GYNECOMASTIA (Male breast enlargement)
Gynecomastia refers to the enlargement of male breasts, either on the one side (rare) or on both sides. It normally manifests at the age of 13-14 years, when boys enter puberty. It is a normal thing and coincides with the onset and redistribution of male hormones. Microscopy shows glandular tissue with elements of fibrous texture. This normal condition remits as soon as the boy enters adulthood, and breasts are spontaneously restored to normalcy. But what happens when adult males (usually a great number of them) continue to suffer from enlarged breasts or see their condition worse? Gynecomastia is classified into 4 grades, depending on the severity of the case. What is really important to know, is the exact clinical characteristics of these men (Fig. 1) so that interested individuals are well-informed on what plastic surgery has to offer today.
CLINICAL FEATURES (Fig. Ι)
The vast majority on men aged 18-45 (50-60% of our patients) exhibits moderate breast enlargement involved with localized fat tissue which is called Pseudogynecomastia. Typically, it is the continuance of juvenile gynecomastia, combined with localized fat tissue at a second time; it manifests as a fat deposit but has glandular elements, too. To a certain percentage, this group of patients may have loose skin if the man is a little heavier than normal, or if he is above 30 years of age.
A smaller percentage (20% of our patients) exhibits the typical gynecomastia signs, i.e. they have a slight breast enlargement as a result of continuing juvenile gynecomastia. Its clinical features are ‘ping pong ball-like’ breasts and localized glandular elements. This group of patients comprises males who have used steroids in the past for chest enlargement (like body builders) and have developed glandular type of gynecomastia.
A new increasing group of patients comprises individuals who lost a huge amount of weight, either following a diet or with bariatric surgery (gastric bypass, sleeve gastrectomy, gastric band). Commonly, these individuals have very loose skin, which in certain cases resembles female breasts.
Our methodology entails the obtaining of medical history and the clinical examination of the patient. This procedure helps us classify gynecomastia and provide advise on the applicable surgery type. Any hormonal tests prior to the surgery are subject to the individual clinical examination and medical history of each patient.
Removal of the Fat Deposit and segment of the gland
Surgical treatment aims at restoring the problem with the smallest incisions possible. The surgeon examines the amount of excess skin in order to determine the applicable solution for the patient. If the skin has good elasticity and gynecomastia seems to be merely the result of fat accumulation, then liposuction is the appropriate technique to apply. On many occasions, the gland is also involved and must also be removed. 90% of the cases are treated with a small incision around the areola (the dark part of the nipple), with or without skin removal. If the skin is not loose, we perform incisions at the 3 o’clock and 9 o’clock positions in order to remove the fat and eliminate gynecomastia. In case the patient has loose skin, we agree with the patient to remove the excess skin with a circular incision which will be hidden in the dark part of the areola. Circular skin removal facilitates the procedure in cases where loose skin is involved. Lastly, severe gynecomastia with serious skin loosening (man boobs) is probably an indication for transverse incision (indicated for very special cases with extreme skin loosening) –the latter being a special category, the advantages and disadvantages of which must be thoroughly discussed with the patient.
Watch the procedure on video.
After the surgery
The next morning, the patients are discharged from the Clinic feeling very well. Most of them want to be discharged on the same night of the surgery. They all resume their professional activities within 2-3 days, and they wear a special vest for 3 weeks. So far, we have encountered no complications, save for 2-3 cases that developed fluid accumulation, which was immediately drained in our Office. All patients start a special workout program 4 weeks later, and 80% of the patients change their lifestyle and eating habits, while they follow a special training program to improve their body shape