Gynecomastia is breast enlargement in the form of a woman in a man. This condition, which usually occurs together in adolescence, can also be seen in advanced age or childhood.
In fact, male and female breasts are the same in structure. The reason why it is shaped differently in different sexes over time is due to different hormone levels. In other words, regardless of the chromosomal sex, an increase in the level of female hormone (estrogen) or excessive sensitivity of the breast tissue to estrogen leads to breast development in the female direction. Likewise, the lack of estrogen or the unresponsiveness of the tissues to estrogen cause breast development in the male direction.
The male hormone (testosterone) and estrogen are very similar in molecular structure. Therefore, increased testosterone at puberty produces somewhat estrogen-like effects. Again, while testosterone is broken down in the body, some of it turns into estrogen. Another issue is the amount of fat in the body. In obese people, testosterone can be converted to estrogen in adipose tissue. During adolescence, the response of tissues to hormones also increases. As a result of all these events, some amount of breast enlargement occurs in almost every man during adolescence. In some cases, this growth is more than normal (gynecomastia) and leads to an undesirable situation. However, in any case, this growth affects both breasts and is symmetrical. Although it is a harmless condition in terms of health, it creates psychological and social difficulties.
This situation that occurs in adolescence is mostly an innocent event, but breast enlargement in men that occurs at other ages except adolescence may not be an innocent event. An underlying cause should be sought, especially in unilateral or asymmetrical growths. It can be a tumor that causes excess hormone secretion, or it can be a side effect of hormone drugs or other drugs (especially anabolic steroids used in bodybuilding). Chronic diseases (cirrhosis, etc.) can also lead to similar conditions. Breast cancer is not only seen in women, it should be determined whether breast enlargement is due to the mass or not. Such conditions are not called gynecomastia. Their treatment should also be directed towards the underlying cause.
The treatment of gynecomastia is the removal of excess tissue in the breast area compared to the body. In true gynecomastia, this tissue consists of milk glands. However, in most gynecomastia, this tissue is a mixture of mammary gland and adipose tissue. As mentioned before, gynecomastia is more common in obese people. Therefore, a situation arises due to both fat distribution disorder (lipomastia) and an increase in the sebaceous gland (glandular). Which of these tissues has more can change the shape of the surgery, the scar and the healing process. In general, this rate can be estimated by examination, but in suspicious cases, information about the possible mass and tissue composition (fat or mammary gland) is obtained by preoperative ultrasound examination.
There is no cure for true gynecomastia other than surgery. The treatment of the above-mentioned abnormal conditions is the treatment of the underlying problem (drug, tumor, liver disease, etc.). Apart from this, false gynecomastia (lipomastia) that occurs completely due to adiposity can be reduced by losing weight, but even if the normal weight is achieved, the breast area will be more fat compared to the body. In the same way, chest muscles can be developed with sports, but the mammary glands on the muscle are not affected by sports.
While deciding on the operation, the breast is expected to take its final shape. If no change has been noticed in the last 6 months, the decision for surgery can be taken.
Excess tissues are removed by surgery. These tissues are fat, mammary gland and skin. Often there is excess of all of these tissues, but what happens is which one is more.
The most important point is excess skin. If the breast skin is greatly enlarged and sagging, the surgery to be performed is similar to breast reduction surgery performed in women, and it becomes difficult to perform an operation without or with less scars.
If there is not a large amount of enlargement and sagging of the breast skin, if it is thought that the skin may shrink after the surgery, operations that result in scarless or very little scars can be performed.
In this case, if the adipose tissue is excessive, liposuction is the most appropriate method. With liposuction, excess fat is broken up with thin cannulas and pulled through small holes with the help of vacuum, leaving no traces. The mammary glands that cannot be removed by liposuction can be removed with a small incision in the lower part of the dark circular area (areola) of the breast.
If there is a mammary gland-dominated growth and there is no excess adipose tissue, these tissues can be removed through a crescent-shaped incision made under the dark circular region of the breast. It will leave a scar that will not be obvious.
In cases where there is no severe lubrication, liposuction can also be performed under local anesthesia and sedation. However, general anesthesia is a more suitable option in any case, if there is no obstacle. The operation takes between 1.5 and 2.5 hours. A maximum of one night of hospitalization is required. Sometimes drains can be placed.
It is not one of the painful surgeries. However, postoperative painkillers and antibiotics should be used. At the end of the operation, pressure bandages are applied. This bandage is not removed for about 1 week. Stitches do not need to be removed, the only stitches in the holes opened for liposuction are removed if they do not fall off on their own after a week. Then, a special corset in the form of a tight athlete is used, tight clothes should be preferred between 2-6 months according to the skin sagging.
After 2-3 days, you can return to normal life with tight bandages and clothes. A car can be used, a desk job can be done. There is no harm in doing physical movements as long as tight clothes allow. Bruises pass in 15 days, swelling lasts for 1-2 months.
The final shape of the breasts depends on the pre-operative skin sagging and the amount of tissue removed. In general, it becomes normal after 2 months, during which time the scars start to turn pink. It would be right to wait for 1 month to enter the sea, but it is essential to be protected from the sun for 2-3 months.
Apart from the risks of anesthesia and general surgery, it cannot be said that it is a risky operation. The most common complication is bleeding. Tight bandage greatly reduces the risk in this regard. Infection is also usually not a problem with proper technique and antibiotics.
In open surgeries other than liposuction, if the incision is kept too long, loss of circulation and sensation in the nipple may occur. Mild loss of sensation may resolve spontaneously.
There may be asymmetry and fluctuations after surgery. Although most can improve over time, minor local interventions may be required.
The mammary glands removed by open surgery are sent to pathology just in case, if there is a suspicious situation, your doctor will inform you before the surgery.
In some cases, the scars may become thickened or discolored. Scar revision may be required in the future.
If a patient with pre-operative skin excess and breast sagging is not performed, the skin excess will increase after the surgery. Over time, especially sports, massage and tight clothing will help the skin to shrink. However, since no change is expected after the 6th month, surgery should be performed in the form of breast lifting (mastopexy).