It is female like breast in males. Before you continue to read, it is wise to know that it is not a harmful condition and mostly a cosmetic problem. The patients are basically suffering from psychological issues and social problems were they do not wish to socialize due to shame and embarrassment. They try to cover themselves with loose cloths and avoid tight cloths/T shirts or open shirts in public.
Gynacomastia is divided into 2 types for basic understanding of readers:
1. Idiopathic means no underlying cause or reason present for growth of breast. These constitute 90% of the cases.
2. Secondary means there is underlying reason for breast enlargement. There are number of reasons like drugs (antidepressants, antihypertensives, cemetidine, etc), testicular diseases or underdeveloped testes, excessive alcohol intake, thyroid and liver disease. If you meet your doctor he will able to come to conclusion and few patients may require investigations to rule out secondary cause. The importance of this is if you do not get treated for the cause and only undergo surgery for gynacomastia there is a high chance of reoccurrence. This doesn’t mean that if you get treated for cause the gynacomastia will subside, it will still require surgery.
Gynacomastia is graded according to size and skin laxity by simon et al,
Grade 1 : Small enlargement, no skin excess
Grade 2a: Moderate enlargement, no skin excess
Grade 2b: Moderate enlargement with extra skin
Grade 3 : Marked enlargement with extra skin.
Treatment of gynacomastia is liposuction with surgical excision in grade 1and 2a/b. In grade 3 there is excess skin is present which also needs to be removed.
Post operative care and pressure garment for 1 to 2 months is required to achieve good results.
1. How many days I have stay in hospital?
Answer: It is day care procedure and most of the patients tolerate surgery well and go home on the same day evening. Few patient may have to stay back for a day if drains(tubes) are placed.
2. What anesthesia will be used?
Answer: I do these surgeries under general anesthesia as it is comfortable for the patient. It can be done under local anaesthesia if you are co operating as minor discomfort can be there.
3. Will it have any side effects?
Answer: It is a safe procedure but few problems can arise. Most commonly we see minor complications like collection of fluid (seroma) or blood (haematoma) in empty space created by removal of breast. These are addressed by just needle aspiration of fluid. Wound healing problems, partial nipple or skin necrosis, contour deformity and reoccurrence are very rare.
4. Will it reoccur?
Answer: It will not reoccur if the underlying cause is addressed as in secondary gynacomastia. In pseudo gynacomastia which is fat deposition in male breast and not breast gland over growth can reoccur if you do not maintain your weight, as fat gets deposited everywhere including breast.
5. Will there be scars?
Answer: Yes. Periareolar means junction of nipple(areolar/black skin) to normal skin 1-2cm scar will be present but is usually be hidden and cannot be made out expect on close observation. I do not put extra incision on normal skin in axilla or chest.
6. How long is the procedure?
Answer: It generally takes 3 hours.
7. How early can I go to work?
Answer: I usually advice rest for 1 week. However routine activity like walking , eating will started on same day. After 48 hours bathing , light weights can be lifted, work from home can be resumed.
8. Can I do regular exercise after procedure?
Answer: 1 week after regular walking and lower limb exercises can be started. Regular gym and running after 3 weeks.