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Gynaecomastia

Unilateral or bilateral enlargement of breast tissue caused by hormonal changes in adolescent males is medically referred to as “gynecomastia”.

The term gynecomastia is derived from the Greek words “gynec” that means feminine and “mastos” that means breast. It is a common disorder but is hardly mentioned in public. Gynecomastia is a problem seen 40-60% of men. It adversely affects the mental states of men by feminizing their bodies. The biggest complaint of men with gynecomastia is about being teased by their friends. Most of the boys, who avoid wearing tight t-shirts, swimming in the sea and pool, and changing their clothes when they are not alone, are not aware of the fact that their disease is curable; so, they suffer from it unnecessarily. Especially teenagers can be very cruel to each other, in such a way as to cause the teenager to feel depressed and feel  not complete regarding his gender.

Gynecomastia often appears in cases where estrogen (female hormone) levels rise while testosterone (male hormone) levels decrease. Such a cases can be seen physiologically in infants, teenagers and adults. Gynecomastia is observed in 40% of teenagers and 35% of adults.

Although the most common cause of gynecomastia is hormonal imbalances observed in adolescence, it is a condition mostly encountered at the age of 14. Most of them are a normal and acceptable condition that will recede within a couple of years. If a recession is still not seen at the end of the second year, than you can search for a solution.

Among other reasons, we can mention about the use of hormone-containing drugs, developmental disorders of male reproductive organs, testicular diseases, hormone-producing tumors, hepatitis, cirrhosis, lung cancer and lung diseases, thyroid gland diseases, and excessive alcohol or drug consumption, and the use of steroids. This deformity is usually seen in young men entering adolescence. Although the vast majority of boys experience an enlargement of breast tissue during this period, the enlargement is not at a noticeable level, and the breast shrinks and recedes to its normal size within a year after adolescence. However, sometimes these changes continue with progress, and the breast remains bigger than the required size. This growth can be unilateral or bilateral.

The condition that appears in association with obesity, in which the breast seems bigger due to lipoidosis, without enlargement of the mammary gland, is referred to as ‘pseudogynecomastia’. Pseudogynecomastiaas well is a commonly encountered problem.

The symptoms of gynecomastia include stiff mammary glands, which have not grown and have remained like a button, size differences of the breasts, enlargement of the breast that is similar to enlargement of female breast, and even excessively sagging breasts.

The types of gynecomastia include:

  • Breast enlargement due to increased adipose tissue: Fatty gynecomastia
  • Breast enlargement due to increased breast tissue: Glandular Gynaecomastia:
  • Breast enlargement due to both increased adipose tissue and increased breast tissue: Fatty & Glandular Gynaecomastia:

In the treatment of gynecomastia, there are two approaches as the surgical removal of the excess tissue, and non-surgical removal of the excess tissue with the liposuction procedure.

In the vast majority of patients with gynecomastia, liposuction alone can give satisfactory results. In patients, who have also excessive and dense breast tissue besides fat, ultrasonic liposuction (VASER) can be used. If it remains inadequate, the excess breast tissue is removed through a short incision made around the nipple. In patients with excess skin and sagging nipple, the skin is removed in such a way as to ensure that the scar remains around the nipple. In male patients, it is required to be attentive not to remain another scar, unless it is inevitable.

Before gynecomastia operation, first the cause of the gynecomastia should be clarified. If a hormonal disorder is likely to be the reason, an Endocrinology Specialist should assess this condition. Hormonal tests should be performed. In case of any disorder, first this has to be treated. In gynecomastia cases that appears during adolescence period, it is generally enough to wait for a certain period of time and most of the time it improves in couple of years.

Gynecomastia surgery is done under general anesthesia, in an operation room. The surgery takes 1 to 2 hours, depending on the procedure to be carried out.

  1. If the cause of the gynecomastia is excess breast tissue, surgical removal of the excess breast tissue is required. Surgery can be done alone but can also be done in combination with liposuction, with intent to achieve a nice contour by removing the excess fats around it. In this procedure, an incision is made around the nipple or in the armpit, in such a way as to ensure it to be unnoticeable. The excess breast tissue is accessed and removed through that incision. A longer incision may be needed in bigger breasts that requires the removal of a part of skin as well. In cases where also the removal of excess adipose tissue is required, liposuction is performed by entering through the same incision.
  2. If the patient’s gynecomastia is caused by excess fats, the liposuction procedure alone will be adequate. This procedure is carried out by means of cannula inserted through a 2-3 mm incision. The biggest advantage of this procedure is that there is no scar tissue after the operation.