MALE GYNECOMASTIA
The ideal male chest is considered to be athletic looking, with broad shoulders, a narrow waist and a smooth, sculpted chest. Gynecomastia, or breast development in a male, is a condition that results in a localized, excess amount of glandular and fatty tissue in one, or both, sides of a male’s chest. Though most commonly a spontaneous development, gynecomastia can result from a number of causes: hormonal changes, obesity, drugs, or from the use of some medicines.
Gynecomastia can develop at any age, with young patients often enduring teasing in early childhood, leading to self-esteem issues, while men may avoid certain physical activities, or intimacy, as a result of development in later years.
Surgery aims to permanently remove this excess breast tissue; thereby, flattening and enhancing a patient’s chest contours.
SURGERY CONSIDERATIONS
Gynecomastia Factors
Trying to determine the cause of gynecomastia is relevant, as it will guide treatment options. Not a comprehensive list, but reasons for its development include:
Hormonal: An imbalance of male and female circulating hormones
Due to Disorders: Cirrhosis, Hyperthyroidism, Testicular tumors, adrenal tumors
Medications: Calcium channel blockers, spironolactone, anabolic steroids, marijuana
Idiopathic: the most common reason, it means spontaneously, or without known cause
Gynecomastia Characteristics
Though patients typically present with a breast mass of excess fat and glandular tissue, they may also have enlarged areola, and excess chest skin. The ideal gynecomastia patient is one who is physically healthy and of normal body weight, has tried and failed alternative treatments, and who’s breast development has remained unchanged for a year or more.
SURGICAL TECHNIQUES
In gynecomastia cases with little skin excess, liposuction techniques alone may be used. Liposuction requires creating small (0.5-1.0 cm) incisions in the skin, camouflaged in body creases or inconspicuous areas of the chest. Fluid containing medications aimed to provide pain-relief, and limit blood loss, is then infused into the problem area, before special instruments are used to suction out the excess tissue. Careful attention to detail during the suction phase ensures enough fat is removed to smooth the problem area, while leaving enough fat behind to create a pleasing contour with the surrounding chest.
When the gynecomastia is more severe, with excess skin tissue present and enlarged areola, direct excision of the tissues may be required. This will lead to longer incisions on the chest but achieves a more pleasing contour. It also allows for the areola to be reduced, or nipple repositioned, as necessary.
RECOVERY
After surgery, bandages and gauze are placed over incisions, and a compression garment applied to aid in skin retraction and to minimize swelling. The compression garment is worn for four weeks.
Prescription pain medication is typically required for the first days after surgery, and for sleeping at night. A dull chest soreness may persist for several weeks after surgery.
Full recovery will take weeks to months, depending on the type of procedure performed, with return to work dictated by how well patients feel, and the typical duties required of the job.
RISKS
We believe in being preemptive to avoid any risks associated with surgery, but occasionally the following may occur:
Bleeding/Hematoma – A small amount of bleeding is common after surgery, but if severe enough, another operation may be required to stop it. Bleeding can also form a collection, termed a hematoma, which presents as a swollen, painful, and bruised chest. These require drainage to prevent secondary problems.
Seroma – A fluid collection may form under the skin after surgery, and may require drainage. This can typically be performed in the office.
Infection – Gynecomastia surgery carries a small risk of infection, but if one occurs, it may require oral, or intravenous, antibiotics.
Poor Cosmesis – Despite proper technique, a skin or contour irregularity may occur. The incisions may have poor healing, or a wound may develop, leading to the possibility of additional need for surgery.
Under/Over Correction – All attempts are made to leave a smooth chest contour, but, in rare cases, over correction (removing too much tissue), or under correction (not removing enough tissue) may occur. This would require additional surgery to correct.
FAQS
Can’t I just exercise?
Though a proper diet and exercise regimen is one of the first steps in treating gynecomastia, it may not give you a flat chest. The breast tissue present is only somewhat diet and exercise sensitive, so despite best intentions, you may have a residual contour irregularity that requires surgery to effectively treat.
Why causes gynecomastia?
There are many causes of gynecomastia. The most common is “idiopathic,” which means either spontaneously, or without known cause. Other reasons include: an imbalance between male and female hormones within the body, conditions such as cirrhosis, medications like calcium channel blockers, drugs like marijuana and anabolic steroids.
How common is gynecomastia?
Studies have found that up to 65% of adolescent males experience transient gynecomastia.
