Gynecomastia means enlargement of male breast. It can affect one or both breast. The condition may be familial or have no cause or occasionally due to medical related problems like liver disease and drugs related.
The breast enlarges either by increasing the glandular tissue or just by fatty deposits.
Surgery in breast reduction depends upon the nature of the enlargement.
- Glandular enlargement will need excision.
- Fatty tissue in excess will need liposuction.
- A combination of liposuction and excision is usually done to get optimum cosmetic result.
Some improvements of techniques in the treatment of breast hypertrophy have also allowed a better result in the surgery of gynecomastia. Although it would seem that a simple solution should be adequate for a simple, visible subcutaneous mass, the challenge of obtaining a smooth and flat result has been helped by the technique of liposuction with circumareolar excision. For body-builders who are relatively thin, presenting a very small amount of fat over the area of the chest, treatment has been found to be satisfactory by simply excising the actual hypertrophic gland without having to remove any fat; however, in older patients as well as the average adolescent or middle-aged man, gynecomastia is often a mixture of breast tissue and fat, and the combination of gland excision with liposuction is most useful.
Indications
The diagnosis of gynecomastia is simple and straightforward It consists of a visible and palpable enlargement of the chest area around the nipple, similar in configuration to the female breast.
Gynecomastia is found in adolescent and middle-aged men, thus indicating some hormonal factors. It is sometimes tender, always embarrassing to the patients, and rarely malignant.
Laboratory tests rarely will show any hormonal problem. The condition is common and often improves spontaneously in young men, to return when they reach middle age.
The Procedure
In cases of pure glandular hypertrophy, the treatment consists of a subcutaneous mastectomy performed preferably through an infra-areolar incision. This treatment is done in cases in which there is no excess skin development, thus allowing redraping in the postoperative period.
A semicircular incision is made at the junction of the skin and areola, leaving a layer of 0.5cm of dermis, and the ducts are transected, freeing completely the areola by sharp dissection. The remaining portion of the surgery is performed by blunt undermining of the skin, using curved scissors and attempting to leave a layer of fat if it is present under the skin. The undermining encompasses the whole gland which occupies the chest wall for a large surface. With the gland lifted, its medial border is dissected from the pectoralis fascia underneath, freeing the whole gland by sharp and blunt dissection. The lateral aspect of the gland is freed from the pectoralis fascia and the fascia of the serratus below. Closure of the large cavity is performed by tacking sutures applied circumferentially to maintain the skin against the chest wall and prevent a large hematoma formation.
Drains are left, especially in body-builders. In whom large muscles with an excess circulation is present.
Gynecomastia Treatment When Fat Is Associated with Glandular Hypertrophy
In some cases in adolescent and middle-aged men, a combination of fat interspersed with glandular hypertrophy is found around the gland, and it extends into the gland itself and above it. In these cases, it is advisable to perform liposuction either before the glandular excision or after it, to obtain a smooth contour to the chest wall.
In such cases of gynecomastia, either pure or with fat hypertrophy, the treatment is often a combination of the two techniques of liposuction and excision. In cases in which there is an excess skin that will probably not adapt to the new chest wall, it is often necessary to excise a horizontal portion of skin at the level and below the level of the areola. The patients will have less aesthetically pleasing results, because they are marred by a large scar.
Preparing for the Operation
These investigation may have to be done to rule out any breast disease or tumour.
Products that contain Aspirin, Vitamin E, or Evening Primrose oil should be avoided for four weeks before surgery. The use of Vitamin K (10mg daily) for three days before surgery is recommended.
Strong alcoholic drinks should be avoided before surgery.
Important: Patients should not smoke for two weeks before surgery and for a few days after surgery. Smoking interferes with the circulation of blood to the skin and can cause death of the skin flaps.
If the patient develops any signs of infection, pustules or boils on the face or body before surgery, the doctor should be notified immediately.
On the day of the surgery, the patient should wear comfortable, loose clothing that do not have to be pulled over the head, to the hospital.
Patients must not wear any make-up (including mascara and nail polish) when they go into surgery. If the patient tints, dyes or bleaches his or her hair, this should be done no later than one week before surgery.
Surgery is done under local or general anaesthesia.
Post Operative Care
- Take a week off work.
- Takes 4 to 5 weeks to resume normal activity.
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