Gynaecomastia is the enlargement of the male breast tissue. It’s a medical term that originates from the Greek words for “women-like breasts”. It’s commonly known as “man boobs”. As we tell our patients from abroad, you should not worry for this condition is far more common than many people realize (gynaecomastia affects an estimated 40 to 60 percent of the male population) and there’s a treatment.
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What causes gynaecomastia?
Growth of breast tissue in men is due to a estrogen/androgen imbalance. This may be attributable to internal causes (increased secretion of estrogens by the testes or adrenal glands, extra glandular aromatization of estrogen precursors, decreased estrogen degradation) or external, such as exposure to estrogen-like chemicals, or exogenous estrogens and use of drug.
Gynaecomastia can be due to different causes:
- Idiopathic gynecomastia (no detectable abnormality) 25%
- Pubertal gynecomastia 25%
- Secondary to medication 10–20%
- Cirrhosis or malnutrition 8%
- Primary hypogonadism 8%
- Testicular tumors 3%
- Secondary hypogonadism 2%
- Hyperthyroidism 1.5%
- Chronic renal disease 1%
In our practice, 70% of patients have either idiopathic or pubertal gynecomastia (many of them who suffer are adults with gynecomastia since their puberty). 20% are due to intake of anabolic steroids and 10% are involutional (senile) gynecomastia.
Pubertal gynecomastia is so far the most common. It appears to be due to an elevated conversion of adrenal androgens to estrogens during daytime when testosterone secretion is low (in puberty testosterone usually is secreted at night). In 75% of teenagers with gynecomastia, this disappears in 2-3 years after onset.
How is the diagnosis for gynaecomastia?
The diagnosis is basically clinical. But we consider some aspects as well as:
- Detailed family history and medical history to identify any of the causes listed above, especially cirrhosis, renal failure, hyperthyroidism, medication.
- Physical exploration of abdomen and testes
- Laboratory assessment for renal, hepatic and thyroid function
- Mainly in boys, Luteinizing hormone, follicule-stimulating hormone, estradiol, dehydroepiandrosterone and chorionic gonadotropin.
Mammogram and ultrasonography are not strictly necessary, but they can be useful especially in senile gynecomastia for differential diagnosis of breast cancer, and especially if you have had breast discharge, bleeding, unilateral gynecomastia, or skin dimpling
I have gynaecomastia, am I a good candidate for male breast reduction surgery?
The best candidates for a male breast reduction are those men who have firm, elastic skin that will reshape to the body’s new contours. In some instances, surgery may be discouraged for overweight men who have not first tried an exercise and diet regimen.
The objectives of surgical treatment are:
- flattening of the thoracic region;
- elimination of the inframammary fold;
- correct positioning of the nipple-areola complex;
- removal of redundant skin;
- symmetrization between the two hemithoraxes and the two areolas;
- containment of scars
Dr. Benito is one of the few worldwide renowned leaders in male cosmetic surgery and especially in the treatment of gynaecomastia with non-invasive techniques. He’s been invited to many conferences to share his deep knowledge and experience in advanced techniques of gynaecomastia treatment.
What’s male breast reduction all about?
Gynaecomastia can be treated with liposuction and/or by cutting out excess glandular tissue. The procedure for male breast reduction takes an average of two hours, usually on an outpatient basis, using general or local anesthesia. If excessive glandular tissue, fat and skin is present, it will be removed.
Pec implants can be placed at the same time to change completely the chest and give a masculine look.
We think one of the critical points in surgery of the gynecomastia is to know how much gland has to be left under the areola to avoid its collapse and retraction. If too much, the areola will be pulled by the pectoralis muscle. If too little, the patient will complain that he still has gynecomastia. Our approach is to leave the same thickness as the surrounding skin, to leave the most homogeneous flap on the chest. The compressive girdle and massaging will help the flap to adapt over the muscle
Surgery may be performed alone or in conjunction with lipoplasty, where the suction device will typically be inserted through the existing incisions. For the removal of excess fatty tissue alone, liposuction may be all that is needed; in such cases, scars will be small and barely visible.
The main complications in surgical management of gynecomastia are:
- Hematoma: expansive hematoma could lead to nipple areola necrosis or to fibrosis and skin irregularities.
- Excessive excision leaving to areolar depression and irregularities
- Incomplete excision
- Skin hyperpigmentation
Will my breasts grow back after gynaecomastia surgery?
No, results are permanent, although subsequent obesity can create a gynecomastia-like effect. Anabolizants, of course, should not be taken. Some of the benefits of surgery include a firmer, flatter, more contoured masculine chest which may give the male patient a boost in self-confidence. There is little downtime, and you may return to work within one week usually, unless you are involved in strenuous activities. To assist with the healing process, the patient will wear an elastic pressure garment for 3-6 weeks and must avoid exposing scarred areas to the sun for at least 6 months.