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Gynecomastia is an abnormal benign enlargement of the
male breast. It may be classified as either physiologic
or pathologic, and although its origin is multi factorial, in most cases
an identifiable cause is never found.
The physiologic type occurs during puberty. This type
is often self-limiting and regresses spontaneously, with most cases resolving
within three years. If this condition persists into adolescence further,
hormonal evaluation is warranted.
The pathologic type involves an imbalance in the ratio
of the female hormone, estrogen, and the male hormone,
androgen, or a defect in the tissue receptors of androgens.
In adults, gynecomastia is associated with increasing
age and in particular testicular hypofunction, an increase in body fat,
and an increase in the estrogen/androgen ratio. This may be associated
with medications, tumors, chronic disease, and a host of other conditions.
In many cases there is a genetic predisposition. If your father suffered
with this condition, it may be passed on to his sons. In most cases the
etiology is unknown.
For males who feel self-conscious about their appearance,
breast-reduction surgery can help. The procedure removes fat and glandular
tissue from the breasts, and in extreme cases removes excess skin, resulting
in a more pleasing contour of the chest.
In many cases, a more pleasing contour can be achieved
with liposuction alone. In more involved situations the excess glandular
tissue may require direct excision with a scalpel. This may be performed
alone or in conjunction liposuction. In some extreme cases the surrounding
skin envelope may need adjusting. When additional skin is removed, this
will lead to more scarring.
The surgery is performed on an out patient basis, allowing
the patient to return to the comfort of their own home. Usually, general
anesthesia is used. The procedure takes around two hours depending on
the extent of the deformity. Surprisedly, after the surgery there is
minimal discomfort.
With the liposuction technique, Ultrasonic liposuction is particularly advantageous.
This approach is more effective in removing the excess tissue and in contouring
the breast shape. The Ultrasonic technique uses a solid metal probe to emulsify
the fat. It is always performed in conjunction with Standard liposuction technique.
A narrow, hollow, metal straw-like tube called a cannula, attached to a vacuum
pump, is inserted through a small incision. The cannula is moved back and forth
under the skin with deliberate strokes breaking up the fat and suctioning it
out.
The incisions are closed with dissolvable sutures and covered with a dressing.
Then a compressive garment is applied. After the surgery, there will be a fair
amount of bruising and swelling. The bruising will dissipate in several weeks
but the swelling can last several months. Most patients return to work within
several days and regular exercise in two to three weeks.
As with any surgical procedure there are risks. These include infection, excessive
bleeding, skin injury, adverse reaction to anesthesia, temporary loss of breast
sensation and fluid accumulation. The procedure may also result in noticeable
scars, permanent pigment changes in the skin, asymmetry in the breast contour
or size or contour irregularity.
Generally, gynecomastia surgery is very rewarding. It can enhance your appearance
and self-confidence. The results are permanent and significant. If your expectations
are realistic, chances are good that you’ll be very satisfied with your
new look.
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