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Gynaecomastia is enlargement of the male breast tissue. Gynae means 'woman' and mastos means 'breast' in Greek. It can be defined as the presence of >2 cm of palpable, firm, subareolar gland and ductal breast tissue.
Gynaecomastia is common and is thought to be present in at least a third of men in the course of their lifetime.
The presence of gynaecomastia not causing any problems is reported as 60-90% of young babies, 50-60% of teeagagers, and 70% in men aged 50-69.
Breast cancer is only detected in 1% of cases of male breast enlargement.
I-minor but visible breast enlargement without skin redundancy;
IIa-moderate breast enlargement without skin redundancy;
IIb-moderate breast enlargement with minor skin redundancy;
III-gross breast enlargement with skin redundancy so as to simulate a pendulous female breast.
During your consultation
General background to your condition
Commonly, gynaecomastia is asymptomatic.
Onset and duration of breast enlargement.
Any use of drugs
Past medical history
A Full examination and palpation of the breast tissue. If unclear about this onset or cause an Ultrasound scan maybe necessary.
Size and asymmetry.
Any evidence of liver disease, renal impairment or thyroid disease.
Discussion about the Management of your Gynaecomastia
Intervention choice will depend on the aim, be it alleviation of tenderness, cosmetic appearance, anxiety regarding cause, or treatment of underlying disease.
Treat the underlying cause if found - eg, removal of the medication causing gynaecomastia. Gynaecomastia associated with obesity may respond to weight loss although breast tissue usually remains.
If no underlying cause is discovered then surgical removal of breast tissue is the only effective therapy.
SURGERY FOR GYNAECOMASTIA
If your gynecomastia consists primarily of excess fatty tissue, I will use liposuction to remove the excess fat. Through a tiny incision, a fine hollow tube called a cannula is inserted to vacuum the fat layer that lies beneath the skin. The cannula is pushed and pulled through the fat layer, breaking up the fat cells and suctioning them out. The suction action is provided by a vacuum pump.
Excess Breast Tissue
If there is excessive breast tissue that is also causing enlargement of your breast then this will have to be removed as well. The incision is in the lower half of the areolar (brown area) and is usually well hidden. In this case you will need drains after the procedure. Liposuction is usually also performed to contour the breast and the area towards the arm pits.
Breast Tissue excision and Skin excess excision
This rarely has to be performed but leaves much larger scars on the chest wall. This type of surgery is confined to the gynaecomastia type iib and type iii (see earlier) as the breast has dropped and there is an excess of skin as well as breast tissue and fat. In this circumstance, liposuction, removal of breast tissue and skin will all have to occur.
Preparation for Surgery
Smokers will be asked to stop smoking 3 weeks prior to surgery. Also do NOT use nicotine patches as these can cause a delay in healing.
Aspirin and some anti-inflammatory drugs used for the treatment or arthritis can cause increased bleeding, so you should avoid taking these medications for 2 weeks before surgery.
The operation takes about an hour each side. You will go to recovery and then the ward. You will have a compression garment on by the tiume you get to recovery. Expect a one night stay and the removal of the drains the next day if they have not drained a lot of fluid. If they do, you may have to go home with them
It is best to try and find a garment like the picture which compresses the upper and lower chest. This garment must be worn for the first 2-3 weeks day and night and then for the next 4 weeks at night. This helps contour the chest and reduces the swelling.
1 night stay in hospital
May go home with drains
Simple pain relief such as paracetamol with some codeine
Compression garment for 6 weeks.
Wound review at hospital in 2 weeks
See me in clinic at 6-8 weeks.
Return to work / driving at one week
Return to heavy lifting needs about 3 weeks.
True results especially of liposuction seen at 5-6 months.
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FOR THE PDF FILE ON GYNAECOMASTIA. IT HAS FAR MORE INFORMATION ABOUT THIS CONDITION AND INFORMATION ABOUT THE RISKS AND SURGERY.