Gynecomastia or male breast reduction surgery: A source of complexes with an easy solution.

21 Aug Gynecomastia or male breast reduction surgery: A source of complexes with an easy solution.

When we talk about gynecomastia, we are talking about a common deformity in the male chest. Basically, gynecomastia is a benign increase in the size of the breast in the male, of multifactorial origin. In most cases it is idiopathic in origin (the specific cause is not known), and in many other cases it appears that an imbalance between estradiol and testosterone is the underlying cause. Surgical correction is sometimes necessary to restore masculinity to the torso.

First of all, when dealing with a gynecomastia, the health professional must make an adequate diagnosis of its origin, and determine if its development has been caused by a physiological imbalance, or if on the contrary, behind this anomaly there is a pathology or disease that requires treatment (a tumor, pathological hormonal alterations, use of drugs, etc.).

The prevalence of gynecomastia in adolescent males is quite high, there are studies that place it at 38-64% of adolescent males, although in most of these cases, gynecomastia eventually disappears with development, at the end of adolescence. Therefore, in children and young people, it is advisable to wait until their development is complete in most cases before corrective surgery is indicated.

Gynecomastia can be caused by an excess of adipose tissue or be concentrated in an exaggerated development of the mammary gland. Pseudogynecomastia” is the alteration in which excessive breast development is exclusively at the expense of adipose or fatty tissue, cases that are closely related to excess weight.

It is common that gynecomastia in cases where it does not resolve spontaneously with development and growth, or with medical treatments, is a great complex and is experienced as a real deformity, which results in a loss of self-esteem and self-image with a significant psychosocial impact.

The most important factors to consider when treating gynecomastia are:

1. Breast size
2. Excess skin
3. Breast ptosis (the degree to which the breast is sagging or drooping).
4. Composition (gland and/or adipose tissue)
5. Deformity: the most typical is tuberosity.
6. Nipple malposition
7. Chest shape

Regarding the surgical correction of gynecomastia, there are basically 3 basic procedures that are combined according to the individual requirements and characteristics of each patient:

1. Breast tissue excision.
2. Liposuction of mammary adipose tissue.
3. Skin resection. It can be pure circumareolar (around the areola), circumareolar with transverse extensions, or spindle-shaped at the level of the sulcus.
4. Combination of the above.
5. Sometimes it is necessary to graft the areola, if the excess tissue is severe and it is very ptosic or sagging.

Gynecomastia in bodybuilders.

In this type of patient the psychological impact is even greater since they are subjected to great demands, imposed both by themselves and by the competitions in which they participate.

In this population group, gynecomastia or mammary gland enlargement is almost exclusively due to an increase in glandular development (since they present almost inexistent percentages of body fat).

In these patients the appearance of gynecomastia is generally due to the use of anabolic steroids or ingestion of hormonal compounds sold in sports nutrition stores. Despite stopping the use of these drugs, gynecomastia as a deformity usually remains.

Surgical correction in these cases is more demanding than in other patients. This is due to the following reasons:

1. Gynecomastia is usually purely glandular, without excess adipose tissue, so it requires a very precise excision in order not to leave sequelae, subsidence or irregularities.
2. Tissues are usually highly vascularized due to overtraining and hormonal influence.
3. The entire gland must be resected to prevent recurrence (if remnants are left, it may recur on many occasions).
4. These patients are demanding and perfectionists, and will not settle for a mediocre or poor result.

What things should be taken into account when performing this surgery?

1. Smoking is a relative contraindication. Tobacco has negative effects on healing.
2. It must be performed in an operating room with the necessary safety conditions.
3. The type of anesthesia will vary depending on the procedure: from deep sedation if only liposuction is required, to general anesthesia if the procedure requires more procedures.
4. The duration of the procedure is 60-120 minutes.
5. Admission is usually 12 to 24 hours.
6. Drains are generally not used, except in cases in which the cutaneous or glandular resection is too extensive.
7. After the operation, compression garments should be worn for 4-6 weeks.
8. The recovery period is 1-2 weeks to recover normal life activities, and 4-6 weeks to resume sports practice.
9. Complications are rare, although sometimes there could be hematoma, seroma, infection, skin or areola necrosis, poor healing, contour alterations, redundant skin, asymmetries, etc. This is why it is so important to choose a good surgeon with experience in this pathology.

If you are considering undergoing this procedure, you can request a visit to our office to learn about your specific case, analyze your individual characteristics and give you personalized advice. We will be pleased to assist you.

Dr. María Eloísa Villaverde Doménech. Specialist in plastic, aesthetic and reconstructive surgery.

You can find me at: Hospital 9 d’Octubre, Valencia. Contact: 684148979; info@dravillaverde.com