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by Op. Dr. Evren Tevfik İşçi
Males having breasts that are larger than they should be is called gynecomastia. In other words, it is the abnormal but benign overgrowth of the breast tissue in males due to the imbalance of the estrogen and testosterone hormones. Currently, the increase in hormone-injected food consumption, medications that are used, overconsumption of alcohol, thyroid, kidney and liver diseases and hormonal disorders can cause the issue of gynecomastia, that is, males having breasts that are larger than they should be. Gynecomastia can sometimes be seen in one breast, while sometimes in both breasts. In addition, both breasts can be affected irregularly by the development of gynecomastia and grow to different sizes
If you feel like you are not free with your choice of clothing, if you are uncomfortable with your breasts protruding especially with your t-shirt choices, you might have a gynecomastia problem. In this case, a doctor’s examination is necessary to make a gynecomastia diagnosis, and to determine its degree, reason and the treatment to go with. In addition, an endocrinologist examination is necessary when there is pain, sensitivity, swelling in the breasts and discharge from the nipple. Usually a breast ultrasound and hormone workups are requested after the examination.
Not Every Gynecomastia Requires Surgery
Gynecomastia is a health issue that mostly affects teenagers. The problem of oversized breasts in more than 20% of adult males usually appears around the age of 13-14. The expectation s that the breasts shrink on their own as a result of the balancing of the hormones. Approaching the boys during this time when they are already going through a sensitive period is vital for their mental health.
The patient should be under control for around 2 years in order to understand whether the teenager has gynecomastia and to decide a gynecomastia surgery as a way of solution. The patient’s diet should be fixed during this time. It is important that they should eat healthy foods that do not contain any additives that might have a negative impact on the hormones and not overeat so that the weight is under control. Just like the other areas of the body, breasts grow as well with excessive weight. An obese person should not receive a gynecomastia diagnosis before they get back to their normal weight. An intervention might be up on the table if there is no reduction in the breasts after a controlled waiting period of 2 years. Gynecomastia is a situation which can cause psychological issues in teenager boys especially.
In addition to the teenager boys, the development of gynecomastia can be seen temporarily in newborn babies with the effect of hormonal changes. The gynecomastia that is seen in newborn boy babies with the effects of the hormones that are transferred from the mother usually resolves on its own within 1-2 months.
How to Understand the Presence of Gynecomastia by Hand?
During a gynecomastia examination, it is controlled whether the secretory glands due to the release of estrogen can be felt by hand. No hard and lumpy tissue is felt especially under the nipple with breast overgrowth due to the increase in fat production. And in patients developing gynecomastia, there is a hard, dense, rubbery and lump tissue that is felt under the nipple.
How is Gynecomastia Treated?
The treatment for gynecomastia is determined specific to the patient. In gynecomastia cases which do not get better on their own or which cause pain, sensitivity and psychological issues enough to negatively effect the person’s life, medication treatment or surgical intervention might be discussed.
If there are different issues underlying the development of gynecomastia like poor nutrition, hypogonadism or cirrhosis, they are treated first. A change of medication is preferred if there is a medication that might cause the gynecomastia.
In the glandular type gynecomastia, there is much hard breast tissue which needs to be surgically removed. In the mixed type gynecomastia, both the fat tissue and the glandular tissue are high in amount. And in the fatty type gynecomastia, because there is fat tissue the most, the liposuction procedure is preferred.
The Nydick classification is based on when the prognosis of gynecomastia in teenager boys and their response to treatment are measured. This means that the type of the gynecomastia is determined based on the size of the fibro-glandular disc under the areola. In cases where the disc diameter is less than 4 mm, the problem is expected to go away on its own. In disc diameters between 4-6 cm, medical treatment is preferred, and surgical procedure is preferred when it is larger than 6 cm.
The most effective and definitive method for the treatment of gynecomastia is the gynecomastia surgery which is one under general anesthesia. The surgical intervention to be applied is determined depending on the person’s breast tissue size and excess skin.
Before and After the Gynecomastia Surgery
The patient goes through a thorough examination before the gynecomastia surgery. The scope of the surgical procedure to be applied and which methods to be used are determined. At this stage, the patient should inform the doctor fully regarding any medications that they are taking regularly as well as their medical history. It is vital to quit Aspirin and similar blood thinning medications at least 1 week before the surgery.
The patients wear a gynecomastia corset for the recommended time after the gynecomastia surgery. There might be sensitivity, bruising, pain and edema in the area of application for the first few days following the surgery. The patient should fully follow the recommendations about lying on their backs and not taking showers for the first 3 days after the surgery. The doctors recommend not to lie facedown for at least 1 week after the operation.
Patients should not be lifting heavy weights for at least 3 weeks after the surgery, and avoid heavy exercise, activities that might cause receiving a blow on the chest area, and activities that might cause edema like sauna and Turkish baths for 6 weeks.