What is gynecomastia?
Breast development in men in a similar way to women, which means female type breast development is called “gynecomastia”. It may be temporary, and it is expected to regress within 1 year after its appearance. If the gynecomastia exists for more than 1 year, it must be investigated and this condition should be treated according to its cause.
What are the causes of gynecomastia?
Gynecomastia is most often “idiopathic”. So, the reason is not known exactly. In addition, it can be physiological in the neonatal period, adolescence, and old age. In addition, this situation may be due to the drugs used (steroids etc.) or to pathological causes such as thyroid disorders, liver disorders and tumors.
Why does gynecomastia bother people?
Men with gynecomastia cannot easily wear the clothes they want. They have self-confidence problems when they are topless, and they show a slightly hunched posture to hide their breasts. The biggest aim in gynecomastia surgery is to destroy feminine breast image, to prevent the individual from experiencing psychological and social problems and to increase the self-confidence of the individual.
Does gynecomastia increase the risk of breast cancer in men?
The answer is “no”. Studies have shown that the presence of isolated gynecomastia does not increase the risk of male breast cancer.
What examinations are performed in a patient presenting with gynecomastia?
Although the most common cause of gynecomastia is idiopathic (the cause is unknown), other conditions that may cause gynecomastia should also be excluded. In the history to be taken, drug use and additional diseases are questioned. The patient’s hormone profile is checked, and detailed examinations are made when deemed necessary. Also, skin quality and skin excess are the conditions that should be evaluated. In addition, a breast ultrasound will be very helpful in understanding the type of gynecomastia.
What are the types of gynecomastia?
Gynecomastia may be due to excess fat tissue (this is called “pseudogynecomastia”) or excess breast gland tissue. In some cases, these two reasons go together. Differentiating this situation will be important in the treatment approach. Physical examination and breast ultrasound are very informative in this regard.
What are the surgical methods used in the treatment of gynecomastia and how is the surgical method to be chosen?
In gynecomastia surgery, two different methods can be mentioned simply. The first of these is the process of removing excess fat tissue from the breast with the liposuction method. (See Liposuction (Fat Removal) Section). In this surgery, 1-centimeter incisions are made on both side walls of the chest. The adipose tissue under the breast is destroyed with the help of cannulas advanced through these incisions, and these fragmented fat tissues are taken out of the body with a negative pressure vacuum system. If the main cause of gynecomastia is excess fat tissue, this procedure is very effective. Another method is the surgical removal of the glandular tissue under the breast, through a semicircular incision from the border of the brown ring around the nipple. This is preferred if the main cause of gynecomastia is the breast gland tissue. When necessary, both methods can be combined, and when necessary, excess skin can be removed during surgery. As it is understood, it is very important to understand the main type of gynecomastia with the physical examination and imaging methods and to determine the surgical method. Gynecomastia surgeries are performed under general anesthesia and take an average of 1-2 hours.
What is my personal approach to gynecomastia surgeries?
Based on the studies and my personal experience, I prefer making liposuction in the first session rather than making an incision around the nipple, unless there is an obvious excess of breast gland tissue. In this way, I remove excess fat tissue from the breast area and allow the excess skin to adapt more to the fat-removed chest wall. Usually, this method treats the problem alone. If there is still more breast tissue and excess skin at the postoperative 6th month- 1 year control, I prefer to remove the excess breast tissue and skin with an incision around the nipple in the 2nd session.
How is the post-operative period after gynecomastia surgery?
When leaving the operating room, the patient is dressed in silicone-supported compression foams and a special medical corset over them. The purpose of foams and corsets is to allow the skin to adapt quickly to the chest wall, to reduce edema and pain. In the postoperative 1st week, the foams are removed and only corsets are used. Depending on the situation, the patient can go home on the evening of the surgery or stay in the hospital that night and be discharged the next morning. You can take a shower 3 days after the operation. While taking a shower, the foams and the corset are removed. During that time, you are allowed to wash and dry the corset. It is recommended not to touch the foams with water in order not to lose their form. After the shower, the foams should be positioned in the same way, the washed and dried corset should be placed on the foams with the same tension. I recommend that patients who think that they cannot do this should take a shower after the 1st week control when the foams will be removed. Post-operative pain responds to painkillers and decreases day by day. Edema is maximum on the 3rd day, starts to decrease after the 3rd day, almost completely disappears at the end of the 6th week. Patients can usually return to their daily activities which will not force themselves at the end of the 1st week and return to their daily routine at the end of the 3rd week. You can start to exercise generally at the end of the 4th week, without being too heavy. The use of corsets for 4-6 weeks increases the comfort of this process and accelerates the healing. The sutures do not need to be removed since the liposuction holes or the incision around the brown ring will be closed with absorbable sutures. If only liposuction is performed, a drain is not used. If the breast tissue is removed with an incision made around the nipple, a drain can be used, and this drain is removed before the patient is discharged. The effect is evident in the first days after the procedure. With the decrease in edema and bruising, the result can be clearly seen after approximately 6 weeks, while it should be noted that 3-6 months should be waited for the final result.
Will there be any scars after gynecomastia surgery?
If the liposuction method is preferred, the incisions are in millimeters and on both side walls of the chest. If an incision is made from the brown ring around the nipple, this scar will also be camouflaged because it is at the transitional border. In addition, due to the nature of wound healing, the prominence of these scars will decrease significantly within 6 months – 1 year.
What are the complications that can be seen after gynecomastia surgery?
After this surgery, there may be bruising, color changes (purple-green-yellow), stiffness, tingling or numbness, slight irregularities in the skin and minimal asymmetries in the operation area. The mentioned conditions improve usually within the 3rd week.
Summary
Gynecomastia surgery provides a dramatic improvement in the appearance of feminine type breasts that do not go away with exercise or diet. Thanks to the elimination of the feminine breast appearance, patients behave more comfortably in the choice of clothes. This surgery prevents the individual from experiencing psychological and social problems, and increases the self-confidence of the person. Pain, bruising, color changes that will exist in the first days after the surgery and scars will be very small and affordable costs for the better breast appearance that has not improved for years. You can look to the articles related to the subject in the References section. Best regards.
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