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Gynecomastia is breast glandular development in males. There are many potential causes including hormonal fluctuations, medications, medical conditions, and illicit drugs such as marijuana and anabolic steroids. 40% of adolescent males develop breast tissue during puberty due to changes in hormonal levels (estrogens and androgens) or the cellular response to hormones. Most cases of gynecomastia resolve after puberty, but if larger amount of breast tissue fail to resolve, gynecomastia can be a source of considerable embarrassment. In these cases, medical evaluation and surgical treatment is recommended. Some elderly men also develop gynecomastia due to altered conversion of testosterone to estrogen, but treatment is usually not indicated.
Laboratory evaluation can determine if gynecomastia is due to a condition such as liver disease, alcoholism, renal failure, chromosomal anomalies, or endocrine abnormalities or tumors. Physical exam will help determine if there is a testicular, breast, or pituitary tumor as a cause. Further evaluation with radiographs or ultrasound may be indicated. Most cases however have no associated medical problem. In these cases, cosmetic surgery can be helpful. The technique needed is dependent on the amount of excess skin and the components of the breast tissue. Individuals whose breast is primarily fat can be treated with liposuction with minimal scarring. Ultrasonic liposuction assists the removal of dense fat and breast tissue as well as skin tightening. Firm breast tissue, a large breast plate, or marked excess skin requires surgical removal, typically through an incision limited to the lower half of the areola. However, severe skin excess will require additional scarring like a breast reduction, and possibly moving the nipple/areola as a graft.
The operation is usually performed on an outpatient basis with sedation and local anesthesia, but major corrections may require general anesthesia and overnight observation. In some instances, one night admission to the hospital may be necessary. Recuperation is rapid in most cases and 1 and 2 weeks after surgery, sutures are removed and activities resumed. Bruising will last up to a week. Compression can minimize swelling but the true result will still be masked for 1 to 2 months. Additional skin removal may be necessary at that time as a simple excision if the skin does not contract enough. Potential problems include scarring, nipple retraction after removal of the excess tissue, altered nipple sensation or viability, asymmetry, and an unexpected malignancy diagnosis.
All of the descriptions for the various procedures are condensed from the text of the upcoming textbook written by Dr. Christopher Park and Dr. Malcolm Marks and are copyrighted, "The Artistry of Plastic Surgery: Exploring the Experience” . |
