Same as the female breast, the male breast is comprised of breast tissue and fat tissue surrounding it. But these are atrophic (decreased in size) formations. The enlargement of male breast tissue in a way to cause a significant protuberance is called “gynecomastia.” This situation may cause severe psychological and social issues, especially in younger patients; among others, they become introverted, develop bad posture, wear baggy clothes and avoid swimming.
In the beginning of puberty, breast growth, fullness and sensitivity due to hormonal reasons is natural. This generally temporary condition may become permanent due to various causes. In young men, the cause is most often not a hormonal anomaly. Rarely tumors, hormonal imbalances or medications may cause one or two sided breast enlargement. In most cases, these rare situations appear at a later age. For a distinct diagnosis, a detailed history, if necessary, visualization techniques (ultrasound, MRI etc.) and hormone analyses will be requested.
The treatment of gynecomastia is surgery. Gynecomastia severity is categorized in 3 grades depending on the size of the breast and excess skin. In Grade 1, the growth is within limited boundaries, there is no loosening nor sagging of the skin. In the event that the breast mass is proven to mainly consist of fat tissue during the consultation, gynecomastia may be treated with only suction (liposuction). If the breast tissue contains breast tissue in addition to fat tissue, it is possible to extract the tissue with a small incision in the areola and reshape the contours.
In Grade 2, the breast has the appearance of a relatively large female breast, however no sagging is observed. The same treatment methods will be applied.
In the third grade, in addition to the other issues, excess skin and sagging are present to an extent that it will require treatment of the skin. In the event the sagging is severe, certain surgical methods are suggested to remove excess skin.
Use of aspirin should be avoided for 10 days preceding the operation. Laboratory testing is also necessary. In addition, the doctor should be informed of any patient history, past diseases and medications.
The surgery is performed in hospital environment. General anesthesia can be opted for, although it is possible to have local anesthesia combined with sedation to numb the area and calm the patient. If an open surgical procedure is chosen, a drain must be placed to the area, aiming to remove accumulation of fluids such as blood and serum and avoid the possible complications that may arise. The drain will be taken out within 24 – 48 hours.
A special compression top (commonly called a gynecomastia tank top or corset) will be put on at the end of the surgery. The use of the corset is quite simple and it provides more comfort as it reduces pain and swelling. It will be worn continually during the first 3 weeks. The patient can take it off after day 4 – 5 and shower. For two weeks following the third week, especially during the day and during heavy physical activities, wearing the corset will be beneficial.
The post-operative period is generally comfortable. After the first day, there will be no movement limitation. Swelling, sensitivity, pain and even sporadic contusions in the surgical area may occur during the first days. These will usually start healing after 2 – 3 days. Sensitivity may last for a few weeks.
Swimming will be allowed after the second week. During 6 weeks, external factors that may cause swelling such as very hot baths or solariums should be avoided. The same way, heavy exercises and other activities where there is possibility of a blow to the chest should be avoided for 6 weeks.
When planned correctly, this surgery has a very low the complication (infections, bleeding) and is one of the cosmetic procedures that yield the most pleasing results.