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.
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:
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.
The diagnosis is basically clinical. But we consider some aspects as well as:
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
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He worked at the Hospital Clínic in Barcelona where he worked as a specialist in Plastic Surgery and repaired for 16 years.
Fifteen years ago, together with two other professionals, he founded Antiaging Group Barcelona, at the forefront of Aesthetic Medicine and Surgery. He has developed professionally in the field of care, research and teaching, being his fields of interest facial surgery, breast surgery and body contouring with implants.
In breast surgery is a specialist in transaxillary breast augmentation and secondary breast surgery. He has introduced the use of ultrasound in Plastic Surgery and recently the use of 3D implants in thoracic malformations.
University Specialist in Plastic, Reconstructive and Aesthetic Surgery, having completed his training at the Hospital Clinic in Barcelona.
He has worked in hospitals in the United Kingdom and Zaragoza and is currently part of the Breast Unit of the Plastic Surgery Service of the Hospital de Bellvitge in Barcelona.
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:
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:
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.
