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gynecomastia

Gynecomastia

Gynecomastia is the abnormal, benign enlargement of the male breast (usually bilateral but sometimes unilateral) resulting from a proliferation of the glandular component of the breast. It is a common disorder of the male breast and one of the most usual aesthetic problems. It may be caused by the development of mammary gland, the increased accumulation of fat or a combination of both factors. The result is that breasts become visibly overgrown.

Gynecomastia usually appears during puberty, and affects more than 65% of the adolescents and over 40% of adult men. In most cases, gynecomastia is idiopathic where no cause is found. Some of the factors that may cause gynecomastia include genetic disorders, gene-related syndromes (e.g., Klinefelter syndrome), the use of steroids and antidepressants, obesity, chronic liver diseases, male sex organ impairment, hormonal disorders, and aging.

Gynecomastia can cause adverse psychological effects on men, because it makes them feel less masculine. For that reason, more and more men resort to plastic surgeons to solve their problem. Treatment can be either surgical or medical.

An ultrasound on both breasts is performed to evaluate the composition of breasts. Breasts may be found to consist mainly of adipose tissue with normal breast gland, or there may be excessive adipose tissue with enlarged breast gland. The surgical treatment of the two aforementioned cases is different.

Where there is excessive adipose tissue with normal breast gland, the breast will be subjected to liposuction. In our clinic we perform bloodless liposuction under local anesthesia with a solution of xyloxaine 1% with adrenaline 1:200000. After making an incision under the breast (which then heals and is invisible) the surgeon injects a local anesthetic on the adipose and breast tissue and inserts the fiber optic of the laser to melt and liquefy the fat topically. In the second stage, a small cannula is inserted that suctions the fat, which is then eliminated from the body.

The result is immediately observable and permanent, the downtime is zero, there is no pain but only a mild sensitivity in the area and the patient is required to wear a special compression vest for the first month. However, he will be able to resume his daily activities on the same, or the following day. Mild exercise is allowed five days after the operation and heavier exercise 15 days after. The final results will appear after 1 to 3 months.

One of the methods to treat gynecomastia is by subcutaneous mastectomy. No skin is removed, and it is performed via one incision at the lower limit between the nipple and the skin. The particular method is preferred when the excess adipose tissue coexists with a hypertrophic mammary gland (breast). The local anesthetic is administered through a tiny incision of up to one centimeter, just like in the case of the laser-assisted liposuction treatment. Then the mammary gland is removed and sent for histological examination. This is followed by laser liposuction and the fat is removed as described above.

The postoperative instructions and the final result are the same as in the case of the laser-assisted  liposuction treatment.

Where gynecomastia is accompanied by sagging skin and breast ptosis, it is preferred to have concomitant breast lift (mastopexy), which will require general anesthesia. Apart from the fat and the hypertrophic mammary gland, the excess, sagging skin will also be removed. The particular procedure leaves more scars around the nipple and/or under the breast.

The postoperative course is normal and although it will require more recovery time than the traditional liposuction, patients will be able to quickly return to their normal activities.

At Cosmetic Derma Medicine, we are able to perform the first two methods under local anesthesia with excellent results. The third technique requires an outpatient clinic and an anesthesiologist.

In all cases only local anesthesia will be administered and we will use the method of laser-assisted liposuction namely “SmartLipo” treatment, i.e., a subcutaneous ND-Yag laser that enters below the skin and emits light at 1064 nm, which is selectively absorbed by the adipose tissue.

The advantages of a laser liposuction for gynecomastia over the traditional technique are as follows:

  •  Only local anesthesia is required and the procedure is performed at our specially equipped premises.
  • The patient requires no pre-operative preparation.
  • It is an absolutely safe method, since it requires no sedation, analgesia or general anesthesia.
  • The procedure takes less than 1½ hours.
  • Before the procedure, the laser melts and liquefies the fat, so that it can be suctioned with very fine tools. Therefore the incision is much smaller and practically invisible, while the fat is evenly removed, without leaving minor lumps or bumps on the chest area.
  • At the same time, the laser tightens the skin, which is very important, as it eliminates post-surgical skin laxity.
  • The patient may return home immediately after treatment.
  • The downtime involved is very short, there is no pain, swelling or bruising, and the patient will be able to immediately return to his/her activities and work. A special compression vest should be worn though.

The patient will be required to follow the instructions listed below after a laser liposuction treatment (with or without subcutaneous mastectomy).

  •  Wear a special vest for 20 to 30 days.
  • Take preventive antibiotics for 3 to 5 days according to the doctor’s instructions.
  • Avoid wetting the treated area on the first day. One will be able to shower normally during the following days.
  • Avoid intense physical activity for 15 days.
  • Avoid mild activity for the first 5–7 days. Resume exercise after one week (treadmill – bike).
  • Massage the area with a special cream for 1–3 months, so as melted fat is efficiently removed by the lymph circulation.

Gynecomastia may also be treated with medications. This is possible when gynecomastia is due to hormonal and endocrine causes. The medical treatment of gynecomastia should be performed in cooperation with a special endocrinologist, and involves the administration of medications such as clomiphene.

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