What is Gynecomastia?
- Gynecomastia comes from the Greek term meaning woman-like breasts.
- It is very common and thought to affect 65% of boys in the 14-to 15 year age group and up to 30% of older men.
- Generally, it develops during early puberty. In many cases, it resolves after the puberty growth spurt.
- The majority of the time, gynecomastia occurs without a known cause and is a normal finding. However, it can be associated with an underlying disease at any age and warrants evaluation by a qualified physician.
- Causes that must be ruled out include:
- Increase in estrogen
- Decrease in androgens
- Deficiency in androgen receptors
- Testosterone imbalance
- Pituitary gland tumors
- Adrenal gland tumors
- Prostate tumors
- Testicular tumors
- Thyroid disease
- There are certain prescription drugs and recreational drugs that may play a role in the development of Gynecomastia.
- Marijuana and heroin are known to potentially lead to Gynecomastia.
- The prescription drugs thought to contribute to gynecomastia include:
- Antihypertensive drugs
How is Gynecomastia treated?
- If the gynecomastia is due to marijuana or prescription drugs, discontinuing these may help the condition.
- If gynecomastia developed during early puberty, it is best to allow the young man to complete puberty prior to any type of surgical intervention as the condition may resolve on its own.
- If the gynecomastia persists after the growth spurt and is not due to any type of drugs or medical conditions, then it is treated with a breast reduction procedure.
What does gynecomastia surgery accomplish?
- The procedure removes the fat and breast (glandular) tissue from the breast.
- In extreme cases, the skin may also need to be removed. This was quite common in the past. Since the introduction of ultrasonic liposuction for treatment of gynecomastia, the need for skin removal is less common.
- Surgery results in flatter firmer and better-contoured breasts.
How is surgery for gynecomastia performed?
- There are four possible approaches to the treatment of gynecomastia.
- Since its introduction in the 1990’s, ultrasonic liposuction has become a preferred approach to treatment of gynecomastia by many plastic surgeons.
- It allows removal of the excess fat and breast tissue through two very small incisions (3-4 mm each) placed within the circumference of the areola. The entire procedure is carried out through these incisions.
- The ultrasound energy helps the skin of the breast shrink back thereby significantly decreasing the potential need for skin removal.
Excellent contouring of the fatty tissue often found in the underarm area is also possible with this technique.
Direct surgical excision
- This technique allows removal of the breast gland tissue and fatty tissue through an incision made within the lower one-half of the areola.
- It works well in situations where the majority of the breast tissue is localized within a well-defined breast mound. However, it does not always provide adequate contouring if there is excess tissue in the underarm area.
- If there is a significant amount of breast tissue that is directly removed, there may be excess skin that does not shrink back. This often necessitates direct excision of the skin through a separate incision.
Direct surgical excision with liposuction
- Some surgeons will use a combination of direct surgical removal of the breast tissue and liposuction of the fatty tissue from the surrounding chest and underarm region.
- Breast reduction with removal of breast tissue and removal of skin
- This technique is reserved for cases of extreme Gynecomastia.
- Unfortunately, it leaves extensive scars which are difficult to hide when undressed.
- Fortunately, this degree of Gynecomastia is not very common.
Who are good candidates for gynecomastia surgery?
- Healthy young men who have completed adolescence and continue to have any degree of Gynecomastia.
- Men of any age who do not have any underlying medical cause for their Gynecomastia.
Are there scars?
- All of the described procedures leave scars.
- The scars from either the ultrasonic liposuction or the incision around the areola for direct excision of the breast tissue are present but are minimal.
- The only scars that are difficult to conceal are those due to direct excision of excess breast skin.