Gynecomastia

GYNECOMASTIA

Gynecomastia is the most common condition of the male breast. It is a benign mass gland hyperplasia and must be differentiated from pseudogynecomastia, in which fat deposition increases. Most men will experience gynecomastia at some stage in their lives. Periods of normal gynecomastia are the first neonatal period (due to maternal estrogen), puberty (due to relatively high estradiol relative to testosterone), and finally the third and fourth ages, in which plasma testosterone levels decrease . The frequency of the condition in the entire population amounts to approximately 30%, while in 75% of them it is bilateral.

It is important to investigate the causes of gynecomastia to rule out pathological causes. However, it is worth noting that men with gynecomastia do not have a higher risk of breast cancer than other men and that this cancer accounts for less than 1% of breast malignancies.

WHAT CAN BE DONE?

After the investigation and staging of unilateral or bilateral gynecomastia is completed, the patient is followed up until his clinical picture stabilizes. A large percentage of gynecomastia regresses. Surgical repair is recommended for patients with persistent gynecomastia for more than 12 months. The surgical solutions suggested depend on the size of the problem and the presence or not of prolapse. In all cases, liposuction and removal of the mass gland is recommended, while in the case of prolapse, a periammary mastopexy is performed with or without the use of a flap.

WHO IS THE SURGERY FOR?

The surgical restoration of gynecomastia is aimed at men in whom other pathological causes have been ruled out or treated and who do not take, on a chronic basis, drugs that cause gynecomastia (eg, diuretics, antimycotic drugs). It is also aimed at men who have stabilized their weight.

WHAT IS THE TYPE OF ANESTHESIA?

The operation is performed under local anesthesia in the doctor's office for small to moderate gynecomastia or with general anesthesia in an organized clinic when there is a significant degree of gynecomastia with prolapse. The duration of the surgery is 1.5 to 2 hours. After the surgery, it is advisable to stay in the clinic for a few hours and immediately mobilize the patient.

WHAT WILL THE SCARS BE LIKE AFTER THE SURGERY?

The type of scars depends on the surgery that will be chosen. As a general rule, small gynecomastia can only be corrected with liposuction and then the incisions are a few millimeters and are hidden around the areola. Larger gynecomastia with accompanying prolapse are corrected with liposuction and radial removal of a mass gland through a perimapillary incision. Scars are easily hidden around the halo. For the majority of men, however, these are negligible in front of the relief they feel from the improvement in the shape and density of their breasts. To avoid misshapen or hypertrophic scars, you will be given instructions immediately after the stitches are removed, and you will be put on a follow-up program if you have a history of keloids.

HOW LONG WILL THE RESULTS LAST?

The results are permanent and will remain stable for years to come, as long as the patient does not put on weight or undergo a treatment that causes a change in the estrogen circulating in his blood.

WHAT ARE THE LIMITATIONS OF THE SURGERY?

The operation cannot correct the quality of the skin of the breasts, it only corrects their shape. The patient should be aware that stretch marks and thinning of the skin cannot be completely improved with surgery. But it can change the shape and size of the nipples if they have grown too much or are asymmetrical. Finally, patients with serious health problems, who cannot receive general anesthesia or those with a dysmorphic syndrome should be prevented from cosmetic surgeries.

WHAT ARE THE RISKS OF GYNECOMASTIA SURGICAL REPAIR?

The doctor will assess your general condition and your history and, if she decides that you are suitable for the surgery, she will inform you about the possible complications and what needs to be done to reduce the possibility of their occurrence. You will also be asked to stop using supplements and medications that affect blood clotting and to refrain from smoking. The anesthesiologist will then talk to you about the type of anesthesia you will receive and the possible complications.

WHAT YOU SHOULD DO BEFORE SURGERY?

Depending on your age, you will be given instructions on the medications you may be taking and should be discontinued or replaced, as well as on the additional testing you may need to do with a mammogram and breast ultrasound.

The doctor will explain the value of smoking cessation and proper nutrition in wound healing. One week before the surgery, measurements will need to be taken to order a special pressure vest, you will be photographed and the consent form will be signed.

WΗΑΤ TO WATCH OUT FOR AFTER THE OPERATION?

You stay in the clinic for the first few hours, but your time away from work must have been calculated at 3-4 days. This doesn't mean you won't be able to do light work much sooner, but you'll generally feel overwhelmed. Abstaining from sports for 2 weeks is also recommended.

When you leave the surgery you will wear a special garment (vest) which you will keep for 6 weeks. There may be ecchymosis, which subsides in the first week, while when there is pain or swelling they are easily treated. Because the sutures are intradermal there is no need to remove sutures.

WHAT IS THE COST OF GYNECOMASTIA RECOVERY?

The cost of the surgery is calculated by adding the cost of the clinic, in which the patient is operated and treated, the fee of the Plastic Surgeon and the Anesthesiologist. The purchase of the special vest must be included in the costs.