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by Op. Dr. Evren Tevfik İşçi
Gynecomastia is a common health problem and is included in the scope of aesthetic and plastic surgery. All doctors trained in this branch can perform gynecomastia surgery. However, first of all, internal medicine or endocrinology examination is needed to make a diagnosis. Then, a gynecomastia operation can be planned with a doctor who is specialized in aesthetic and plastic surgery.
Gynecomastia is excessive breast development in men and occurs with the development of female type breast tissue in men for different reasons. Although it can be seen in infancy and advanced age group, it is known that gynecomastia is mostly seen in adolescence.
Gynecomastia can harm the self-confidence as well as the health of the person, and especially adolescents who have this problem may avoid being in social environments.
What Causes Gynecomastia?
Gynecomastia is caused by irregular or unbalanced testosterone and estrogen hormones in the person. If the amount of testosterone in the body decreases and the amount of estrogen increases, gynecomastia may occur. Although there may be many different reasons behind these hormonal changes, it can also be caused by natural causes from time to time.
Men synthesize a small amount of estrogen hormone, and the shift of testosterone balance to the estrogen side may cause gynecomastia. Almost half of baby boys are born with large breasts due to the estrogen hormone passed to them from their mothers. However, the swollen breast tissue returns to normal within 2-3 weeks after birth. During adolescence, gynecomastia may occur due to hormonal irregularities. Apart from these two groups, gynecomastia is most commonly seen in men between the ages of 50-69.
Gynecomastia Symptoms
As a result of abnormal growth and development in the breast tissue of men, the following may be seen:
- Swelling in the breast tissue;
- One of the breasts is larger than the other;
- Pain or tenderness in the breasts;
- Feeling of a lump in the lower part of the nipple;
- Discharge from one or both of the breasts.
Both breasts should be palpated in order to diagnose gynecomastia. In gynecomastia cases, a hard and walnut-sized mass is felt behind the nipple during palpation. After this finding is detected, breast USG is performed and the diagnosis is confirmed.
Gynecomastia Treatment
Before starting gynecomastia treatment, the first thing to do is to evaluate whether there is a hormonal disorder underlying the disease. Therefore, in case of suspected gynecomastia, an endocrinologist should be consulted first.
It is very important to determine the treatment to be applied according to the type of gynecomastia. There are multiple types of gynecomastia, and the course of gynecomastia cases encountered in adolescence and how they respond to treatment are measured using the Nydick classification. Accordingly, the size of the glandular tissue disc under the brown ring on the nipple is taken into account. If the diameter of this tissue disc is less than 4 cm, the patient is informed and the problem is expected to resolve spontaneously. However, in cases where the patient’s complaint persists for more than 4 years and there is an increase in clinical findings that disturb the patient, it is preferred to initiate the treatment process. In cases where the disc in the patient’s tissue is in the range of 4-6 cm, medical treatment is applied. If the diameter of the disc exceeds 6 cm, then surgical intervention is in question.
Gynecomastia surgery must be performed by a specialist and experienced physician. Surgical intervention is the most effective method that can be preferred in the treatment of gynecomastia, and the content of the intervention is determined for the patient.
In mixed type gynecomastia cases, both glandular tissue and adipose tissue are excessive in the patient. In this case, liposuction combined with a surgical procedure is preferred.
In cases of glandular type gynecomastia, the hard breast tissue is predominantly removed by surgical intervention.
In cases of fatty type gynecomastia, it may be sufficient to apply only the liposuction procedure, since the fat tissue is heavy.
Another classification is made according to the size of the breast tissue and the excess amount of adipose tissue. As a result of this evaluation, the type of surgical intervention is determined for the patient.
Before and After Gynecomastia Surgery
Patients should be careful not to be exposed to sunlight for a long time until two weeks before gynecomastia surgery. Thus, the risk of sun rays causing sunburn and permanent scars on the skin is eliminated.
Smoking should be stopped at least 3 weeks before the operation and alcohol consumption should be stopped 48 hours before the operation. Consumption of food and drink should be interrupted at least 5 hours before. Likewise, the taking aspirin and similar drugs should be discontinued at least 10 days before.
As long as gynecomastia surgery is performed by a specialist and experienced physician, the risk of complications is extremely low. The patient may experience pain, edema and bruising for a few days after the application. However, this will relieve in a few days.
The patient should avoid heavy lifting, squatting and bending for at least 3 weeks after gynecomastia surgery. In order to reduce edema and swelling, the corset should be used for at least 3 weeks without removing it. For the first 3 days after the operation, the patient should lie on his back and not take a shower. Especially after the gynecomastia surgery performed in the summer months, the patient should not swim in the sea for at least 1 week and should not stay under the sun for a long time.
