Gynecomastia is enlargement of the breast tissues in boys or men. Both men and women have breast tissues and being control by our body hormones. “Male” hormone testosterone and “female” hormone estrogens are present in both men and women. For men level of testosterone is higher than level of estrogen, so men don’t grow boobs. Changes in balance of hormones in male causes the breast tissue grow and develop gynecomastia.
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- Gynecomastia in teenagers – Breast tissue growth happens in men during three stages in the life span of an individual and they are infancy, adolescence and old age. When teenagers go through puberty and becomes sexually mature, there are a lot of hormonal changes including estrogen dominance for some time and this can cause development of breast tissue. Not all boys going through puberty will experience this but estimated 50% may develop breast tissue growth. This called pubertal or teenage gynecomastia.
- Gynecomastia in adults– Men who are significantly overweight are very likely to feel some enlargement of their breast tissue. This is partly caused by fat tissue under the skin on the chest wall, and partly by true breast glandular tissue. Fat tissue anywhere in the body encourages formation of estrogen, and thus can lead to gynecomastia.
- Medications– Certain medicines can also cause Gynecomastia, medication like:
- Heart medicines
- Anti-anxiety drugs
- AIDS treatments
- Tricyclic antidepressants
- Drugs that treat heartburn
- Other substance like:
- Anabolic steroids for body building
- Medical condition– there are certain medical conditions that may also cause Gynecomastia including:
- Klinefelter syndrome
- Kidney disease
- Liver disease
- Foods– some foods naturally contain high levels of phytoestrogens, chemicals which closely mimic estrogen and can ‘trick’ the breast tissue into growing in response. Some foods contain high levels of phytoestrogens include:
- Flax and sesame seeds
- Soy milk and tofu
- Cereals and dread containing flax seeds
- Process foods
- Dried fruits
- Breast pain or tenderness
- Enlarged areola
- Nipple discharge (occasionally)
- Hard lumps
GRADE 1– Swelling behind the nipple and areola
- SEVERITY: Very mild
GRADE 2– Swelling across chest wall, indistinct edges
- SEVERITY: Mild to high
GRADE 3– More prominent swelling, definite edge
- SEVERITY: High and visible
GRADE 4– Sagging of breast (Feminization)
- SEVERITY: Severe and visibly feminine
Most men don’t need treatment for gynecomastia, if the problem caused by puberty. As most cases will go away on their own. Early treatment is advice, like weight loss and stopping of medication that might cause the problem. There are also medication that men can try to reduce the swelling. If early treatment and medication does not work then surgery might be suggested.
Gynecomastia maybe not a serious problem, but it can cause emotional discomfort, embarrassment and impair self-confidence. To avoid these situations some men choose to undergo a surgery to remove the breast tissue. The type of surgery the doctor will recommend will based on his evaluation. The surgery usually carried out by a plastic surgeon and done it in an outpatient visit.
Proper investigations and evaluation needed to work out the cause of the problem, these include the following:
- Physical examination
- Blood tests
- Ultrasound scan of the breast tissue
- Other scans like MRI of the breast area
Types of surgery for gynecomastia we offer here at Rattinan clinic:
- LIPOSUCTION– Fat removal surgery, this technique removes only the fatty tissue not the breast glandular tissue. Can be done together with Mastectomy.
- MASTECTOMY– Surgical removal of breast tissue, the small curved incision is around the areola. Can be done together with liposuction and areola reduction.
For severe case of gynecomastia, surgeon will consider removing the excess skin along with the glandular tissue.
Gynecomastia surgery risks
Gynecomastia surgery is very safe but before deciding to have a surgery, patient need to consider the risks and benefits of having the procedure done.
The day of your surgery you will asked to sign a consent form to make sure that you understand fully the potential risk and complications.
Gynecomastia surgery risks include:
- Pain after gynecomastia surgery
- Infection of the wounds
- Collection of swelling fluid under the skin
- Regrowth of the breast tissue over time
- Poor appearance of the chest
- Poor appearance of the scars
Preparation for surgery
- Lab tests – to check your health status and any pre-existing conditions or risk factors.
- Stop certain medications for 1 week including aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) and blood thinners, all of which can increase the risk for bleeding. Certain vitamin and herbal medicine like omega-3 fatty acids, gingko biloba and green tea may also increase bleeding risk.
- Stop smoking and drinking alcohol prior to surgery.
- Also avoid caffeine the day of the surgery, the numb medication we use have adrenaline that might increase heart rate. Caffeine might result to adverse reaction of adrenaline, and heart rate may increase more.
- Fasting of food and water for 6-8 hours on the day of the surgery.
- Wear loose clothing on the day of the surgery for comfort. Because in some case patients have a tube attached to drain the excess blood or fluids and on top of the wound dressing you need to wear a compression garment to reduce the swelling and support the chest contour after surgery.
Post operation care instructions
- Dressings or bandages will applied on the incisions and you will wear a compression vest 24 hours for 3 days and 12 hours for 1 month.
- You will be given medications with instructions, to help in healing and reduce potential infections.
- If you develop rash or having allergic reaction to the medication, please call the clinic immediately.
- When bathing make sure to pat the incision area dry. No soaking or swimming for at least 1 month or until the incision is fully healed. To minimize the risk of infections.
- Schedule an appointment for changing the wound dressing if cannot done by yourself.
- Cleaning the incisions at home. Wipe the incision gently with Bethadine and the surrounding skin with alcohol. Do not apply alcohol over the incision directly, then afterwards place the water resistant Band-Aids before shower.
- Schedule follow-up checkup and when to remove the stitches.
- It’s normal to feel burning, soreness on the breast and drainage coming out from the incision line during recovery.
- Bruising and swelling will be expected for a few months and may take some time to go away.
- Liposuction areas need massaged to help break any lumps or bumps; you may use any lotion of your choice. Massaging in a circular motion all around the treated area.
- Exercise and vigorous activity could start after 2 weeks.
- The first month post-surgery most patients may notice a 50% reduction of the area treated. It takes time for the swelling to go away. Takes about 6 months to 1 year to see the final results.
- May start applying scar creams to the incisions after stitch off, if the incision line looks good and there are no open wounds or scabs.
- Sometimes the suture will take time to dissolve and may reach the surface, if this happens you can carefully cut them.
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