Gynaecomastia

Gynecomastia is the formation of female breasts in men, whereby one or both breasts are bigger than normal. The correction of gynecomastia can result in a great improvement of the chest area.

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GYNAECOMASTIA

Gynecomastia is the formation of female breasts in men, whereby one or both breasts are bigger than normal. Breast development in men can be painful but also be a source of embarrassment during sports, swimming and visits to the sauna and the beach. With gynecomastia in general there is excess breast tissue. In some instances, breast development is mainly fatty tissues (pseudo-gynecomastia). There are various causes of breast development in men among which adipositas, side effect of many different medicines, hormones, puberty, metabolic changes or breast cancer in men. Often it is difficult to point out the cause of the gynecomastia. Sometimes breast development is a sign of a serious disease such as thyroid disease, liver disease, a tumor of the adrenals or testis. If there is any suspicion of one of these diseases this needs to be investigated, diagnosed and treated accordingly. Gynecomastia occurs most often in boys going through puberty. This type of breast development normally disappears on its own within 2 years. If it has not disappeared by then it probably never will and a surgical correction is necessary. Even if the cause of a gynecomastia has been treated the correction often still is needs to be done.

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DETAILS OF THE TREATMENT

THE FIRST CONSULTATION

During the first consultation the cause and severity of the gynecomastia is assessed. Possibly an echo, mammogram and blood tests will be done to ascertain the cause. The spectrum of gynecomastia varies from a visible nodule under the areola to a large, stretched, and ptotic female breast. The correction therefor varies depending on the severity. The surgical technique most appropriate in your case depends on the size and the shape of the breasts, the position of the nipple-areola complex and the quality of the skin. The goal of the correction is to create an as normal and masculine looking chest as possible with as little visible/obvious scars as possible. The technique most appropriate for the correction of your gynecomastia will be discussed in detail.

THE PROCEDURE

The procedure is normally performed under a general anesthetic. Small nodules under the areola can sometimes be excised under local anesthetic. In larger gynecomastia where the breast is not or minimal hanging with good quality skin, liposuction can be used to remove the fat. Any visible hard breast tissue that remains can be excised through a small incision. In a larger breast with low nipple position and poor skin elasticity, the volume of the breast needs to reduced together with skin excision around the areola. Large ptotic breasts with very low nipple position and poor skin quality may require an amputation with replacement of the nipple-areolae as a skin graft. In most procedures liposuction will be used to contour the chest and correct dents after gland excision. Drains are often placed under the skin and connected to little vacuum bottles to remove fluid and blood that could accumulate.

AFTER THE PROCEDURE

After the procedure you can go home with the drains that will be removed at the consulting room after 1 or 2 days. A special chest binder will need to be worn as often as possible for 6 weeks. The area will be sensitive and paracetamol normally is sufficient. In the first couple of weeks the chest can be swollen and bruised. It is advisable to go for lymphatic drainage and massages by a physiotherapist to reduce the swelling and stimulate skin contraction. The pain the day after the procedure is often described as muscle pain. You need to take it easy the first couple of day and strenuous activity and sports should be avoided for 4 - 6 weeks.

RESULTS

The correction of gynecomastia can result in a great improvement of the chest area. Immediately after the procedure the chest will be swollen and the true result will therefore not yet be apparent. The skin takes time to contract around the new breast shape. After 3 months you can clearly judge the success of the procedure. The final result is after one year when the wound healing process is complete. With good preparation and realistic expectations, the correction of gynecomastia will lead to satisfying esthetic results.

RISKS AND COMPLICATIONS

Every surgical procedure has risks and potential complications. Complications that can occur are bleeding, infections, numbness, asymmetry, irregularities and scars. The scars will be kept as small as possible. Only when the breasts are so large that an amputation is indicated large scars across the chest will be necessary. The nipple-areola grafts normally survive well.

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