GYNECOMASTIA ( ENLARGED MALE BREASTS)
Gynecomastia is enlargement of male breasts. Men can get affected by this condition at any age. It results in excess breast tissue in response to hormones.
In most of the cases, no definite cause is seen. Gynecomastia can occur secondary to:
1. Medicines like steroids, antidepressants, agents used in the treatment of cancer etc.
2. Diseases elsewhere like cirrhosis of the liver and certain type of tumors.
3. Secondary to use of alcohol, amphetamines, marijuana etc.
Gynecomastia can result in embarrassment and social inhibitions. It can prevent affected individuals to refrain from participating in sports and other situations where the altered appearance is easily made out.
Male breast enlargement is characterized by:
1. Excess of glandular tissue
2. Excess of fat ( adipose tissue)
3. Excess of skin in long-standing and severe cases
4. Unilateral or bilateral
Individuals with gynecomastia are evaluated to rule out secondary causes of gynecomastia. Male breast enlargement can be a temporary phenomenon in adolescents.
Candidates for plastic surgery include:
1. Patients were not responding to medical management
2. Non-smokers
3. Good general health
4. Those with realistic expectations
Plastic surgery treatment options:
These include:
1. Liposuction: This is performed in individuals with a predominantly fatty component. The fat is sucked out with the help of small tubes with a vacuum. The access sites are loosely sutured. The tissues settle into new appearance once the swelling subsides. Use of pressure garments is advised for 6 months.
2. Excision of glandular tissue: The complete removal of glandular tissue is difficult with liposuction alone. The glandular tissue is removed with the help of a small incision at the junction of the areola ( pigmented skin) and chest skin.
3. Excision of skin: Excess skin is sometimes seen in long standing severe cases of gynecomastia. When it is associated with reduced skin tone, the skin may be excised in the shape of a donut. The wound is closed as a purse string. An advantage of this technique is that it also addresses excess skin. When it is carried out as a part of surgery following massive weight loss the incisions may be extended in the shape of a 'J' to better contour the chest skin.
Postoperative care: Patients can usually go home after a short stay. Small tubes (drains) may be used to drain out the excess of fluid collection from the operated site. These are removed within the first week. The patients are advised to use compression vest for one month to help adapt the operated site to the new contour. Patients can return to work in a week.
How does plastic surgery of gynecomastia help?
An improvement of appearance leads to markedly enhanced self-confidence and better body image.
Related topics.
Well settled areolar scar three months following surgery
Patient journey: The following images describe a patient journey during gynecomastia correction. Patient underwent liposuction and gland removal with an areolar incision under general anesthesia in a hospital setting. Recovery was uneventful.
1. Preoperative appearance of gynecomastia.
5. Dressing after the surgery
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2. Preoperative markings to highlight the muscle, fat and gland
6. Appearance as well as dressing after 3 days
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3. Liposuction
7. Pressure garment
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4. After gland removal with an areolar incision
8. Appearance two weeks following procedure. Residual swelling gradually resolves over the next few months.
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Gynecomastia with excess glandular and fatty tissues with lax skin
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Gynecomastia treated with liposuction, direct excision of gland and dough-nut excision of skin
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Gynecomastia treated in a muscular individual with direct excision of the gland through an areolar incision. Liposuction was not performed.
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Gynecomastia with excess fatty and glandular tissues.
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Gynecomastia treated with liposuction and direct excision through intra-areolar incision under general anesthesia.
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Before: Fatty and glandular excess with good recoil of skin
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After: Liposuction and glandular excision done with an intra-areolar incision
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Before: Gynecomastia in an individual with asymmetry of the underlying muscles (left pec major is bulkier compared to the right).
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After: 6 weeks post-operative image following liposuction and gland removal using areolar incision.
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