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Gynecomastia

About Gynecomastia

Gynecomastia is an abnormal benign enlargement of the male breast. It may be classified as either physiologic or pathologic, and although its origin is multifactorial, 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.

Surgery

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 with 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 outpatient basis, allowing the patient to return to the comfort of their own home. General or local anesthesia is used. The procedure takes around one to two hours depending on the extent of the deformity. Surprisedly, there is only mild discomfort following the surgery.

With the liposuction technique, Ultrasonic liposuction has been beneficial in some cases. 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. I favor specially designed gynecomastia cannulas which are highly effective in removing fat and glandular tissue. The final step in contouring the breast is the release of the breast fold. In some men there is a well defined crease. Release of this crease by internally dividing the ligamentous attachments to the skin soften its appearance and allows the tissues to redrape more effectively providing a more masculine breast contour.

The incisions are small and closed with dissolvable sutures and covered with a dressing. Drains are rarely needed. 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.

Risks

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 irregularities.

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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