Gynecomastia

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What is gynecomastia?

Gynecomastia is the excessive development or enlargement of glandular tissue in males or adolescent boys, and may affect one or both breasts. Gynecomastia also occurs in newborn boys, but is associated with the passage of estrogen from the mother through the placenta. In this case, the balancing of hormones in the baby occurs naturally until a few months after birth. In other cases, breast size becomes larger and there is often asymmetry between the two breasts. The main cause of gynecomastia is an imbalance between the sex hormones testosterone and estrogen. Normally, men produce a very small amount of estrogen and many times more testosterone. Increased levels of estrogen in the male body can lead to breast enlargement.

Hormonal imbalance can occur as a side effect of:

  • medications /corticosteroids, antibiotics, antacids, antidepressants/
  • excessive intake of soy products, which are a source of estrogens
  • opioids
  • Hyperthyroidism
  • kidney failure
  • cirrhosis
  • chronic and untreated testicular infections
  • obesity

The solution is surgical correction of gynecomastia.

When is it done?

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  • In cases of gynecomastia in young boys, which is not naturally reduced by the balance of hormones
  • When the prescribed hormone treatment due to lowered testosterone does not produce results on the accumulation of fat around the breasts
  • For tightening after drastic weight loss
  • For residual fat deposits around the breasts after weight loss

What does gynecomastia correction surgery involve?

There are three possibilities:

  • Liposuction - In cases where gynecomastia is the result of excess fatty tissue, liposuction techniques are sufficient. Several small incisions are made through the breast, a small cannula is inserted. The cannula moves back and forth, peeling off the fatty tissue, which is removed from the body by vacuum. There are different liposuction techniques. Your surgeon will determine which technique is best for you before the procedure.
  • Incision - In case glandular tissue is the main cause of gynecomastia, an incisional method is used. Usually in these cases, in addition to the removal of glandular tissue, excision of excess skin is also necessary. Incision is also required when it is necessary to reduce the size of the areola, and the nipple will be repositioned to preserve the symmetry of the male contour.
  • In more serious cases of gynecomastia, a combination of liposuction with incision.

What is involved in preparing for the operation?

  • In the first place, the problem should be thoroughly discussed with a specialist
  • At the discretion of the specialist surgeon, some blood tests and monitoring of hormone levels in the blood may be done
  • Differential diagnosis with oncological disease
  • Discontinuing medications that increase the risk of bleeding
  • Smoking cessation
  • Maintaining chest muscle tone with moderate exercise
  • In case you are on a diet, it is good to start taking vitamins that will support the recovery period

How does the operation proceed?

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Correction of gynecomastia is usually performed under general anesthesia, but in some cases only light venous sedation with local anesthesia is used.
The duration of surgery is 1-2 hours, depending on the tissue to be removed.

Recovery period

The standard recovery time after surgery to correct gynecomastia is between 4-6 weeks.

What to expect?

  • to the third day after surgery: you may feel pain or pulling in the skin of your breasts, as well as have areas of decreased sensitivity or tingling. Although the result is immediately noticeable, swelling is inevitable, for which a compression garment is recommended to aid drainage and healing. You should have complete rest, slow, short duration walking is allowed. The treating physician may recommend sleeping on your back in an elevated body position of about a degree.
  • 1 week after surgery: pain and swelling decrease, even some patients return to their daily routine, but with light physical exertion. Heavy loads involving the chest muscles should be limited. Wearing compression garments continues throughout the day. Sleeping on your stomach or side is avoided.
  • 2nd postoperative week: The pain and swelling disappear completely. Wearing compression underwear during the day continues. At the end of this period, lying on your side or on your stomach is allowed.
  • 3-4 weeks after surgery: You can resume the heavier workouts by focusing on sparing your chest. Compression garments are no longer necessary.
  • 6th postoperative week: This now marks the end of recovery and patients are expected to be in condition to perform any exercise, including intense chest exercises. Body positioning in all positions is allowed. It is possible that slight swelling around the areolae may occur after greater exertion, but this phenomenon is natural and will be eliminated after a few more weeks.

Useful tips for the postoperative period:

  • Follow your plastic surgeon's instructions and keep your follow-up appointments.
  • Apply a cold compress in the first days after surgery to relieve inflammation and pain.
  • Eat light and healthy food.
  • Stay well hydrated.
  • Take enough vitamins that will help the skin recover.
  • Wear compression underwear for as long as recommended by your doctor.
  • Avoid smoking and alcohol intake as they interfere with recovery and adversely affect hormone balance.
  • Returning to your physical activities, train your back muscles until you reach their pre-intervention training level, and only then proceed to the chest exercises.

Questions you may be interested in:

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  • Does the effect of the surgery last forever?

The answer is YES. However, if the gynaecomastia is due to the use of steroids or other medications, these need to be excluded as you risk a re-accumulation of fatty tissue in the breast area.

  • Are there visible scars?

As with any surgical intervention, the incision lines are present but fade over time. The plastic surgeon will advise you to use bleaching creams. Cosmetic procedures are also available that focus specifically on concealing cicatrix.

  • And can gynecomastia be treated without surgery?

There are auxiliary non-surgical methods, but the way to timely and permanent correction of the condition is surgical intervention.

 

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