GYNECOMASTIA
Gynecomastia is the term given to the overgrowth of glandular and adipose tissue in the male breasts. It is a common condition in men of any age, and can result from hormonal changes, hereditary conditions, disease, advancing age, obesity, use of certain medications, steroid hormones, or use of psychoactive drugs.
For most men in this condition, it causes emotional discomfort and impairs self-confidence to the point of avoiding certain physical activities, social activities, and even intimacy.
WHAT IT IS AND HOW IT IS DONE
Gynecomastia is present in 60% of newborns and disappears spontaneously within a few weeks. In adolescence, just over half of all boys have this condition and most resolve within a few months. To a lesser or greater degree, it is present in at least one third of men between the ages of 25 and 45, and in more than half of men above this age group. Increased male breast volume is strongly correlated with obesity.
It should be noted that breasts over 4 cm in diameter may not regress completely. Depending on the causes, medications and surgery are successfully used to treat Gynecomastia.
Gynecomastia shows a gradation of clinical types ranging from small visible breast enlargement with no skin redundancy to a large breast enlargement with much skin redundancy, becoming feminine in appearance. It is usually bilateral.
Technically, the plastic surgery to correct Gynecomastia is the Reduction Mammaplasty, as it reduces the size of the breast and harmonizes the contour of the chest. In severe cases, excess breast tissue can cause the breasts to sag and their areolas to become enlarged. In these cases, the position and size of the areolas are improved and the excess skin removed through Nipples and Areolas correction surgery.
In cases where there is primarily excess adipose tissue, we use only Liposuction techniques. We insert a cannula, a thin hollow tube, through a small incision in the anterior axillary line. The cannula is moved back and forth in a controlled motion to loosen excess fat that is removed from the body by vacuum suction.
There are several excision techniques we can recommend when breast glandular tissue or excess skin must be removed to correct Gynecomastia. This can be through the areola and nipple (transareolomammary) and around the areola (periareolar or circular). Excision is also necessary if the areola needs to be reduced, or the nipple repositioned to achieve a natural contour.
We decide which techniques are best to use depending on the anatomical peculiarities of the patient. Sometimes we use liposuction and excision in the same procedure. We take into account the one that results in minimal and non-apparent scars, with a good aesthetic result and achieving a masculine body contour.
The surgery lasts between 1 to 2 hours. The anesthesia options are: local with sedation, epidural with sedation or general anesthesia. It depends on both the patient’s sensitivity and the difficulty and complexity of the procedure.
When necessary, we insert a drain temporarily placed under the skin to drain any excess blood and fluid that may accumulate. After surgery, we apply a dressing over the incisions and elastic bandage and put on the compression bandage in patients whose cases are recommended to use it to reduce swelling and provide support to the operated breast.
GYNECOMASTIA DEGREES
Degree 1: There is no skin leftover, but a discrete increase with emphasis on the areola region, where it is already possible to notice that the breast looks “bulging”.
Degree 2A: There is no skin leftover, but a moderate increase where you can see that the protrusion in much of the thoracic region and not only in the breast. The breasts are easily noticeable under clothing.
Degree 2B: Same conditions as 2A, but with redundancy of skin in the chest region, leaving the bulge more apparent, even dressed in clothing that is not tight.
Degree 3: There is a lot of skin overhang and an increase in breast mass leading to cause breast ptosis (drooping). In this condition, they get the appearance of female breasts.
INDICATION
Correction of Gynecomastia is indicated for physically healthy men from adolescence onward who are bothered by the feeling that their breasts are too large. Sometimes, in addition to discomfort, they can cause pain.
The procedure is even indicated for patients at risk for carcinoma (Klinefelter Syndrome, for example), post-obese people who have experienced loss of volume and elasticity of the skin, and in cases where the Gynecomastia is old and has caused fibrosis.
The problem usually occurs in the transition from adolescence to adulthood, a phase when hormone production is most active. When breast enlargement persists for at least 18 to 24 months, the recommendation is to make a diagnosis for treatment indication. However, it can also happen during maturity, when there is a drop in hormonal action.
The ideal is to be at a relatively normal weight and with breast development stabilized.
PREOPERATIVE
It is essential to consult the SCHEDULED THE SURGERY? page which has a series of questions to talk about during the consultations, to help you with your doubts and where you will find recommendations for the day of the procedure.
Also, in the case of Ginecomastia, correction, the following is an checklist to help you get organized:
🅐 Prior lymphatic drainage sessions help prepare the body for surgery and reduce the risk of post-surgical complications, such as infection, excessive edema, hematomas, and scar tissue.
🅑 If indicated, purchase compression bandage from a specialized company and take it on the day of surgery, as it is placed immediately at the end of the procedure. Choose a very comfortable model, tight fitting but not tight, considering the reduction of the breasts.
🅒 Make sure that in this most critical period of recovery, 2 to 3 weeks, no one depends on you in the family or at work. Following the planning to the letter is intended to ensure the desired results.
POSTOPERATIVE
After surgery to correct Gynecomastia, the patient is released after 12 to 24 hours of hospitalization. The pain is usually not very bothersome, but you will likely feel it for a few weeks while the swelling begins to recede.
The first two days should be absolute rest, which is critical for healing. In cases where significant breast volume has been dissected, we use negative pressure drains, removed on the 4th day after the procedure. Sleep on your stomach, with your arms along your body and torso elevated to be more comfortable.
A light diet helps support the medication which makes the stomach more sensitive. Opt for lighter food on Day 1 (fruit, soup, jello, fiber, liquids, etc.). From the 2nd day of the procedure on, you can eat almost anything, but food with a minimum of salt so as not to increase bloating. Drink plenty of liquids. Also, avoid foods that produce gas (such as beans, garlic, chicken etc.), so as not to cause discomfort.
When indicated, the compression bandage is worn for a minimum of 1 month and can be removed only for bathing. Avoid wetting the dressings, but if this happens, try to dry them carefully with a towel and/or a warm hairdryer at least 20 cm away. We provide a schedule for changing the dressing and removing the drain and stitches, which is done in the doctor’s office in stages.
Between the 3rd and the 7th day it is already possible to return moderately to daily activities, but without physical effort. Light walks from the 8th day on are allowed; more intense physical activities, after evaluation. Avoid heavy lifting and do not raise your arms above your shoulders for at least 15 days. From the 3rd week on, you are cleared for light exercise (which does not require so much physical effort), sexual activity, driving, and activities at work and/or study. Practically, after 30 days normal routine is restored.
Get sun on your breasts? Not even if they are under your shirt! Avoid exposing the scars to the sun as much as possible for at least 6 months, so as not to darken the scars. Afterwards, always use sunscreen with a minimum of 30 SPF (sun protection factor).
As with the preoperative, schedule lymphatic drainage sessions every 4 to 6 weeks postoperatively. Besides eliminating fluid accumulation from the body, this treatment activates the immune system, helps reduce pain and discomfort, relieves bruising and swelling, and is effective in preventing and treating fibrosis and scar adhesions.
The planned result takes place between 4 and 6 months. We advise you to lead a healthy lifestyle, without exaggeration, eating properly, exercising and maintaining the ideal weight for your biotype. The scars are permanent, but, in most cases, they tend to improve significantly over time and, after 1 year, should be quite discrete.