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GYNECOMASTIA



The term gynecomastia is used to refer to the development of abnormal breast volume in males. A very large fraction of men, somewhere in the 40%-60% margin, suffers from some degree of gynecomastia. As gynecomastia is a particularly irritating condition, many men choose to undergo the procedure of seeking a plastic surgeon in order to correct their oversized mammary glands.

CAUSES OF GYNECOMASTIA

Gynecomastia may be caused by the following:
1.    Heredity.
2.    Hormonal issues.
3.    Steroid medication.
4.    Genetic anomalies.
5.    Genetic syndromes.
6.    Liver diseases.
7.    Malfunctions of the genital organs.
8.    Obesity.
9.    Marijuana use.
10.    Malignant tumours.
11.    Aging.
In the main, however, overlarge breasts in men tend to be caused by heredity.


PSEUDOGYNECOMASTIA

We must differentiate between the terms ‘gynecomastia’ and ‘pseudogynecomastia’. In most cases wherein gynecomastia is diagnosed, we are actually dealing with pseudogynecomastia. Gynecomastia refers to issues caused by a hypertrophic gland, whereas pseudogynecomastia refers to aggregation of fat in the male breast, without the presence of a hypertrophic gland.

99% percent of cases dealing with overlarge breasts are caused by pseudogynecomastia; only 1% are actually due to gynecomastia. The diagnosis to differentiate between the two is usually performed via a mastography or ultrasound scan.
 
PSYCHOLOGICAL EFFECTS OF GYNECOMASTIA

Overlarge breasts are a major cosmetic issue for men. Gynecomastia can have a heavy psychological effect on men, equivalent to that experienced by women who entirely lack breasts. Those subject to gynecomastia may feel that their masculinity is reduced. The condition can damage the patient’s social life, as they will try to avoid exposing their chest at the beach, the gym, etc. In addition, it limits their choices when it comes to clothing, as they are prevented from wearing anything that is too close-fitting.

SUITABLE CANDIDATES FOR GYNECOMASTIA CORRECTION

Patients who have a hereditary proclivity towards developing overlarge breasts tend to be most eligible for a corrective procedure. In contrast, patients who have drinking problems or are frequent users of marijuana are not suitable for this procedure.

Only psychologically well-balanced candidates with realistic expectations should attempt to undergo the corrective procedure for gynecomastia.


BEFORE THE OPERATION

It is best to hold a comprehensive discussion with your surgeon beforehand, and fully outline your medical history. Ask that he or she give you their opinion on which they consider to be the best method for your case.
It is likely that you will need to have a mastography, i.e. an X-ray over the chest area. In some cases, an ultrasound scan may also be required. These can help to confirm that there are no tumours in the breasts, as well as to reveal the suspension of the breasts. These images of the breasts are likely to help determine the type of operation that will be performed.

Do not consume aspirin up to ten days before the operation, or alcohol two days before it. Discuss with your surgeon whether or not the size of your nipples is satisfactory, and whether or not you will like it reduced.

OPERATION TECHNIQUES

Gynecomastia operations should only be performed in very well organized work environments, i.e. a hospital environment with a fully equipped surgical facility. The infrastructure of a fully equipped surgical facility may appear to be an excessive requirement for dealing with a reasonably minor operation such correcting gynecomastia, but it is always best to be over-prepared in terms of organization and resources, even if these turn out to have been unnecessary.

The patient is given a choice between localized and general anaesthesia. The localized choice, of course, should always be administered by a specialized anaesthesiologist using the correct medication.





There are two main methods for correcting overlarge breasts:

1.    SUBCUTANEOUS MASTECTOMY:
An incision is made at the lowest point of the nipple
, 3 centimetres in length. Through this incision, the surgeon removes the excess of fat or the mammary gland via an open method, i.e. with full visibility. Once the removal is complete, the incision is sutured. The mark left by the incision will heal in time. In general, nipple scarring tends to be very faint and does not pose an aesthetic problem.

2.    LIPOSUCTION:
This is performed similar to standard liposuction, i.e. via a small incision into which a metallic cannula is inserted, which siphons the fat. In order for this method to be undertaken, we must be certain that we are dealing with fat and not a hypertrophic gland. In any case, as explained above, in 99% of cases we will be dealing with fat. Standard liposuction was the main technique employed to treat gynecomastia for a very long time. In recent years, however, correction via laser lipolysis or power assisted liposuction have also become viable techniques. Laser lipolysis has the edge, as it offers results of very good quality, a greater maximum quantity of removable fat, the shortest recuperation period, and also helps to tighten the skin. The technique is exactly the same as laser liposuction, which is performed on other parts of the body, and as such can be combined with such operations. This mean that many patients may, in tandem with correcting their gynecomasty, choose to have laser liposuction performed on the front or side of their belly, or wherever else they need.

Whichever method is employed, a compression bandage will have to be placed on the chest after the operation, in order to aid the tissues to reattach correctly. In addition, an operation can be performed at the same time to reduce the nipple’s diameter. In this case, however, the incision must be made around the circumference of the nipple, and will of course leave a small, circular scar.

Patients who suffer from sagging skin around their breast may require special treatment. If the degree of sagging is not too large, then the removal of the mammary gland alone may resolve the problem. When dealing with a large degree of sagging, however, we may well need to remove skin. The disadvantage of this method is that it leaves many more scars.

There are techniques available wherein, up to a medium degree of sagging, one can have their problem corrected without having to be subjected to additional incisions. Laser lipolysis, for example, can also help with this, thanks to the tightening it causes in the skin.

The aforementioned methods come in several variations. For example, an open removal can be combined with a liposuction of the entire area, for even better results.

It is important that the surgeon be experienced with such operations, so that he or she be better able to determine which is the best technique to apply to each case.


AFTER THE OPERATION




As soon as the operation is complete, the doctor will set a compression bandage in place. This serves almost like a splint, keeping the skin held firmly in place in order for it to re-attach properly. Pressure is usually exerted by means of a type of corset, which is specially designed for use on this area, and is referred to as a ‘waistcoat’. The ‘waistcoat’ should remain in place 24 hours a day for the duration of one month. Of course, one can remove it in order to wash.

The patient is usually required to remain at the clinic for a few hours, but rarely does one need to remain overnight.

In terms of pain, the degree of irritation a patient is likely to feel tends to be quite small to the point of being non-existent. In some cases where greater irritation is experienced, this can be easily dealt with using painkillers. There will be some swelling and possibly some bruising in the chest area for the first few days, but these will gradually recede.

After a month has passed the patient should be in very good condition, as should easily be able to visit the beach for a swim, for example, without making it apparent that they have undergone surgery. The final result will become fully visible after six months, though the patient’s chest should appear normal after about a month.
The possibility of complications arising (hematoma, infections, etc.) is quite small, and even if they do arise they are easy to deal with.

Generally speaking, gynecomastia can cause heavy psychological issues in male patient. Its correction is fairly easy, and for this reason many men approach plastic surgeons in order to correct their overlarge chest. The psychological uplift experienced by patients who have successfully undergone the procedure has rendered gynecomastia correction as one of the most popular cosmetic operations with men worldwide.