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by Op. Dr. Evren Tevfik İşçi
Gynecomastia is a frequently seen health issue and it is within the scope of aesthetic and plastic surgery. All doctors who are trained in this area can do a gynecomastia operation. However, an examination at the internal diseases or endocrinology is needed for a diagnosis. Then, the gynecomastia operation can be planned with a doctor who is specialized in aesthetic and plastic surgery.
Gynecomastia is the overgrowth of the breasts in men and it occurs when female type breast tissue develops in men due to different reasons. It can be seen in babies and the elderly, but gynecomastia is known to be seen mostly during puberty.
Gynecomastia can harm a person’s health as well as their self-confidence and people, especially teenagers, who are having this problem can avoid being in social situations.
What is the Reason for Gynecomastia?
Gynecomastia is because of the irregular or imbalanced testosterone and estrogen hormones in a person. If the amount of testosterone in the body decreases and the amount of estrogen increases, the problem of gynecomastia might occur. Although there might be lots of different reasons underlying these hormonal changes, it can also stem from natural causes from time to time.
Males synthesize a little amount of estrogen hormone, and when the testosterone balance shifts toward the estrogen side, it might cause gynecomastia. Almost half of male babies are born with enlarged breasts due to the estrogen hormone which is transferred to them from their mothers. However, the breast tissue which has a swollen appearance goes back to normal on its own within the 2-3 weeks after birth. Gynecomastia might occur due to the hormonal irregularities during puberty. Gynecomastia is seen in men between the ages of 50-69 the most after these two groups.
Symptoms of Gynecomastia
As a result of the abnormal overgrowth and development in the male breast tissue, there might be;
- Swelling in the breast tissue,
- Breasts having different sizes,
- Pain or sensitivity in the breasts,
- A lump sensation at the bottom of the nipple,
- And discharge from one of or both of the breasts.
Both breasts should be examined by hand for a diagnosis of gynecomastia. In gynecomastia cases, a hard walnut-sized lump is felt during hand examination behind the nipple. After this finding is discovered, the diagnosis is confirmed with a breast ultrasound.
Gynecomastia Treatment
The first thing to do before starting gynecomastia treatment is to evaluate whether a hormonal disorder underlies the disease. Therefore, an endocrinologist should firstly be consulted in case of suspected gynecomastia.
It is crucial that the treatment is determined depending on the type of the gynecomastia. Gynecomastia has multiple types and the prognosis and response to treatment for the gynecomastia cases seen during puberty are measured using the Nydick classification. For that, the size of the fibro-glandular disc below the brown ring in the nipple is taken into consideration. The patient is informed if the diameter of this tissue disk is less than 4 cm and the problem is expected to go away on its own. However, in cases where the patient’s complaints have been ongoing for more than 4 years and there is an increase in the clinical findings that have been giving the patient discomfort, starting the treatment process is preferred. A medical treatment is applied when the disc in the patient’s tissue is between 4-6 cm. If the disc’s diameter exceeds 6 cm, then a surgical intervention is in question.
A gynecomastia surgery must absolutely be done by an experienced doctor who is an expert in the field. Surgical intervention is the most effective method that can be preferred for the treatment of gynecomastia and the context of the intervention is determined specific to the patient.
In the mixed type gynecomastia cases, both the glandular tissue and the fat tissue are excessive in the patient. In this case, it is preferred that a liposuction is applied combined with the surgical intervention.
In the glandular type gynecomastia cases, because there is much hard breast tissue, it is surgically removed.
In the fatty type gynecomastia cases, there is fat tissue the most and thus the application of liposuction alone might do.
Another classification is done depending on the size of the breast tissue and the excessiveness of the amount of fat tissue. The type of the surgical intervention is determined specific to the patient after this evaluation.
Before and After the Gynecomastia Surgery
About two weeks prior to the gynecomastia surgery, patients should make sure not to be exposed to sunlight for long periods of time. Thus, the risk of causing sun burns and permanent scars on the skin will be eliminated.
Smoking should be stopped at least 3 weeks prior to the surgery, and alcohol consumption 48 hours in advance. Eating and drinking should be stopped at least 5 hours before. Also, a break should be taken from taking Aspirin and similar medications at least 10 days in advance.
As long as it is done by an expert and experienced doctor, a gynecomastia surgery is highly unlikely to have complications. Pain, swelling and bruising can be seen in the patients for several days after the application. But this will get better on its own within several days.
The patient should avoid lifting weights, and from activities like crouching down and bending for at least 3 weeks after the gynecomastia surgery. The corset that is worn to reduce edema and swelling should be worn for at least 3 weeks without taking it off. For the first 3 days after the surgery, lying should be on the back and no showers. Especially after the gynecomastia surgeries that are done during the summer, the patient should not go swimming in the sea and stay under the Sun for long periods of time for at least 1 week.