The term gynecomastia (or lipomastia) has prevailed internationally, although it is inappropriate and men who have this problem may consider it derogatory. It is usually a hypertrophy of fat and mammary gland and occurs during adolescence. In most cases, there is no organic hormonal disorder and is the result of a hormonal failure during puberty when secondary gender characteristics develop.
Many times, boys who have this problem try to camouflage it by gaining weight, however adiposity can also be a cause of gynecomastia.
Depending on the case, we distinguish the following forms of gynecomastia:
- Adolescent gynecomastia: occurs during adolescence and usually resolves at the age of 25
- Gynecomastia due to obesity: occurs when BMI is over 30
- Idiopathic gynecomastia: the most common form of gynecomastia, without apparent aetiology, usually hereditary
- Gynecomastia in the elderly: due to hormonal disorders
- Pathological gynecomastia: due to hormonal disorders, medications or organic diseases
- Breast cancer: very rare form, usually presents unilateral breast enlargement
The surgical correction of gynecomastia mainly concerns cases of idiopathic gynecomastia, which account for almost 80% of the cases, adolescent gynecomastia or due to high body weight. In order to be able to proceed to surgical correction, a hormonal check by an endocrinologist and possibly an andrological examination are preceded. If another breast condition is suspected, an ultrasound or mammography should definitely be performed.
We distinguish 4 cases of gynecomastia, depending on the severity:
- 1st degree gynecomastia: it is the simplest case, where there is a small swelling of the gland and fat, without having the appearance of a female breast. It is estimated that up to 70% of the male population has 1st degree gynecomastia and very often does not bother aesthetically.
- 2nd degree gynecomastia: There is a greater swelling of the gland, which usually shifts the nipple outwards and creates discomfort, as the nipple can often be seen under the clothes. It is the most frequent case in which surgical intervention is performed.
- 3rd degree gynecomastia: Now the shape of the breast is more reminiscent of a woman, with a strong projection of the nipple and a well-formed submammary fold, with a large distance of the fold from the nipple. These cases create intense discomfort and surgical correction is recommended, even in adolescence.
- 4th degree gynecomastia: These cases are mainly found in the conjunction or as a result of obesity or after great weight loss. In addition to intense breast swelling, which is usually fully formed like the female breast, sagging can coexist.
Gynecomastia correction techniques
The correction of gynecomastia, as long as there is no hormonal or other disorder that causes it, is purely surgical. The choice of technique depends on the severity of gynecomastia and the percentage of fat in relation to the glandular elements.
Liposuction is the method of choice when there is no enlargement of the mammary gland, that is, in the case of lipomastia. Liposuction is also used as a supplement to the armpits and breast perimeter to perfect the result. Classic liposuction, however, is not sufficient to remove the denser parts of gynecomastia around the gland, so we use assisted liposuction techniques, such as Bodyjet and Microaire techniques. With the help of the cannula, it is easier to “break” the connective tissue around the gland, or even to remove a part of the gland when it is relatively small. The advantage of correcting gynecomastia with liposuction is the absence of scarring, as well as faster recovery.
When it comes to larger swelling of the gland or there is not a large amount of fat in the chest, surgical removal of the gland is preferable. During classical surgery, a small semicircular incision is made in the lower half of the nipple, from where the mammary gland is removed almost entirely and then, if necessary, liposuction is performed around the gland to smooth the entire surface of the breast. The removal method is done using a tumescent solution, which allows us to perform the operation even under local anaesthesia, reduces recovery and usually makes the use of drains unnecessary. In more extensive cases of gynecomastia of the 3rd or 4th degree, where there may be enough sagging of the skin, a circular incision is made around the nipple, from where the gland is removed and at the same time periareolar skin tightening is performed or it may be necessary to extend the scars on either side of the nipples when the sagging is more extensive. In very large gynecomastia, even a modified double incision mastectomy or a breast reduction technique may need to be done.
Recovery after gynecomastia procedure
The correction of gynecomastia has many different techniques and recovery depends a lot on the type of surgery.
In gynecomastia of the 1st or 2nd degree, removal of the gland can be performed under local anaesthesia or with a combination of local and sedation. Recovery is quite fast, there is almost no pain postoperatively, and the scarring under the nipple disappears almost completely after a few weeks. In order not to collect fluid and to optimize the result, elastic pressure in form of a special garment is needed as well as abstinence from exercise for 6 weeks
When it comes to lipomastia and we choose liposuction as a treatment treatment, the operation is performed under general anaesthesia or under local anaesthesia and sedation. It usually has more bruises than when the gland is removed surgically and mild pain for 3-4 days, however the advantage is that elastic pressure is needed for a shorter period, usually 2-3 weeks and daily activities and exercise can start after the 3rd week. In addition, the scar is much smaller and we can correct both breasts from a single small incision in the midline.
In 3rd and 4th degree gynecomastia, recovery is usually longer and scars take longer to heal and not be as visible. You also need to abstain from exercise for 2-3 months usually.