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World-Class Plastic Surgeons Share All You Need to Know About Gynecomastia
What is Gynecomastia, Surgery, Symptoms, Causes, and Treatment
BMC Plastic Surgeon: Gynecomastia is a pathology of the mammary glands in men, revealed by a one- or two-sided increase in their size due to hypertrophy of the glandular or adipose tissue.
It manifests itself as compaction and enlargement of the breast, a feeling of heaviness, pain during palpation. It can regress on its own. With the ineffectiveness of conservative therapy, surgical treatment is indicated, since the prolonged existence of Gynecomastia poses a risk in the development of a malignant tumor of the mammary gland.
In case of Gynecomastia, mammary glands can reach from 2 to 10 cm (usually about 4 cm) in diameter The frequency of gynecomastia is from 50 to 70% among healthy adolescents 13-14 years old, about 40% – among young men, up to 60% – 70% – among older men. Gynecomastia gives men physical discomfort and psychological difficulties.
What are the Gynecomastia Types?
BMC Plastic Surgeon: Distinguish true Gynecomastia and false (or pseudo-gynecomastia). True gynecomastia is characterized by hypertrophy of the glandular tissue and stroma, pseudo-gynecomastia is caused by massive deposits of adipose tissue, increasing the volume of the mammary glands, and is observed in men with obesity.
There is true gynecomastia, as a variant of the physiological norm at certain age periods, and pathological Gynecomastia, which is a symptom of serious pathologies in the body.
True idiopathic (physiological) Gynecomastia can be of three types:
- Gynecomastia of the Neonatal Period – breast swelling is observed in 60-90% of newborns. This condition is due to the influence of the sex hormones of the mother, which got into the child’s body in utero. It does not require treatment, the mammary glands are reduced after 2-4 weeks.
- Gynecomastia of the Pubertal Period – develops in 30-60% of adolescents aged 13-14; in 80% of cases, there is bilateral enlargement of the glands. It is caused by the immaturity of the male reproductive system and the predominance of female sex hormones over male ones. Usually regresses independently within 1-2 years.
- Gynecomastia of advanced age – observed in men 50-80 years old due to a decrease in testosterone production and a predominance of estrogen.
With Gynecomastia, a bilateral symmetrical increase in both mammary glands (in 80%) or an asymmetric increase in one gland can be observed.
What are the Symptoms and Causes of Gynecomastia?
BMC Plastic Surgeon: Normally, the mammary glands in men are an underdeveloped, rudimentary organ consisting of a small amount of glandular and adipose tissue, short ducts and a nipple. The development and functioning of the mammary glands depend on the effects of female sex hormones – estrogen and the pituitary hormone – prolactin. Normally, in the male body, the amount of estrogen does not exceed 0.001% of the androgen content, and they quickly undergo destruction in the liver. For a number of reasons, the percentage of androgens/estrogens changes in the direction of the increase in the latter or a decrease in the sensitivity of tissues to the action of testosterone occurs. Under the influence of estrogens, the development and growth of the male mammary glands in the female type begins with the intensive development of glandular tissue. With the development of pituitary adenoma producing prolactin, in the mammary glands, fatty deposits and connective tissue development. With gynecomastia, the glands enlarge and become denser.
True Pathological Gynecomastia in men can be caused by the following groups of reasons:
- Violation of the ratio of testosterone and estrogen in the body of a man. This condition can be observed with hormone active tumors of the pituitary gland, testes, adrenal glands, stomach, pancreas, lungs, primary and age-related hypogonadism (insufficient functioning of the gonads), prostate adenoma, inflammatory processes in the testicles, Addison’s disease, etc .;
- Hyperprolactinemia – increased secretion of prolactin in pituitary tumors, hypothyroidism;\
- Diseases accompanied by metabolic disorders – with diffuse toxic goiter, diabetes mellitus, obesity, pulmonary tuberculosis, etc .;
With Gynecomastia of the neonatal period, slight engorgement and enlargement of the mammary glands, sometimes with colostrum-like secretions, are noted. In other forms of gynecomastia, the mammary glands can increase from 2 to 10 – 15 cm in diameter and reach a mass of up to 160 g. The nipple grows, the areola becomes sharply pigmented and expanded to 2-3 cm in diameter. In rare cases, a milky type of discharge from the nipple is noted.
Usually, enlarged glands are painless, a feeling of pressure, increased sensitivity of the nipples, discomfort when wearing clothes may be noted.
With unilateral Gynecomastia, the likelihood of tumor damage to the breast increases. Hormone-active tumors producing estrogen and chorionic gonadotropin cause a rapid increase in the mammary glands, their soreness and a feeling of fullness. Gynecomastia caused by hyperprolactinemia is accompanied by oligospermia, impotence, and symptoms of central nervous system damage.
During gynecomastia, three stages are distinguished: developing (proliferating) – initial changes, the first 4 months, when the reverse development of gynecomastia is possible with appropriate medical treatment; intermediate – characterized by the maturation of glandular tissue; runs from 4 months to a year; fibrous – the appearance in the mammary gland of connective and adipose tissue; regression of the pathological process is almost impossible.
How do you treat Gynecomastia at BMC?
BMC Plastic Surgeon: The physiological types of Gynecomastia usually disappear spontaneously and do not require medical correction. Sometimes, hormones such as clomiphene, tamoxifen, dihydrotestosterone, danazol, testolactone can be prescribed to suppress high estrogen concentrations during physiological gynecomastia in adolescents. If drug treatment does not lead to a decrease in the size of the mammary glands, then plastic surgery comes to the rescue.
Breast tissue is removed, and liposuction is performed (removal of fat in adjacent areas).
Treatment of pathological Gynecomastia is determined by the underlying disease that caused the enlargement of the mammary glands. To normalize the ratio of testosterone and estrogen in gynecomastia, conservative hormone therapy with testosterone is performed. It is effective in the first 4 months. after the occurrence of gynecomastia. With an excess of estrogen in the male body, antiestrogen therapy with tamoxifen is prescribed, which blocks the effect of estrogen on the mammary glands. Gynecomastia caused by taking medication usually disappears on its own after discontinuation of the drug.
Surgical treatment for Gynecomastia is carried out in cases where conservative therapy is ineffective, or it is obviously clear that drug treatment will not give the desired result (for tumor lesions). The surgical treatment of gynecomastia is carried out in the following types of operations: it consists of removing the breast tissue and restoring its physiological contour.
The following types of procedures at BMC are used:
- Subcutaneous Mastectomy with preservation of the areola from para-areolar incision
- Subcutaneous Mastectomy from para-areolar incision with liposuction;
- Endoscopic Mastectomy (with small enlargements of the mammary glands)
Subcutaneous and Endoscopic Mastectomy operations are well tolerated by patients, do not require long hospitalization (usually 2 days) and long rehabilitation. The first 2-3 weeks after a mastectomy, you need to wear elastic underwear to form the correct muscle contour and reduce skin. After 5-7 days, you can already start normal work, and after a month – to sports training.
How can men diagnose Gynecomastia?
BMC Plastic Surgeon: Gynecomastia of newborns and adolescents is characterized by a favorable course. In the post-puberty period, gynecomastia disappears within 2 years in 75% of young men, in the next 3 years – in another 15%. The outcome in pathological forms of gynecomastia depends on the possibility of eliminating the cause of the disease. Predictably more favorable drug gynecomastia, less – gynecomastia caused by chronic diseases.