Gynecomastia in Hyderabad

Gynaecomastia or   Male Breast Reduction surgery is usually combined with liposuction of chest area to contour it evenly and aesthetically. Tumescent solution is injected into the breast and liposuction of the breast is done. Liposuction involves sucking out fatty tissue in liquid form by hollow metal tubes through small hidden holes. Liposuction alone is usually not successful in completely treating gynaecomastia because the hardened glands and fibrous tissues can not be sucked out. Therefore after liposuction removal of remaining tissues is done through a semicircular cut along the lower margin of the areola (the dark skin around the nipple). The complete removal of excess tissue is thus done, and skin lies flat on muscle. Stitches are self-absorbable. Excess skin in grade I and II gynaecomastia usually shrinks but in very large grade III gynecomastia treatment or male breast fat removal is required through extra incisions.  After that, a compressive vest is worn 24 hours a day for a month. The recovery time may be less or more depending on individual healing.

Both male and female fetuses in uterus have breast buds. In the female, the breast glands grow under the influence of female hormones during puberty, pregnancy and breastfeeding. In males, breast gland remains underdeveloped because they have male hormones and very little female hormones. During puberty and development of secondary sexual characters, if the delicate balance of male and female hormones is disturbed male breast gland can grow and look like a female breast. Most times the blood hormone levels do not show this imbalance, and the problem is entirely due to breast glands being oversensitive to a normal level of hormones. That is why most men with gynaecomastia do not have any other symptom of feminization, and they are perfectly normal men, with just a cosmetic deformity of male breasts.

“True gynaecomastia” is seen in men of normal weight. Here breast is composed of glands, tough fibrous tissue and some fat intermingled with each other. In “Pseudo gynaecomastia” which is found in obese people fat element is predominant. Gynaecomastia is classified into grade Ist to Grade IIIrd, depending on size, grade 3 being large and saggy breasts, literally indistinguishable from female breasts.

In the majority of cases, there is no specific cause, and it is due to hypersensitivity of a breast to circulating female hormones (estrogen) during puberty. Hormonal analysis of blood usually is normal in these cases. Obesity and fat deposit in the breast also is a common situation nowadays. Obesity is also associated with relative estrogen excess. Physiological gynaecomastia can also occur in newborns and old age.

In a very small number of cases, gynaecomastia may be due to some specific cause like:

• Usage of certain drugs like anabolic steroids, oestrogens (for the treatment of prostate cancer), long term usage of antacids like cimetidine and omeprazole, some drugs used for treating psychosis, spironolactone and finasteride (antiandrogens), imatinib.
• Supplements used for body building containing anabolic steroids or performance enhancing substances containing hormone androstenedione.
• Additives like alcohol or marijuana.
• Some genetic conditions like Klinefelter’s syndrome.
• Chronic liver disease, hyperthyroidism, adrenal tumours.
• Diseases of testes of pituitary leading to a reduction in male hormones.

If gynaecomastia is the only complaint, no other tests are required except routine tests done before surgery.

Pubertal gynaecomastia usually spontaneously subsides by 18 years of age without any treatment. Otherwise, there are no medications for treating this condition. Plastic surgery can cure it permanently.

Surgery can be done at any age safely if gynaecomastia is causing psychological distress. If a person is comfortable with it, he can wait until the age of 18 because there is a chance it can regress by itself.

In the case of true gynaecomastia person is usually normal in weight, and breast enlargement is due to overgrowth of the gland, weight loss does not help. In other cases where there is some element of obesity weight loss affects the breasts size somewhat but does not usually cure it entirely. Exercising the pectorals may further highlight the breast gland.

Surgery offers a permanent cure. The only exception being in some obese people where gynaecomastia was treated by liposuction. If they do not maintain weight fat can come back on a chest.

Liposuction involves sucking out fatty tissue in liquid form by hollow metal tubes through small hidden holes. Liposuction alone is usually not successful in completely treating gynaecomastia because the tough glands and fibrous tissues can not be sucked out. Therefore after liposuction removal of remaining tissues through a small cut gives results. Occasionally liposuction alone may work in very soft and fatty breasts, but it is difficult to predict that beforehand. If after liposuction the chest is completely flat surgeon can decide to stop with liposuction alone.

You can expect flat normal chest after surgery. If you have been going to the gym and not able to achieve pectoral muscle definition you can do so after surgery. Scars are minimal, to begin with and usually fade in a couple of months. If your gynaecomastia is very large (Grade IIIrd) then you can expect some additional scars.

Surgery is followed by swelling of the operated area usually. Compression garment helps in early reduction of swelling. It also helps in skin redraping in larger gynaecomastia. Garment provide the firm but elastic compression. It should be worn 24 hours a day except during bath, for one month. It helps to keep an extra garment for washing.

One week is the usual time. It can be less or more depending on the nature of your job.

Two to three days stay after surgery is adequate usually.

It is a day care surgery so you can leave the hospital 6 hours after surgery. Like any day care surgery, it is mandatory for you to have someone to take your place of stay with you for next 24 hours to reach the hospital in case of any need. People without any attendant may choose to stay in the hospital for 24 hours.

Usually, there is small band-aid like dressing on the nipple area and vests worn over that. Next day after the check-up in the clinic you can have the bath. Subsequently every day after the bath you just need to apply antibiotic ointment and cover the nipple with sterile cotton pads (available in market ) and use compression garment to keep them in place. You will also need to take oral antibiotics and painkillers as advised by the doctor. After first week usually medicines and dressing are not required. Compression garment alone is continued 24 hours a day for next one month.

Stitches are healed in 10 days. There is swelling, bruising and tenderness over the chest which goes down over next couple of weeks. Final results are appreciable after one month with some more improvement over next six months. Scars fade gradually over next one year.

Scars behave differently in different people. Usually, they are inconspicuous but in some people with the tendency of forming bad scars can become hypertrophic or keloidal. If scars are looking red or itchy after one month, it is advised to consult your plastic surgeon immediately to treat them early.

Occasionally here can be numbness or lack of sensation that could last up to a year. Infrequent complications may include infection, nipple damage, fluid accumulation, bleeding, scarring or pigment changes. Postoperative asymmetry, while rare, is possible; a second procedure may be needed to remove additional tissue. Like any other surgery, small risk of anaesthesia should be borne in mind.

Yes, occasionally when gynaecomastia is small, local anaesthesia alone can be used.

Gynaecomastia surgery is commonly combined with abdominal liposuction and facial surgeries like rhinoplasty.