Gynecomastia is not an uncommon disorder. It can present in young
males as they go through puberty and the hormone levels in the blood
rise. The disorder can also be found in older male patients who have
been exposed to extrinsic hormones, like testosterone or estrogen. In
either case, enlargement of the male breasts occurs, causing them to
resemble female breasts. This can be further exacerbated by fat
accumulation on the chest, which will worsen the aesthetic situation.
Cases that are not related to hormonal issues s are usually called
idiopathic, which means there is no medical explanation for the
development of the disorder. However, it is important that a young
patient have a consultation with his pediatrician in order to rule out
any hormonal imbalance he might have. Once it has been ascertained
that the patient has no endocrine issues, we can proceed with surgical
treatment.
males as they go through puberty and the hormone levels in the blood
rise. The disorder can also be found in older male patients who have
been exposed to extrinsic hormones, like testosterone or estrogen. In
either case, enlargement of the male breasts occurs, causing them to
resemble female breasts. This can be further exacerbated by fat
accumulation on the chest, which will worsen the aesthetic situation.
Cases that are not related to hormonal issues s are usually called
idiopathic, which means there is no medical explanation for the
development of the disorder. However, it is important that a young
patient have a consultation with his pediatrician in order to rule out
any hormonal imbalance he might have. Once it has been ascertained
that the patient has no endocrine issues, we can proceed with surgical
treatment.
In a young patient who simply develops enlargement of the breasts
without any component of fat surrounding or infiltrating the breasts,
the indicated treatment consists of making a small incision around the
areola and subsequent removal of the gland; the procedure is
technically called a subcutaneous mastectomy. The removed tissue is
routinely submitted for examination by a pathologist. At the end of
the surgery, the incision will be closed with resorbable sutures, and
a compression vest will be used for approximately 1-2 weeks until the
swelling in the area subsides, the stitches are absorbed and the wound
has healed, allowing the patient to return to his normal activities.
without any component of fat surrounding or infiltrating the breasts,
the indicated treatment consists of making a small incision around the
areola and subsequent removal of the gland; the procedure is
technically called a subcutaneous mastectomy. The removed tissue is
routinely submitted for examination by a pathologist. At the end of
the surgery, the incision will be closed with resorbable sutures, and
a compression vest will be used for approximately 1-2 weeks until the
swelling in the area subsides, the stitches are absorbed and the wound
has healed, allowing the patient to return to his normal activities.
In other cases, when a fatty component is added to true gynecomastia,
the treatment is different. This could be the case in a young patient
who is overweight, but is usually seen in older patients. Breast
tissue has a large component of fat, which can be up to 50% of the
total volume, and also is spread across the entire pectoral (chest)
area. A combined procedure must be done in order to avoid deformities
of the chest that usually are created when the procedure is not
properly done, and result in severe indentation deformities under the
areolae. Ultrasonic-assisted lipectomy should be done first to remove
some of the breast tissue and the fat in the area, followed by removal
of the residual breast gland that we then locate under the areola,
which is entered through a small incision performed in that area. The
procedure starts with infiltration of tumescent solution, the same as
used for liposculpture. Two small incisions, one on each side
(laterally and medially) of the subpectoral fold (i.e. where the
pectoralis muscle ends), are made, and through those incisions
ultrasonic liposuction is performed, removing as much breast tissue
and fat as possible in order to create a smooth and flattened chest
area. The residual ?lump? of dense, fibrous breast tissue will then
be surgically removed through a peri-areolar incision. This part of
the surgery is facilitated by the dissection that was already
performed with the ultrasonic cannula, and allows the surgeon to
smoothly remove the remaining portions of breast tissue, creating a
smooth, regular surface at the end of the surgery. This combined
approach leads to excellent results and high patient satisfaction. In
cases in which ultrasonic liposuction is performed, a drain is left in
place to allow for faster healing. A compression vest is also
utilized. The drain is usually removed 2-3 days postoperatively. The
compression vest should be maintained in place for approximately 3
weeks. Nevertheless, the patient will be ready to go back to school
or work approximately 2-3 days after the surgery is performed.
the treatment is different. This could be the case in a young patient
who is overweight, but is usually seen in older patients. Breast
tissue has a large component of fat, which can be up to 50% of the
total volume, and also is spread across the entire pectoral (chest)
area. A combined procedure must be done in order to avoid deformities
of the chest that usually are created when the procedure is not
properly done, and result in severe indentation deformities under the
areolae. Ultrasonic-assisted lipectomy should be done first to remove
some of the breast tissue and the fat in the area, followed by removal
of the residual breast gland that we then locate under the areola,
which is entered through a small incision performed in that area. The
procedure starts with infiltration of tumescent solution, the same as
used for liposculpture. Two small incisions, one on each side
(laterally and medially) of the subpectoral fold (i.e. where the
pectoralis muscle ends), are made, and through those incisions
ultrasonic liposuction is performed, removing as much breast tissue
and fat as possible in order to create a smooth and flattened chest
area. The residual ?lump? of dense, fibrous breast tissue will then
be surgically removed through a peri-areolar incision. This part of
the surgery is facilitated by the dissection that was already
performed with the ultrasonic cannula, and allows the surgeon to
smoothly remove the remaining portions of breast tissue, creating a
smooth, regular surface at the end of the surgery. This combined
approach leads to excellent results and high patient satisfaction. In
cases in which ultrasonic liposuction is performed, a drain is left in
place to allow for faster healing. A compression vest is also
utilized. The drain is usually removed 2-3 days postoperatively. The
compression vest should be maintained in place for approximately 3
weeks. Nevertheless, the patient will be ready to go back to school
or work approximately 2-3 days after the surgery is performed.
Finally, there are cases in which, secondary to extreme obesity, the
skin in the area becomes completely stretched, so that in addition to
removing the fat and the breast tissue, the excess skin needs to be
addressed. These cases are more complex and require different
incisions in order to remove the excess skin. The most important goal
in this disorder is to achieve a smooth surface at the end of the
procedure, remove the breast tissue and avoid complications that are
nearly impossible to treat once they occur.
skin in the area becomes completely stretched, so that in addition to
removing the fat and the breast tissue, the excess skin needs to be
addressed. These cases are more complex and require different
incisions in order to remove the excess skin. The most important goal
in this disorder is to achieve a smooth surface at the end of the
procedure, remove the breast tissue and avoid complications that are
nearly impossible to treat once they occur.
If you need further information, do not hesitate to contact our practice!
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