Gynecomastia

The causes of gynecomastia can be the development of a massive gland, increased fat accumulation or a combination of both factors. This results in the breasts being visibly hypertrophied.

Gynecomastia usually occurs in adolescence. It affects more than 65% of adolescents and more than 40% of adults. In most cases, gynecomastia is idiopathic as no cause can be found.

Some factors that may cause it are: birth defects, syndromes caused by genes (e.g. Klinefelter's syndrome), the use of steroid drugs and antidepressants, obesity, chronic liver disease, genital dysfunction, hormonal disorders, and ageing.

Before the treatment of gynecomastia, an ultrasound examination of both breasts is performed in order to assess the composition of the breasts. The breasts may consist mainly of adipose tissue with a normal mass gland or there may be excess adipose tissue with an enlarged mass gland. The surgical treatment differs in these two cases.

In the case of excess adipose tissue with a normal mass gland, liposuction is practically carried out in the breast area. In our clinic we apply the minimally invasive liposuction under local anesthesia using a 1% xylocaine solution with adrenaline 1:200000. After a hole is opened in the submammary fold (which is then healed and invisible), local anesthesia is performed on the fatty and massive tissue and then the optical fiber of the laser is inserted which melts and liquefies the fat locally. During the second stage, a small cannula is inserted and sucks up the fat which is then expelled.

• The result is immediate and permanent, the recovery time is zero, there is no pain but only mild tenderness, the patient needs to wear a special vest for the first month and returns to daily activities the same or the next day. Mild exercise is allowed after five days, and heavier exercise after 15 days. The final shaping of the result requires 1-3 months.
• One of the methods of treating gynecomastia is subcutaneous mastectomy without skin removal, which is performed through an incision at the lower border between the nipple and the skin. This method is preferred when, in addition to excess fat, a hypertrophic mass gland (breast) is present. During this procedure, a local anaesthetic is administered through an inconspicuous incision no more than one centimetre long, as in the case of laser liposuction for the treatment of gynaecomastia. The mass gland is then removed and sent for histological examination. Laser liposuction is then carried out and the fat is removed in the manner described above.
• The postoperative instructions and outcome are the same as in the case of laser liposuction of the breasts. In some cases where, in addition to gynecomastia, skin sagging and breast droop coexist, simultaneous breast lift surgery (mastopexy) is preferred. In this case, general anaesthesia is required and in addition to the removal of fat and perhaps the massive hypertrophic gland, the excess loose skin is also removed. This is an operation that leaves more scarring around the nipple or even under the breast.
• The post-operative course is smooth and the return to activities is quick although it takes longer than traditional liposuction.
• At Cosmetic Derma Medicine we perform the first two techniques under local anesthesia with excellent results. The third technique requires an external clinic and an anesthesiologist.
• In all cases, only local anesthesia is used and laser liposuction is used, which is a subcutaneous ND-Yag laser that enters under the skin and emits light at 1064 nm that is selectively absorbed by the adipose tissue.