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Gynaecomastia
Gynaecomastia is a condition in which males develop enlargement
of the breast. This is quite common in adolescents and is often
first noted at the onset of puberty. The medical literature
reports rates as low as 8 per cent and as high as 65 per cent.
Most of these cases are due to changes in the hormonal secretion
with temporary excess of estrogen-like substances or relative
deficiencies of testosterone-like substances. This imbalance can
lead to temporary increases in the amount of ductal tissue
present on one or both sides. The majority of cases show
enlargement on both sides. The degree of enlargement varies
widely. The milder cases usually resolve in three months to a
year.?
By late teens most of these patients will
have normal appearing male breasts without any form of
treatment. For some the problem persists. Because young boys are
reluctant to discuss their concerns they are likely to simply
try to hide their abnormal appearance with clothing. They may
try to avoid gym classes, athletic activities, and swimming or
beach activities and this may affect their behaviour too.
Apart from Gynaecomastia seen in adolescence,
which is by far the commonest cause, there are other rarer
causes for this problem. It could be due to endocrine gland
malfunction and tumours. Some types of liver disease and cancers
of several types can produce gynaecomastia. However, these are
extremely rare instances.
Some cases are due to congenital syndromes
and others may be related to drug use such as steroids or
marijuana. Prolonged use of certain prescription drugs may also
cause gynaecomastia as a side-effect. There is a second peak in
incidence late in life and here the risk of ductal carcinoma of
the breast must be a stronger consideration so that biopsy of
the breast may be necessary.
Treatment:
Liposuction and excision:
When gynaecomastia is severe; when it is the
cause of abnormal behaviour and loss of body image; when it
persists, and in those cases where there is a suspicion of
malignancy, surgical treatment is indicated.
The incision for this operation is placed
just inside the areolar border (dark area of the breast) where
it is less likely to be conspicuous. The glandular tissue must
be removed.
This firm, fibrous tissue extends from the
nipple areolar complex down to the surface of the pectoral
muscles beneath. About 60 to 80 per cent of the tissue in a
gynecomastia is made up of fat.
At Hande Hospital we always use liposuction
to remove the fatty tissue, which surrounds the ductal and
glandular tissue. Without liposuction, patients would have a
“doughnut” or a “volcano” shaped defect after removal of the
ductal tissue and the patients are unhappy with the inferior
results.
Liposuction is a procedure where fat is
sucked out from under the skin with a blunt needle. Between
three and four litres of fat can be sucked out in one sitting.
Liposuction of the abdomen and hips may also be performed
simultaneously along with correction of gynaecomastia. Several
of our patients have opted for this.
Stay in hospital is usually for a period of
about three days. A drainage tube is placed to prevent any
haematoma (collection of blood) under the skin, which is removed
at the end of three days. The patient, after discharge, can
perform light work straightaway. Strenuous exercise and going to
the gym, etc., may have to wait for a period of up to 15 days.
Complications:
The most common complication following
surgical removal of the ductal tissue is haematoma. To prevent
this complication, we take meticulous care in securing
haemostasis and also routinely place a suction drain that is
removed at the end of three days. Bleeding and haematoma
formation is more common in patients with bleeding disorders and
those taking drugs like aspirin. If a patient is taking any such
medication or has a bleeding problem, it has to be brought to
the notice of the surgeon. Discontinuing aspirin for a period of
seven days before the surgery will suffice.
Some residual deformity of the nipple areolar
area may remain despite the best efforts of the surgeon. This is
relatively rare. With any operation, a wound infection could
occur. Again this is extremely rare and is more prone to occur
in those patients who have diabetes. Control of diabetes before
surgery has made this complication almost non-existent.
Inadvertent injury to the blood supply to the
nipple areolar region could result in loss of skin in the nipple
areolar area. The vast majority of patients undergoing this
operation is very pleased and adopt a more normal life with
regard to exposure of the chest in normal social situations. As
said earlier, adding liposuction to conventional surgery has
greatly enhanced patient satisfaction.
This write-up is given only as information.
Please contact your doctor for further details and queries. You
are not abnormal in any way if you have gynaecomastia. There is
no connection or correlation with your ability to have sex or
bear children and gynaecomastia and surgery for the same has no
effect on these either.
Dr Krishna Hande
MS., FRCS., MCh (Plastic)
HANDE HOSPITAL
44, LAKSHMI TALKIES ROAD,
SHENOY NAGAR,
CHENNAI 600030
Ph: 26644517,26646422
Web Site:
http://www.handehospital.org
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