such medication or has a bleeding problem, it has to be brought to the notice of the surgeon. Discontinuing aspirin for a period of seven days before the surgery will suffice.

Some residual deformity of the nipple areolar area may remain despite the best efforts of the surgeon. This is relatively rare. With any operation, a wound infection could occur. Again this is extremely rare and is more prone to occur in those patients who have diabetes. Control of diabetes before surgery has made this complication almost non-existent. Inadvertent injury to the blood supply to the nipple areolar region could result in loss of sin in the nipple areolar area. The vast majority of patients undergoing this operation are very pleased and adopt a more normal life with regard to exposure of the chest in normal social situations. As said earlier, adding liposuction to conventional surgery has greatly enhanced patient satisfaction

Alternatives to surgical correction for Gynecomastia

Liposuction - Liposuction is used to remove excessive fat tissue from the breasts and under arm area.

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