Gynecomastia

Gynecomastia is a condition characterized by an increase in male breast tissue. Gynecomastia is caused by an imbalance in the hormones estrogen and testosterone, which can be caused by a variety of factors, including puberty, hormonal changes, obesity, certain medications and underlying medical conditions.

During puberty, gynecomastia may develop temporarily in up to 70% of boys due to hormonal fluctuations. In most cases, this condition disappears on its own when the hormone level stabilizes. However, in some cases, excess breast tissue remains, leading to psychological discomfort and body image problems. Adult-onset gynecomastia is more likely to be related to underlying medical conditions or the use of medications, such as anabolic steroids, antiandrogens, or some antidepressants.

Although gynecomastia is not life-threatening, its psychological effect should not be underestimated. Men dealing with this condition may experience embarrassment, social withdrawal and reduced self-esteem. The stigma surrounding the perceived feminization of the male chest can lead to avoidance of certain activities, including swimming or going shirtless in public.

Types of gynecomastia

Gynecomastia is classified into different types based on underlying causes and characteristics:

• Physiological gynecomastia: this type is common during different stages of life, such as childhood, puberty and aging. It occurs due to a temporary hormonal imbalance between estrogen and testosterone. Pubertal gynecomastia, for example, affects up to 70% of adolescent boys and usually resolves within a few years.

• Non-physiological gynecomastia: this type is often associated with some medical conditions or the use of drugs. Medical conditions such as liver disease, kidney disease, and hormonal disorders can lead to gynecomastia. Medications such as antiandrogens, certain antidepressants, and anabolic steroids can also promote breast tissue enlargement.

• Pseudogynecomastia: unlike true gynecomastia, which involves the growth of glandular tissue, pseudogynecomastia is characterized by the accumulation of fat in the chest area. It can occur in overweight or obese individuals and is more related to excess body fat than hormonal imbalance.

• Unilateral vs. Bilateral Gynecomastia: gynecomastia can affect one breast (unilateral) or both breasts (bilateral). Unilateral gynecomastia can be more worrisome because it can sometimes indicate problems like breast tumors. However, most cases of gynecomastia are bilateral.

• Severe gynecomastia: this type is characterized by a significant increase in breast tissue, which can cause considerable physical and emotional discomfort. Severe gynecomastia may require more intensive treatments such as surgical removal of excess tissue.

How to distinguish real from pseudogynecomastia?

Distinguishing true gynecomastia from pseudogynecomastia is crucial for proper diagnosis and treatment. True gynecomastia involves an increase in glandular breast tissue, which is the result of a hormonal imbalance. It feels firm or rubbery, and a small, firm lump can be felt behind the nipple.

Pseudogynecomastia, on the other hand, is characterized by the accumulation of fat in the breasts without the growth of glandular tissue. The breast area looks softer and more uniformly fatty, similar to excess body fat.

It is often necessary to supplement the physical examination with imaging (most often ultrasound) or hormone tests, in order to accurately distinguish between the two conditions and recommend appropriate interventions, which can vary from lifestyle changes to surgical procedures.

What are the surgical methods of gynecomastia treatment?

The choice of surgical method for the treatment of gynecomastia depends on several factors:

1. Type of tissue: in gynecomastia made of glandular tissue, this tissue can only be removed by an open surgical method, while excess fat tissue in pseudogynecomastia can be removed by liposuction.
2. Existence of excess skin: in types of gynecomastia in which there is no significant excess skin, it is possible to achieve that after the removal of glandular or fatty tissue, the skin retracts, while in the case of large excess skin, it is sometimes necessary to perform an surgery similar to a mastectomy, that is, the removal of the entire breast tissue and skin with a nipple transplant to the appropriate position.
3. Size and position of the nipple: gynecomastia is often associated with enlarged and drooping nipples, which need to be reduced and raised to the appropriate position during surgery. Such surgery on the nipples can sometimes lead to reduced sensation in the nipples.

What does the preoperative process look like?

During the examination the doctor will explain all the details of the surgery, advise you in choosing the type of surgery and familiarize you with the postoperative protocol. You will also talk to the doctor about your medical history, the medications you are taking that may need to be changed in the period around the surgery, any drug allergies and your habits such as smoking, which may also have an effect on the outcome of the surgery. You will be given a list of tests to be done before the surgery.

What to expect on the day of surgery?

On the day of surgery, it is important that you do not take food at least 6 hours before the agreed time of surgery, and clear liquids at least two hours before. If you have an increased risk of developing deep vein thrombosis of the legs, we will ask you to visit the hospital the evening before the surgery to receive a medicine that will prevent the formation of clots in your legs during the surgery. After the surgery, you will stay for some time in the hospital until the anesthesiologist assesses that you are ready to be discharged, and if necessary, you may stay in the hospital until the next morning. At discharge, you will have two drains connected to two plastic bottles. They are used to ensure that the fluid that usually accumulates around the implant after surgery is not retained in your body, but is emptied into vials. Before you are discharged home, we will place a special brace on you to prevent fluid from accumulating in the wound, support your abdominal wall and speed up healing, which usually takes about 6 weeks.

After surgery

Drains are removed at the first check-up, which is usually 2-3 days after surgery. You can shower freely seven days after the surgery. You can expect to return to light physical activities and driving a car in 2 weeks, while for more difficult physical activities you should wait 4-6 weeks. It is important to pay attention not to strain the abdominal wall in the first month after surgery and if you have irregular digestion, to take one of the means to ease digestion. You should also pay attention to the care of the scar, which from the third week after the surgery needs to be massaged twice daily with a moisturizing cream.