Gynecomastia surgery

Gynecomastia is the excessive growth of breast gland tissue in males. Physiologically, it transiently occurs during puberty and spontaneously regresses. It can also occur at any stage of a man's life and affect one or both breasts. Gynecomastia can be glandular, fatty, or mixed. Fatty gynecomastia can occur with obesity and may also be hereditary. Other causes of gynecomastia include endocrine disorders, liver cirrhosis, or side effects of pharmacological treatment. True gynecomastia is observed in some overweight men over fifty.

Gynecomastia is defined as the enlargement of breast glands (overgrowth of the proper glandular tissue of the nipple) in males. Gynecomastia is a symptom that can arise from various causes and at any age. It occurs bilaterally or unilaterally, usually more commonly on the left side.

Non-pathological gynecomastia is encountered in most newborns on days 3-5 of life. It is caused by the so-called "pregnancy reaction," which is associated with a high level of estrogens in the maternal placental-fetal circulation. This symptom usually regresses within 3-4 weeks.

Gynecomastia in young children, even before puberty, can be caused by the absorption of small amounts of estrogens through the skin, inhalation, or ingestion. Sometimes it can be caused by the administration of androgens or vitamin D.

Two-thirds of boys experience noticeable enlargement of one or both breast glands during mid-puberty, sometimes with transient tenderness or sensitivity to touch. This is due to subcutaneous overgrowth of the breast gland. Typically, this is a cosmetic issue that resolves within a few months.

Sometimes we encounter lipomastia characterized by an excess of fatty tissue, which, unlike the overgrowth of proper glandular tissue in true gynecomastia, has a soft consistency. Increased fatty tissue in the chest area is common in obese men. Usually, the history and examination (lack of palpable hardness around the nipple capsule) suggest lipomastia.

Some men over fifty with significant obesity have true gynecomastia. It is believed that the cause of this abnormality is the conversion of so-called early androgens to estrogens under the influence of increasing fatty tissue.

Until now, it was believed that the main mammotropic factor, i.e., influencing breast growth, is prolactin. There is a close relationship between the action of prolactin, estrogens, and progesterone in the process of breast growth. Although most men with gynecomastia have a normal level of prolactin, elevated estrogen levels may stimulate its secretion.

Thus, gynecomastia is likely associated with an imbalance between androgen and estrogen levels. A relative excess of estrogens caused by a decrease in androgens may be a sufficient stimulus to stimulate breast growth. However, it seems that the decisive influence on breast development lies in what happens in the hypothalamic-pituitary centers. Hence, the conclusion that the true cause of gynecomastia lies in primary or secondary hyperactivity of the pituitary gland, and that the indirect action of other hormones, including adrenal and thyroid hormones, cannot be completely ruled out. The goal of gynecomastia surgery is to reduce one or both breast glands.

Procedure

Glandular gynecomastia is operated on with an incision around half the capsule of the areola, removing excess glandular tissue. In cases of significant gland enlargement, excess skin is excised. Liposuction, which leaves no traces, yields good results in fatty gynecomastia. Liposuction combined with excision of excess gland tissue gives the best results in mixed gynecomastia.

Postoperative course

In the case of gland excision, drains are left in for up to 48 hours. Stitches are removed after 10 days. Until the stitches are removed, a compressive dressing is left around the chest. Postoperative scars are practically invisible. Immediately after surgery, swelling, bruising, and pain may occur, lasting for several weeks. The final effect is visible after several months (skin contraction time).

Possible complications

Rare complications include hematoma formation or scar hypertrophy.

Anesthesia

The procedure is performed under local or general anesthesia.

Conditions for performing the procedure

A prerequisite for performing the procedure is good overall health and normal results of basic laboratory tests. Contraindications to the procedure include uncontrolled diabetes, purulent inflammatory conditions of the skin in the operated areas, and bleeding disorders.

Required tests

•     Bleeding and coagulation time test
•     Morphology
•     Ultrasound examination
•     Endocrinologist's opinion

The length of stay in the clinic is 1 day under general anesthesia, and absence usually lasts about 7 days.