Gynecomastia is the abnormal enlargement of the male mammary gland. This enlargement can have a major glandular component (during puberty), a fat accumulation component, or a mix of both, and it can happen at any age and circumstances.
It is a relatively common condition which has very diverse causes:
It may appear spontaneously during puberty or be triggered through the use of certain medications such as estrogens, corticoids, spironolactone, sulpiride, digoxin, cimetidine, neuroleptics, amphetamines, anabolic steroids and many others, or substances such as cannabis. Gynecomastia can also be caused by hormonal disorders and the use of medication for prostate problems.
When gynecomastia is persistent, especially in young people, it becomes an aesthetic alteration which carries a significant emotional impact (a psychological complex). It can affect the teenager’s social life and relationships and requires a solution.
Gynecomastia diagnosis is quite straightforward, given the appearance of a pronounced volume in the male’s breasts. Usually it is the patient the one who notices the alteration and brings the matter to the doctor.
In most cases the treatment is surgery-based, save for those where adolescents are suffering from what is called a pseudogynecomastia (presence of excess fat) that will be normalized during the growth spurt without the need for any treatment.
Surgical intervention is the correct therapeutic option in cases of non-reversible gynecomastia. It addresses the aesthetic repercussions of the condition rather than the possible functional aspects of the disorder. The treatment of the disease should be deferred if the affected patient is an adolescent male who has had the gynecomastia for less than two years.
Taking into account the patient’s age, morphology and degree of gynecomastia, the doctor will choose one of the following surgery techniques.
- Simple surgical excision: is indicated in young adolescent patients with enlarged breasts basically due to glandular hypertrophy.
- Surgical excision + liposuction: indicated in obese adults (pycnical habit) whose breast volume is predominantly fat-based.
- Isolated liposuction: indicada en adultos obesos (hábito pícnico) con mamas de consistencia predominantemente grasa.
- Skin-fat-glandular tissue excision + NAC autograft (nipple-areolar complex): indicated in individuals with significant weight loss that present excess skin in addition to a certain amount of glandular tissue.
WHO NEEDS IT?
Any male who has developed an abnormal breast volume after adolescence.
- In case of glandular-predominant gynecomastia (excision): general anaesthesia.
- In case of fat-predominant gynecomastia (liposuction): local anaesthesia, plus sedation.
Glandular excision: while still in the operating room the patient will be fitted with a compressive girdle to be worn for a month in order to have the breast’s skin adhere to the deeper tissues underneath.
After recovering from the effects of anaesthesia the patient will be moved to his hospital room where he will stay until the next day after drainage removal.
Stitches will be removed 10 to 15 days later.
Fat liposuction: : the patient does not have to stay in hospital and can go home three to four hours after the liposuction. Usually 48 hours of rest are prescribed after which a certain freedom of movement is allowed, as long as it doesn’t involve any sudden movements or the handling of weighty objects. 10 to 15 days later the stitches are removed and the patient can resume his daily activities.
HOW LONG UNTIL FINAL RESULTS ARE REACHED?
It takes three to four days to normalize the patient’s habits and a month to easily perceive the final results of the procedure.
The risks of this type of intervention are very low, just as in any surgical procedure done under general anaesthesia.
Despite that, there is a very low possibility of complications, which are:
Haematoma: is the accumulation of blood that occurs when a blood vessel will not clot. To prevent it, drainage is put in place. If it occurs anyway and it is too large, the surgeon can choose to operate again to evacuate it.
Infection: Risk of infection is very rare nowadays as it is prevented through the use of antibiotic treatment. If it did occur , and depending on its intensity it could affect the appearance of the scar.
Hypertrophic scarring: is an excessive thickening of the scar.