True “physiologic” gynecomastia is thought to be due to an altered estrogen/androgen balance or from increased sensitivity of the breast tissue to normal estrogen level. In puberty, breast enlargement can occur in 60-70% of adolescents, with a median age onset of 14 years. Many of these patients will have the issue resolve spontaneously in an average of 18 months. If the tissue is painful, inactive fibrotic tissue (not proliferating), or is greater than 4 cm it is more likely to persist into adulthood.
True “pathologic” gynecomastia is associated with too much estrogen or too little androgen. This can be caused by:
- Medication (aldactone, estrogens, androgens, calcium channel blockers, hypertension
- Tumors (adrenal, testicular)
- Endocrine (hyperthyroid)
- Liver disease
- Chromosomal abnormalities (Klinefelters)
- Anabolic steroids
- Illegal drugs (marijuana, heroin, methadone, alcohol)have been linked.
If it is true gynecomastia with a glandular component, there are other causes that need to be evaluated: puberty, anabolic steroids, marijuana use, genetic disorders and syndromes, chronic liver disease, tumors, and some medications.
Do you have male breasts ?
It is important that you should get a proper consultation with an endocrinologist who can rule out any cause for the condition. You no longer need to suffer this condition as scientific advances in aesthetic surgery allow us to get rid of male breasts without leaving any skin mark. Unfortunately, there is presently no non-surgical way to get rid of male breasts.
Most teenage boys experience some degree of breast enlargement which affects one or both breasts. However, by early adulthood less than 10% have a residual problem. This incidence rises with age, reaching approximately 30% (1 in 3) in older men. Although the cause of gynecomastia is largely unknown some possible causes include: medicines (for high blood pressure, heart disease prostate and testicular cancer), drugs (such as marijuana anabolic steroids, digitalis and cimetidine), some diseases (such as liver failure and some cancers) and some very rare congenital abnormalities.
It is possible to remove the gland and excess skin leaving an almost normal looking chest. The scars are not visible if only liposuction is used. In other techniques, the scar is barely visible. This procedure give a feeling of normalcy and improved self confidence..
- GRADE I – Minimal hypertrophy without ptosis (<250g)
- GRADE II – moderate breast enlargement, (250-500g) exceeding areola boundaries. Edges indistinct from the chest.
- GRADE III – moderate breast enlargement, (>500g) exceeding areola boundary. Edges are distinct, skin is redundant.
- GRADE IV – marked breast enlargement, skin redundancy, and feminization of the breast.
The First Consultation
Your firstconsultation with your plastic surgeonwill educate you as to how gynecomastia surgery can improve the appearance of your chest. Your goals and specific needs will be discussed. You will be fully educated regarding the procedure, the various options available for gynecomastia correction, their likely outcomes and potential risks associated.At this consultation a detailed chest examination and measurements along with photographs will also be taken. However some criteria are essential for a good and successful outcome of the procedure. Patients must be in good physical and psychological health, be realistic in their expectations, have good skin elasticity. They must have implemented the option of dieting and exercising as first options prior to resorting to surgery.
It is important for you to provide complete information about your past medical history, any medical illness, drug allergies, previous surgeries, and medications that you currently take.
General Guidelines prior to Surgery
- Detailed Chest examination and measurements
- Pre-Operative Photographs for medical record keeping
- Obtain laboratory testing or a medical evaluation
- Pre-operative Anaesthetic assessment for fitness for surgery
- Sign an informed Consent Form
- Stop smoking prior to surgery
- Take certain medications or adjust your current medications
- Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they increaserisk of bleeding.
- Maintain a stable weight for 3 months prior to the date of surgery
Gynaecomastia removal surgery is performed under general anaesthetic in hospital. The attending Anaesthetist will explain the type and risks of the particular form of anaesthesia for your operation prior to surgery.Liposuction of the chest wall and or breast tissue excision are standard treatment. For those men with tissue that is more glandular in nature, all breast tissue directly under the nipple is removed via a small incision. If the breasts are fatty, it is possible to get rid of the breast gland by liposuction alone.
In some people, ultrasonic assisted liposuction is an excellent approach. The excess skin contracts and remodels over the chest wall in the next six weeks.In a few cases, if there is a very large amount of extra skin, it may be necessary to remove this tissue. The surgery normally lasts 1 ½ to 3 hours.
Gynaecomastia is a day care surgery and you will be discharged within 12 hours of your procedure. It usually takes 1-2 days to recover from the surgery. Pain at the surgical site is controlled by pain medication. You will have a soft dressing around chest for firm support. Healing time is usually 7 days. Stitches are usually absorbable and do not need to be removed.
After the operation the chest though reduced is usually temporarily swollen numbed and bruised. This will settle down over the next 2 weeks.
You will be instructed to wear an elastic vest for 6-8 weeks. This allows all empty spaces to collapse, allowing the skin to retract and settle on the chest wall. Sun exposure is to be avoided for at least six months to prevent permanently altering the skin pigmentation.Patients can get back to work within 3-5 days of the procedure. You can get back to a normal exercise programme 6 weeks after the surgery. It is important to remember that the final appearance after the surgery may take approximately 3-4 months.