Gynecomastia

Gynecomastia or male breast enlargement is a common problem in men. Gynecomastia causes much social embarrassment, and psychological stress as these young men are not able to wear tight fitting dresses, visit public gyms, swimming pools, religious ceremonies which need disrobing of the upper clothes etc. Young men in hostels are often at the receiving end of jokes and ridicule. These people try to hide Gynecomastia by wearing loose clothes, but severe grades are difficult to hide.

What is gynecomastia?

It is an abnormal swelling of the breast tissue in men. Normal breast tissue including glandular tissue is not developed. In some individuals, due to various causes this tissue can enlarge and become visible. This tissue has two components:

  • Fatty tissue: This is soft and made up of fat cells
  • Glandular tissue: This is firm and made up of enlarged glands and fibrous tissue.

What causes gynecomastia?

Gynecomastia can occur due to several causes such as hormonal abnormality, drugs, obesity etc. However, a majority of men with Gynaecomastia are otherwise normal. It is important to be seen by a qualified surgeon to rule out any underlying condition causing it.

What are the treatment options?

Drugs such as Tamoxifen have been advocated for management, but surgery remains the mainstay of treatment for many patients. Selected cases may need to be checked for any hormonal abnormality and by ultrasound scanning to rule out any breast pathology. Hitherto, an extensive procedure subtotal mastectomy was the treatment of choice. However, with the introduction of tumescent liposuction, the treatment has become simpler and effective. It is cosmetically more acceptable as the scar is minimal.

What is mastectomy?

Mastectomy is a surgical procedure to remove the enlarged breast tissue. It is done under general anesthesia. It is done through a 5 cm incision around the nipple, the gland is dissected out and removed. Drains are placed to remove any bleeding.

How does liposuction treat gynecomastia?

Gynecomastia can be treated easily by liposuction as it removes the enlarged tissue in a simple manner under local anesthesia. In liposuction for Gynaecomastia, 1-2 small holes (adits) of size 3 mm are made on either side. Then three steps are done:

  1. Liposuction to remove fatty tissue: A powered machine is used to remove tougher fat tissue.
  2. Glandular extraction: Through the same small holes, the glandular tissue is teased out and removed. This is tissue is difficult to remove with liposuction alone.
  3. Laser lipolysis and skin tightening: Laser is used to break down the tissue further, which improves the result post-operatively. At the same time, it also causes the skin to contract and adhere to the chest wall.

How is liposuction superior to mastectomy?

Liposuction is preferable to mastectomy for several reasons:

  • Anesthesia: We perform liposuction under local tumescent anesthesia, while mastectomy requires general anesthesia.
  • Incision: Liposuction is done through small 3mm incisions which are not visible and need no sutures. Mastectomy needs a bigger 5 cm incision which can heal with a bad scar in people
  • Result: Liposuction gives a smoother result as it gradually removes tissue from all areas and can be sculpted as needed. Mastectomy can sometimes lead to a saucer-like deformity if all the tissue is removed from the center and none from the edges
  • Bleeding: Liposuction causes minimal blood loss. Mastectomy often needs the use of drains after surgery to remove collected blood.

Results of liposuction in patients with gynecomastia