Gynecomastia
What is gynecomastia ?
“Gyneco” means female and “Mastia” means breast So term “Gynecomastia” means Female like breasts. Any Condition in males causing increase in Size of breasts is gynecomastia.
What are causes of gynecomastia ?
The gynecomastia occurs most commonly due to sudden increase in estradiol (female hormone) at the time of puberty . This type of gynecomastia presents between 14 – 18 years and commonly subsides to some extent within 2 – 3 years of its point of start. Other causes many be hormonal disorders , Any medical treatment for certain diseases , Endocrine disorders etc. Generally this type of cases are not more than 5 – 10 % of total cases of gynecomastia. They requires treatment of underlying disease first and later on surgery of breasts.
Do male breasts/ Gynecomastia occur in obese patients and is related to eating habits ?
Excess weight gain can cause the male breasts to become bigger as the fat component increases. There is increased conversion of male hormone to female hormone in fatty tissues in obesity especially childhood obesity. This can result in gynecomastia or psuedogynecomastia formation.The glandular component occurs due to a temporary hormonal imbalance during puberty. So excessive foods and lack of physical activity can result in obesity and gynecomastia formation.
Can exercises help me to reduce my male breast ?
Male breasts/ boobs usually have two components- glandular (breast) tissue and fat. The fat component can be reduced by fat reduction through diet and gym. The glandular component will not reduce by any amount exercises. It can be removed only by surgery. Fat beneath the nipple is relatively resistant to exercise also.
Gynecomastia can be operated by which age ? I am 16 years old, can i get it operated right now ?
Physiological gynecomastia occurs between age of 12 – 17 years . Generally it reduces in its size within 2 – 3 years . In any case with history of more than 3 – 4 years of gynecomastia , you can get them operated even at age of 17 years but if gynecomastia has started only at age of 17 , you should wait for at least 2 years before getting it operated . Any gynecomastia which has started after age of 19 years , will require complete hormonal work up.
Do you test hormone levels before operating gynecomastia ?
In our experience if gynecomastia is of more than 4 -5 years of duration and if it started before age of 18 years , on any investigations the hormone levels usually come normal . So we don’t advise hormone levels if the patient has duration of more than 4 -5 years and there is no recent change in size of male breasts during last 2 – 3 years .
In Cases where onset occurs after age of 19 years or gynecomastia is rapidly increasing in size , we do all hormone levels before we perform male breast reduction surgery in patients.
Can gynecomastia treated without any surgery with help of medicines ?
There is no effective non surgical/ medical treatment for developmental male breasts. There are studies which show reduction in gynecomastia in the initial stages of puberty by medical therapy, but reduction to normal size is almost never approached by medicines. Breast reduction surgery is required in almost all cases as It is unlikely that already formed male breast tissue will decrease with any medicines.
If gynecomastia has occured due to a disease or hormonal imbalance, the underlying cause should be treated first. Medicines should be taken only on advice of Endocrinologist. Plastic surgery is the best option for gynecomastia treatment.
How much pain will be there during surgery ?
There are two type of anesthesia . One is called Local anesthesia in which only breast will become numb and there will be no effect on any other muscle or body parts . Local anesthesia carries negligible risk . At AKESO we give local anesthesia in form of tumescent anesthesia . Patient remains awake during the surgery and he does not have pain during surgery.
Second type of anesthesia is called General anesthesia .In this type of anesthesia you become unconsious with help of drugs and all the body muscles are paralysed with help of drugs. Also u are given breath by machine in general anesthesia as the muscles of breathing are also paralysed in general anesthesia . General anesthesia is very risky thing as all body muscle are paralysed when general anesthesia is given to the patient . At AKESO we never use general anesthesia for our patients .
AKESO is one of the rarest clinic which offers you gynecomastia removal with use of any sedative (sleeping pill or injection ) or general anesthesia.
If I have male breasts, does it mean that I have more female hormones?
Male breasts/ gynecomastia develop during the pubertal age- 12-15 years of age. The excess female hormones existed during that time. Normal male hormone levels are soon established. Most men with gynecomastia have completely normal male hormonal levels. If there are other features of low male hormones like lack of facial hair, hormonal tests are required.
What will happen if I do not treat the male breasts? is there any chance of developing cancer in them ?
Male breast/ Gynecomastia is not a disease. If you are not bothered about the appearance, there is no need for treatment. The surgery for Gynecomastia is meant to improve the appearance and create a normal manly chest. This is purely a cosmetic surgery. Most people undergo Gynecomastia surgery to look and feel normal, shed social inhibitions and regain confidence. There is no chance of cancer development in them .
Will the male breasts increase in size with time ?
Since male breast/ Gynecomastia usually have a significant fat component, when there is weight gain, the male breasts also can increase in size. The glandular component does not usually change in size.
Is there a chance of the male breasts occurring again after surgery?
Gynecomastia surgery has two components fat cell removal and Gland removal. The Gynecomastia surgery removes upto 80 – 90 % fat present in male breast and almost entire gland. About 10 – 20 % fat cells are left so that circulation of skin is not effected and you get a male chest shape instead of completely flat chest. These remaining 10 – 20 % fat cells can increase in size if you increase significant weight. It is advisable not to gain weight after the surgery to maintain the good result. Otherwise the result after Gynecomastia surgery is permanent.
My nipple-areola is very large. Can it be reduced in size by surgery?
Large nipple areola is a usual problem with moderate to large sized man boobs. There is no need to cut and reduce the areola size. After Gynecomastia surgery, due to the reduction in size of the breasts, the areola will automatically shrink in size. Areola reduction by surgery will leave big scar all aound the areola.
I have puffy nipples, I don’t know if it is male breasts. What is the difference?
“Puffy nipples in men” is a term that usually denoted Grade 1 Gynecomastia, where there is only a small amount of breast tissue directly under the nipple- areola. Puffy nipple is also male breast, and the treatment is by surgery. Even this tough glandular breast tissue can be removed by keyhole male breast surgery.
I consulted a plastic surgeon nearby and he said that the tough glandular tissue can only be removed by open excision. Is that true?
Liposuction alone will not remove tough gland tissue. But the breast tissue can be removed through small incisions very effectively. In anterior pull through technique, the gland tissue is completely removed under direct vision using a small incision under the areola. Th traditional half circle incision is not needed. The advantage here is that the scar is very small.
When can I start going to office again after male breast surgery?
You can return to normal office work after 24 hrs of Gynecomastia surgery. If your work requires lot of travel or physical work, it is better to take a few days of rest. Driving can be started from next day of surgery.
When can I start my gym routine?
Cardio exercises- treadmill, brisk walking, cycling, elliptical cross trainers- can be started after 2 weeks. Weight training can be started 4 weeks after Gynecomastia surgery.
What can go wrong in the male breast surgery?
Infection, haematoma ( blood cllection ) , asymmetry, under correction, decrease in nipple sensation and poor location of scars are reported. The complication rate in top centres is very low.
What is the purpose of the corset (compression garment) ? Is it compulsory after male breast surgery?
The corset( elastic vest/ compression garment) provides compression immediately after Gynecomastia surgery and thus limits the post operative swelling. It also helps to support the skin during healing and helps to reduce loose skin after surgery.
I have lost about 25 kilos; still my male breasts are prominent. They are sagging also. Can it be corrected by keyhole surgery?
If there is significant sagging of skin, the male breasts can be corrected by open surgery which will remove the excess fat, breast tissue and skin. The location of the scar could be around the areola or on both sides of the areola depending on the severity of sagging.
How is keyhole male breast surgery different from liposuction?
Chest Liposuction removes only fat tissue. Male breasts also have tough glandular tissue which does not come out by traditional Liposuction. Keyhole male breast/ Gynecomastia surgery utilizes a modified method of Liposuction where special cannulae are used to disrupt the glandular tissue. Lateral pull though technique or anterior light pull through to remove the glandular tissue can also be performed through the keyhole. Keyhole surgery is effective in chest fat reduction and complete gland removal without big scars.
Why should Liposuction be done in Gynecomastia? If gland excision only is done, is it not enough?
Most cases of Gynecomastia have a combination of fat and gland tissue. The fat component is usually more than the gland tissue. Doing liposuction in these cases is important to get the normal chest shape and for chest sculpting. If the fat is not removed, the lower chest shape will not improve. The fat cells can enlarge if you put on weight. If the gynecomastia is mainly because of gland tissue, liposuction is not required.
