GYNECOMASTIA (MALE BREAST REDUCTION)
Excessive prominence in the chest can be an embarrassing problem, especially while wearing t-shirts and during sports. A combination of fat and fibrous tissue proliferation results in such problems, which is difficult to treat despite all diet and exercise. Surgical removal of excess tissue is done with combination of liposuction and manual removal. We perform this procedure commonly with excellent patient satisfaction.
It can be a just little conical protrusion called a puffy nipple to a fully developed breast like a female, to severely enlarged gynaecomastia. Mostly it is bilateral but can be unilateral gynecomastia or asymmetrical gynecomastia. the incidence of excess breast tissue in males is 25% among men; more recent studies have reported an overall incidence of 32% to 36. The feeling of having a feminine look might disrupt one’s self-esteem. It often puts one in a very embarrassing situation and can harm the quality of life. Cosmetic surgeons at Sushrutha institute of plastic surgery in Thrissur, Kerala does gynecomastia surgery as daycare surgery. He does male breast reduction under local anesthesia, where he combines advanced Laser and Vaser liposuction with gland excision, it is practically bloodless, painless, stitch-less male boobs reduction surgery.It gives scarless, recovery and permanent male breast reduction result.
|Time Required||60-90 Mins|
|Anesthesia||Local or genaral Anesthesia|
|Success Rate||Very High|
Idiopathic (90%) means A DEFINITE cause of male breast development is elusive.
- stimulation of breast tissue by excess circulating estrogens or estrogen-like substances;or
- Decreases in the androgen-to-estrogen ratio
- defect in androgen receptors.
b. Developmental/Physiological Gynecomastia
Neonatal: In newborn baby because of maternal circulating hormone. It is self limiting condition. Go by itself in few months
Pubertal: More than 2/3 of the adolecent boys have small to severe gynaecomastia relative excess of plasma estradiol compared with testosterone is believed as the cause of pubertal gynecomastia
Aging: . With aging,plasma testosterone levels decline and peripheral conversion of testosterone to estrogen (peripheral aromatization) occurs,Increasing the plasma estrogen-to-androgen ratio at old age leads to breast enlargement
- Hypogonadism(decreased androgen synthesis or increased androgen resistance):
- Acquired (trauma, infection, torsion,radiation exposure, mumps, chemo therapy)
- Hypogonadotropic hypogonadism
- Kallmann’s syndrome
- Pituitary failure (infarction, infection, neoplasm)
d. Tumors(increased estrogen production):
- Steroid-producing (adrenal, testis)
- HCG-producing (testis and others)
- Aromatase-producing (testis)
- Bronchogenic carcinoma
- Thyrotoxicosis (altered testosterone/estrogen binding)
- Renal failure (acquired testicular failure)
- Cirrhosis (increased substrate for peripheral aromatization)
- Adrenal (ACTH deficiency or congenital adrenal hyperplasia)
- Congenital Disorders:
- Klinefelter’s syndrome
- Enzyme defects of testosterone synthesis (may be late onset)
- Vanishing testis syndrome (anorchia)
- Androgen resistance syndromes
- True hermaphrodism and related conditions
- Increased peripheral tissue aromatase
When your body is deprived of adequate nutrition, testosterone levels drop, but estrogen levels remain constant, causing a hormonal imbalance.
- Herpes zoster infection
- Cystic fibrosis
- Myotonic dystrophy
These include antidepressants, cancer treatment, antibiotics, AIDS medications; substance abuse like alcohol or drugs and many more. While consulting with the physician, it is important to discuss the usage of the medicine so that the doctor can provide accurate treatment.
i. Health Conditions
- Hyper thyroidism/ thyrotoxicosis
- kidney disease
- liver failure and cirrhosis
- Adrenal dysfunction
Note: Medical treatment of associated condition is necessary buy they hardly succeed to reduce developed male breast. Only surgery is the definitive solution for gynaecomastia.
k. Chest wall trauma
l. Psychological stress
m. Spinal cord injury
Consistancy Of Gynaecomastia
- Gynaecomastiacontain glandular tissue and fatty tissue in various proportion. Usually gland is felt as soft rubbery mass beneath areola.
- When glandular tissue is predominant, it is hard. called glandular gynaecomastia.
- when fat is predominant it is soft. when practically no gland and gynaecomastia is composed of fat only it is called pseudogynaecomastia.
- caused by overweight and obesity
- symptontomatically seen as male breast
- diagnosed with radiological examination like ultrasonography.
- treatment is diet and exercise and weight loss.
Many studies reviewing males with gynecomastia have demonstrated no increased risk of breast cancer compared with the normal male population.
One percent of all breast cancer occurs in males. The occurrence of male breast cancer is 1 in 400 to 1 in 1000. However, patients with klinefelter’s Syndrome have up to a 60 times greater risk of developing breast cancer. Thus in all non-klinefelter’s patients it is reasonable to Treat gynecomastia surgically with both liposuction and excisional techniques.
This Classification, it takes into consideration of the amount of extra skin compared to chest
Grade 1: Minimal Hypertrophy, (less than 250g of tissue) without ptosis
1a: Primarily glandular
1b: Primary fibrous
Grade 2: moderate hypertrophy (250-500g of breast tissue) without ptosis
2a: Primarily glandular
2b: Primary fibrous
Grade 3: Severe hypertrophy ((>500g of breast tissue with grade 1 ptosis glandular or fibrous)
Grade 4: Severe hypertrophy with grade 2 or 3 ptosis glandular or fibrous
If gland and tissue are enlarged just below the areola and nipple is protruding. Is called puffy nipple male breast can develop really very large and form sever gynaecomastia.
Checkout some different types of Gynecomastia in Thrissur, kerala are:
According to Symmetry:
- Bilateral Gynecomastia
- Asymmetric Gynecomastia
- Unilateral Gynecomastia
According to Size:
- Puffy Nipple Gynecomastia
- Severe Gynecomastia
- If gland and tissue are enlarged just below the areola and nipple is protruding. Is called puffy nipple.
- Male breast can develop really very large and form sever gynaecomastia.
According to Content:
- Pseudo Gynecomastia
- Pure Glandular Gynecomastia
- Mix Gynecomastia
According to Age:
- Neonatal Gynecomastia
- Adolescent Gynecomastia
- Adult Gynecomastia
Male breast reduction have psychological and physical benefit. Gynaecomastia is not a health hazard. It is an emotional concern. Benefits of the male breast reduction surgery are:
1. To wear well fitted cloths.
2. Go to gym or swimming
3. Socialize. No more embarrassment and better socialising to
–Meet friends. No more taunting
–Go freely in business meetings
–Go for marriage
1. Improve your appearance
2. Improve hunch back appearance -people with gynecomastia bends forward unconsciously to hide enlarged moobs giving a hunchback look.
3. Fitness-a reduced chest will help you to indulge in physical activities of your choice and keep yourself fit.
You are right candidate for male breast reduction surgery the breast growth is more than 12 months.
- Male breast is persisting after age of 18
- Have persistent male boobs for last 12 months
- Are unable to lose male breast in spite of exercise and diet
- Enlargement of the breast has become a cause of concern
- Have realistic expectations from the gynecomastia surgery
- You are mentally prepared for surgery and recovery
- Healthy individuals, who have good health or do not have any serious illness that impairs healing,
- Non-smokers (stop smoking) and non-drug user
- It is very necessary to maintain a healthy lifestyle to maintain the results of the procedure
Consultation is an opportunity to get personalised informationabout your gynaecomastia gradeand composition;surgery preparation,result, recovery. And cost: it is an opportunity to know your comfortlevel with cosmetic surgeon, staff and the center
- To get best from your gynaecomastia surgery consultation
It is good to make a list of important questions before proceeding for the consultation step. So you won’t miss addressing any of your concerns.
You should give a brief your cosmetic surgeon about:
- Your concerns
- What result you expect as you can take representative photographs
- Your family history
- Your weight gain, weight loss history
- Your lifestyle including diet habit and physical activity
- Any medical conditions& medical treatments
- Any supplements such as vitamins, fat burner, herbal treatments or nutritional supplements
- Alcohol, smoking, tobacco, and drug uses
- Drug allergies
- Previous surgeries, particularly weight loss surgery
Your Gynaecomastia surgeon will evaluate the following:
- Composition:Fat and glandular
- Under lying chest muscle built up and tone
- Skin quality
- Your general health status and any pre-existing health conditions or risk factors
You come to know about:
- Do you have gynaecomastia or pseudo gynaecomastia?
- Your grade of gynaecomastia and its composition
- Cause of your male breast development
- Is gynaecomatia surgery will benefit you or not?
- What is there specifically for you in terms of gynaecomastia surgery type, duration of surgery?
- Is it safe for you?
- The realistic goal and achievable outcomes of the your surgery
- Gynaecomastia surgery risk & recovery
- Preoperative preparation and post-operative care for the gynaecomastia surgery.
- Total cost of your gynaecomastia surgery.
- What is your comfort level with the cosmetic surgeon?
Cosmetic surgeon will discuss::
Your surgery options, which is best surgery to achieve your goal.
May mark on your body to explain the extent of the gynecomastia surgery. Like area of liposuction, amount of gland to be removed amount of skin will be removed or not,expected length of scar and its location
1. Pre-operative Preparation
The medical general fitness assessment is done.
Any associated medical condition is controlled before surgery.
2. At the time of admission
General preoperative preparation will be done
Gynaecomasta surgeon will discuss your goal and plan with you.
Photographs will be taken and marking is done.
Man boobs Reduction surgery is done under General anesthesia.
4. Gynaecomastia surgery
During gynaecomastia surgery, fat and gland both removed.It gives permanent and better male breast reduction result .Now gynaecomastia surgery is practically painless, bloodless, stichless, scarless.
1. Liposuction Technique
Sometime gynaecomastia have prominent fat component, particularly in obese patient.
Only liposuction will do the work.
Liposuction is done by making a small tiny hole at the armpit region.
2. Excision Technique
Patient with hormone supplement or after weight loss have prominent gland/ fibrous component. Glandular tissue is excised through another tiny peri nipple incision. In puffy nipple only gland removal is enough.
3. Combination of Liposuction & Excision Techniques
Fat and gland both are removed.
Liposuction and gland excision is done. As the gland is removed practically, it is permanent result of male breast reduction surgery
4. Excision of skin
After massive weight loss or large gynecomastia, male breast ptosis is there. One may think to need skin excision at first sight.
Gynaecomastia surgery result is seen immediate after surgery.Major improvement will be seen within a month, as the swelling goes. The final result will be visible within 6-8 months.
What are the Gynecomastia Surgery Results?
Male breast reduction surgery result is permanent and scarless.Gynaecomastia surgery result depends on grade of gynecomastia, surgical expertise, technology and technique used and goal of surgery.
Gynaecomastia surgery recovery is very smooth and fast. Gynecomastia surgery recovery time line is as follows:
1. Local care: After the procedure is completed, dressings or bandages will be applied to your incisions. You will be taught how to do dressing at home
2. Discharge: You will be discharged next day of surgery
3. Diet: There is no dietary restriction after surgery
4. Bathing: after 2 days. Do fresh dressing as advise by doctor.
5. Physical activity:
– Resume an office job in a day or 2.
– Drive in 3 to 4 days .
– Cardio like activity after a week .
– Gym can be started after two months time.
6. Pressure garments: An elastic band or support garment is used to fasten recovery and mold the chest shape
– Initial 2-3 weeks 24 hours
– More 2-3 weeks 8-10 hours
7. Fly back: 2 to 3 days.
Gynecomastia surgery has same complication and risk like any other surgery.Although very rare, surgery specific and anesthesia related risk are mentioned below. Gynaecomastia under local anaesthesia with Vaser liposuction has reduced the complication risk.
1. Gynecomastia Surgery specific risk and complications
- Bleeding: it is very rare as, blunt cannula is used for liposuction.
- Fluid accumulation: Accumulation of fluid is called a seroma. Small seroma gets absorbed by itself. This fluid may need to be drained with a needle. Open drainage technique reduces seroma.
- Infection: Surgical site infection is rare but possible. A severe skin infection may be life-threatening.
- Creater deformity: When excess tissue removed below nipple areola. Proper combination of liposuction and gland excision practically eliminate crater deformity.
- Contour irregularities: Skin may look irregular, bumpy, or wavy due to uneven fat removal, poor healing, or thinly stretched skin. These changes may be permanent. Even difficult to reduce with revision.
- Recurrence of gynecomastia: rare as gland and fat both are removed. Unless you put on large weight, take hormones or have hormonal imbalance.
- Skin necrosis/ loss of skin
- Spot/ Pigmentation: Skin may appear spotted, but rarely does it become permanent.
- Numbness: One may have temporary or permanent numbness in the operative hyperesthesia due to temporary nerve irritation is also possible.
- Fat embolism: Again, very rare, can happen with mega liposuction. Broken fat may travel through the blood and gather in the lungs or to the brain. A fat embolism is a medical emergency.
- Lidocaine toxicity: Lidocaine is an anesthetic drug in infiltration fluid. Although it is safe, in a rare circumstance, lidocaine toxicity can occur, causing serious heart and central nervous system problems.
Internal puncture: It is extremely rare. A cannula can go too deep, may puncture an internal organ. This may require emergency surgical repair
2. Anesthesia related complications
Small reaction to major reaction or fluid imbalance can happen. And it is rarest, rare death can happen.
3. Factors that reduce the risk & complications
There are 2 most important factors that reduced the risk and complications:
1. Expert liposuction surgeon and
2. Accredited plastic surgery center with advance lifesaving facility
- sushrutha institute of plastic surgery has a team of 7 highly qualified and experienced plastic surgeons.
- Its the largest plastic surgery department in kerala.
- we have already done 45000 plus plastic surgeries till now.
- Advanced instrumentation for all plastic surgery procedures.
- A group of highly dedicated nursing staff .
- Dedicated customer relation staff to answer all your queries.
- 24 * 7 plastic surgeon availability
- 24 * 7 ICU Care and round the clock anaesthetist available.
- Being a major plastic surgery centre with all advanced facilities and 24 * 7 service, we can deal with any expected complications then and there .
- The plastic surgery centre and elite hospital are ISO 9000:2008 and NABH certified. we ranked highest in the safety and hygiene measure.
- Separate modern operation theatre, advanced patient’s monitoring system during operation and post-operative care add to the safety of procedure.
- We are all updated with the latest technology. We recommend the particular option of the technology/method of the procedure according to the patient’s need, expectation and desired goal of cosmetic surgery.
how gynecomastia surgery is done in sushrutha plastic surgery?
watch this video, to see the surgery.