Male Mammoplasty – Gynecomastia

Gynecomastia (Big Breast In Men)

Gynecomastia

Gynecomastia

Gynaecomastia Surgery: The term gynecomastia, derived from the Greek words gynec (feminine) and mastos (breast), refers to the excessive growth of male breast tissue caused by any reason.

Like female breast, male breast tissue consists of milk-synthesizing glands, milk ducts (glandular tissue), and adipose tissue. Gynaecomastia Surgery: In gynaecomastia cases, the glandular tissue, adipose tissue and breast skin grow and expand to various extents. This growth is visible to the naked eye, and a hard breast tissue is felt when examined by hand. Gynaecomastia Surgery: In surgical treatment of gynaecomastia, the treatment differs depending on the condition of the components that constitute Gynecomastia.

Incidence Rate of Gynaecomastia

Gynaecomastia can be seen at any ages. It develops in newborns due to estrogen hormones transmitted from the mother, and regresses within a few weeks. In about 60% of men at the beginning of puberty (13-15 years of age), various levels of gynecomastia develop and spontaneously regress within a few years. When they turn 17, the incidence rate drops to %7.7. In advanced ages, incidence rate of gynecomastia increases again due to a decrease in the level of testosterone hormone.

In 25-75% of patients, gynecomastia is observed in the both breasts. The sizes of the two breasts are different from each other in one third of the patients. There may be pain and tenderness in the breasts.

Causes of Gynaecomastia

In 25% of all the cases of gynecomastia, and in about 85% of the cases gynecomastia treated with surgery, any cause cannot be identified (idiopathic gynaecomastia). On the other hand, gynecomastia may develop due to various factors such as cancer likely to cause an increase in blood estrogen levels or a decrease in testosterone levels (adrenal tumors, testicular tumors, lung cancer, liver cancer, etc.), endocrine disorders, metabolic diseases, trauma, psychological stress, obesity, familial property, viral infection, and drugs in particular.

Things To Do Before Contacting The Plastic Surgeon

The patient should definitely be examined by a endocrinology specialist, and the causes of gynecomastia should be investigated, before the surgical correction of gynecomastia. Especially in adults, gynecomastia may be a symptom of a much more serious disease and can easily be overlooked. On the other hand, examination of the breast tissue with ultrasound is important in terms of both the diagnosis of breast cancer and giving an idea about the structural state of the breast.

Relationship between Gynaecomastia and Breast Cancer

The incidence rate of breast cancer in male patients with gynecomastia is not different from the incidence rate in other men. However, in case of unilateral gynecomastia development in patients with Klinefelter’s syndrome, especially breast cancer should be suspected and a breast biopsy should be performed.

Relationship between Gynaecomastia and Testicular Tumor

In various studies, the incidence rate of testicular tumor has been found to be increased in the group of male patients operated due to gynaecomastia. Therefore, it is recommended to evaluate men diagnosed with gynaecomastia, as individuals suspected of having testicular cancer.

Nonsurgical Treatment of Gynaecomastia

It is agreeable to wait in cases of gynecomastia especially the ones seen in newborns and adolescents. Gynecomastia is expected to gradually decline within a period of 1 to 2 year in puberty. If a gynecomastia that has begun at 13-15 years of age still does not decline in about 17 years of age, and if it has serious psychological effects on the individual, it should be assessed in terms of surgery.

If a potential cause for gynecomastia is detected, a decline in the gynecomastia can be expected as a result of the treatment of that cause. In gynecomastia developing due to drugs, it is advisable to wait for a year after the cessation of the drugs.

In the waiting period the gynaecomastia, physical exercises intended for improving the chest muscles are done to reduce the breast tissue; however, the developed chest muscles make the gynecomastia much more noticeable.

Types of Gynaecomastia

Gynecomastia can be classified into 3 types, based on the structure of the overdeveloped breast tissue:

  1. Glandular Type: Hard breast tissue is dominant, and needs to be surgically removed.
  2. Fatty-Glandular Type: There are excess glandular tissue and fatty tissue. It is treated with the combination of surgery and liposuction.
  3. Fatty Type: Fat tissue is dominant. It can be treated with liposuction alone.

According to a different classification made by Simon in 1973, the size of the breast tissue and the excess skin are assessed as a basis:

  • Type I: Small, does not contain excess skin. There is a small and hard tissue under the nipple, which is surgically accessed removed through a small incision made in the nipple.
  • Type IIA: Moderately large, does not contain excess skin.
  • Type IIB: Moderately large, contains excess skin. In these types, gynaecomastia is treated with liposuction alone, with surgery alone, or with the combination of the liposuction and surgery, depending on the dominant type of tissue. Excess skin generally regresses spontaneously within the first 6-month period after surgery. Rarely, the skin needs to be removed as well.
  • Type III: Too large, contains excess skin. The nipple may be sagging downwards. It is difficult to reduce the breast without a noticeable scar, due to the extremely big size of the breast and excess skin. The excess skin is removed by using various techniques, and the sagging nipple is positioned in its appropriate place. Sometimes just the excess breast tissue is removed, and after waiting for a period of 6-9 months, the unrecovered part of the excess skin is removed by being attentive to leave a less noticeable scar.

Surgical Treatment of Gynaecomastia

In the planning of Gynaecomastia;

  • The amount of excess skin,
  • The extent of the sagging in the nipple,
  • The amount of hard glandular tissue in the breast,
  • The amount of fatty tissue in the breast,
  • The size of the brownish part in the nipple, are considered.

In cases where the amount of excess skin is not too much, the excess part of the hard glandular tissue of the breast is generally surgically removed by accessing it through small incisions made within the boundaries of the brownish area around the nipple. If the fatty tissue is dominant in the breast tissue, the procedure involves liposuction alone. As mostly both excess glandular tissue and fatty tissue exist, a better shape can be given to the breast by using a surgical removal procedure in combination with liposuction.

If the diameters of the two nipples are different from each other, incisions can be made in such a way as to equalize these diameters.

If there the nipple is sagging, different incisions can be designed to position the nipple in where it should be.

Cases of gynecomastia with excess skin:

In gynecomastia cases involving excess skin, the elasticity of the skin as well as its ability to recover itself are important. In cases of young people whose skin quality is not impaired, the skin is shrunk with a bandage applied for a period of 4-6 weeks after the removal of fats through liposuction, and consequently, the breast can gain its new shape. Thus, there is no need to remove the excess skin and leave scars. However, in cases of too much excess skin, the incisions are planned in such a way as to ensure the removal of the excess skin as well; and circular, lollipop-shaped or inverted T-shaped scars can be left only around the nipple.

With intent to avoid more than one scar, first liposuction is performed, the excess amount is removed by accessing the tissue through a small incision, and then the patient waits for a period of 6-9 months. During this time, the excess skin recovers itself. If there is still an excess skin at the end of this period, the excess amount skin can be removed by being attentive to leave a less noticeable scar.

In brief, there is not a standard treatment as the only option for gynecomastia. Which procedure is the most appropriate for the patient is determined by the doctor and patient, based on their discussion on the possible consequences.

Anesthesia in Gynaecomastia

In very small and limited gynaecomastia cases, surgery can be done with intravenous sedation and under local anesthesia. In more serious and double-sided cases, it is more comfortable to do the surgery under general anesthesia.

After Gynaecomastia

Drains intended for preventing blood and liquid accumulation may be available in the operation sites for a couple of days after the surgery.

Sutures are generally made in such a way as to ensure that they remain hidden in the skin. The sutures (if any) are removed 5-7 days after the surgery.

Tubular bandage should be used for a period of 4-6 weeks, in order to prevent blood and fluid accumulation in the operation site, ensure the skin to stick on the substrate, and enable it to recover itself.

Active sports activities are restricted for a period of 6 weeks in the postoperative period, in order to prevent wound formation and blood or fluid accumulation in the operation site.

Complications of Gynaecomastia

The most common cosmetic complications include deformities that can be in various forms caused by the surgeries done by doctors who are not plastic surgeons, such as crater-like collapses in the nipple (saucer appearance), or vice versa, in the form of fried egg.

Hematoma (blood) or seroma (tissue fluid) accumulation and infection in the operation site and full or partial circulation disorder in the nipple are the most common complications observed in the early postoperative period.

Mostly complications such as deformities due to excessive or inadequate correction of deformities in the breast, asymmetries between the two breasts and the mispositioned nipple can be observed in the late postoperative period. Other complications may include numbness in the nipple, color changes in the brownish area, and poor wound healing in the operation site.

Concealment of Gynaecomastia

When waiting for the big breast appearance to spontaneously decrease, or waiting until the surgery date, “gynecomastia compression shirts” helping conceal the breasts can be used for concealing the breasts in a boy in puberty.

Gynecomastia compression shirts, which prevent gynecomastia from being noticed when looked from outside, can be used when waiting for gynecomastia surgery or after the surgery.

To get information about Gynaecomastia, Big Breasts in Men, please fill out thcontact form.

Prof. Dr. Cengiz Açıkel, Aesthetic Plastic Surgery Specialist, Gynaecomastia, Big Breasts in Men, Enlargement of Breasts in Men, Male Mammoplasty

Frequently Asked Questions About Gynaecomastia

Incidence Rate of Gynaecomastia
Causes of Gynaecomastia
Things to Do Before Contacting the Plastic Surgeon for Gynaecomastia
Relationship between Gynaecomastia and Breast Cancer
Relationship between Gynaecomastia and Testicular Tumor
Nonsurgical Treatment of Gynaecomastia
Types of Gynaecomastia
Surgical Treatment of Gynaecomastia
Anesthesia in Gynaecomastia
After Gynaecomastia Surgery
Complications of Gynaecomastia
Can Gynaecomastia be Concealed?