What is Gynecomastia?
Gynecomastia (male breast enlargement) is a common aesthetic problem that plastic surgeons deal with. The term refers to any benign enlargement of the male breast, which can be glandular, fatty or a combination of both. This benign change is influenced by various factors ranging from hormonal to external causes.
Causes
Gynecomastia can be due to genetic predisposition, variable hormonal sensitivity and disease-related imbalance, as well as external factors. Since it is multifactorial, a clear cause cannot always be determined. The underlying mechanisms include either a relative or absolute excess of estrogens (feminizing hormone), a decrease in circulating androgens (masculinizing hormone), or defects in androgen receptors. Physiological gynecomastia typically occurs in men during periods of hormonal changes resulting from altered estrogen-androgen balance in breast tissue or increased tissue sensitivity to normal estrogen levels. Pubertal gynecomastia is usually self-limiting, and most cases resolve within three years.
Exogenous factors
Exogenous factors, such as drug use, including marijuana and steroids, can exacerbate gynecomastia at any age. Even in otherwise healthy adults, a gynecomastia necessitates an exhaustive medical work-up.
Pseudogynecomastia
Pseudogynecomastia is an excessive accumulation of fatty tissue in the breasts rather than hypertrophy of the breast glands. This condition is common in men with obesity. The two diseases can usually be distinguished through a physical examination, a mammogram, or an ultrasound scan that shows the glandular tissue. Unlike true gynecomastia, pseudogynecomastia does not cause breast pain or tenderness.
Treatment
In most cases, the primary reason for surgery is the patient’s desire to remove the embarrassing breast enlargement. While obese patients usually benefit from a preoperative weight reduction program, such as our Medically Managed Weight Loss Program, most will still require surgery even after losing weight.
Diagnostics
Before surgery, a careful examination of the skin and subcutaneous tissue is important to assess the degree of hypertrophy of the glands, the surrounding fat and the elasticity of the skin, which ultimately determines the ability of the skin to retract after surgery. For routine gynecomastia surgeries, preoperative preparation often includes a physical examination and blood work, depending on the patient’s symptoms, age, and health. We advise our patients to avoid aspirin, ibuprofen, alcohol, vitamin E and tobacco for at least 10 days before the procedure.
Liposuction
In cases where gynecomastia is primarily due to excessive fatty tissue, vibration-assisted liposuction is often employed to target specific areas for fat removal. This involves creating two small incisions, typically 3-5mm in length, in the breast fold. Using a vibrating liposuction cannula I will reshape the breast into more aesthetically pleasing contours.
Gland removal
When excess glandular tissue is the primary cause of gynecomastia, liposuction alone is often not sufficient. Typically, an incision is made in an inconspicuous location along the lower edge of the areola. Through this small incision I remove the excess glandular tissue from the breast. Afterwards you will experience improved form and increased self-confidence.
BodyTite™
Bipolar radiofrequency technologies such as BodyTite™ can effectively address minimal to moderate skin laxity that can occur even after surgery by shrinking the skin and stimulating collagen production over time, further improving skin tightening. Read more about BodyTite™ and bipolar radiofrequency technology. Excessive skin must be removed surgically through excisions in the breast fold and around the areola. This procedure is often performed after significant weight loss.
Recovery
The speed of your recovery depends on your individual anatomy and the chosen surgical technique, whether it’s liposuction or more invasive tissue excision. Recovery also depends on your overall health. Liposuction typically entails a shorter recovery period. Wounds usually heal within two weeks, while swelling may persist for a few weeks. Wearing a compression garment for several weeks can aid in reducing swelling and better scarring. As swelling subsides, your chest will appear flatter and slimmer. Many patients return to work and light activities within a few days, although vigorous exercise and sweating should be avoided for at least two weeks. On average, the healing process requires about six weeks before upper body exercises can be resumed. Anything causing repetitive shocks to the upper body, including trampoline jumping, jogging, and so forth, should be avoided for 3 months. If you have any further questions or require additional information, please do not hesitate to contact me.