Gynecomastia is enlargement of the male breast gland tissue. The enlargement of the gland itself is often accompanied by increased amount of fatty tissue which permeates the gland, and it also surrounds it. The change can occur on one or both sides and it’s often followed by increased areolas, painful sensitivity of breasts to the touch and a different degree of excess skin. If the breast augmentation resulted solely from increased fat tissue deposits (which most commonly occurs due to general obesity), then the term Pseudogynecomastia or Lipomastia is used.
The causes of gynecomastia are completely unknown in almost 25% of the cases. The important fact is that this problem has a completely different pathogenesis and prognosis for young men, and a different one for older men. In young men, some forms of gynecomastia are relatively common during the puberty, but in more than 75% of cases it will spontaneously withdraw within 2- 3 years. In this sense, the operation should not be rushed at all costs and it should not be done before 18 years of age. The cause is considered to be the imbalance between male and female hormones. Breast augmentation in this age, although most commonly harmless and temporary, could be the cause of serious psychosocial problems.
In older men, however, gynecomastia must be taken more serious and examined more thoroughly since it is almost always connected to either a serious illness (hyperthyroidism, testicular cancer, liver disease, etc.) or with some other larger metabolic disorder The cause could also be the use of some medication, such as spironolactone, ketoconazole, verapamil, anabolic steroids, etc. These men often have a higher or lower testosterone level.
After the standard preoperative preparation, it is necessary to perform endocrine examination in order to investigate the patient’s hormonal status, especially of the sex hormones. Breast ultrasound and mammography are also required.
The operation is usually performed with general anaesthesia and it can last 1-2 hours, depending on the breast size.
If the mammary gland is large and compact, then it is removed through an incision of several cm made on the areola edge, where the skin transitions from light to dark. If there is a larger amount of surrounding fat, it is removed with liposuction during the same procedure. When the mammary gland is smaller and abundantly permeated with fat, the entire procedure can be performed with liposuction, where the incision and the scar are almost absent since the cannulas are inserted into the tissue through small incisions and they are used to remove the fat and gland parts by vacuum suction. There also is a third scenario where the breast is so large that it almost entirely resembles a woman’s, there is an excess of breast skin, areolas are widened and the nipples are lowered. In this case, surgical methods similar to those used for female breast reduction, but modfified, are used and can be periareolar, circumvertical or similar to the reverse T technique.
The patient stays in the hospital for 1 day. The drains are removed after 24 hours. It is required to wear special elastic corsets for 2-4 weeks. The stitches are removed after 7-10 days. In the first several days, the operated region is swollen and painfully sensitive in different degree, and bruising is possible. Strenuous physical activities, heavy lifting and sports are prohibited for a month. In some patients, the recovery is faster, in some it is slower and this cannot always be predicted. Possible complications are: widening and thickening of scars, temporary loss of sensitivity, asymmetry, infections. The scars fade and soften gradually and can be considered aesthetically acceptable, but if it is necessary, they could be corrected later on for and even better result.