Enlarged Breast in Men (Gynecomastia)
Gynecomastia: Structurally, male breasts and female breasts are not too far apart. The only reason men don’t have large breasts is that they don’t secrete enough estrogen.
However in some cases, breast tissues in men start growing and take shape of female breast. This condition is called gynecomastia in medicine.
What are the causes of Gynecomastia?
Gynecomastia, extreme growth of male breast tissue, can be related to various reasons. Physiopathological factors indicate a certain increase of estrogen or estrogen-like structures in blood. But commonly, the reason behind gynecomastia is idiopathic, meaning there is no actual cause behind.
Diseases following low testosterone; Kleinefelter’s Syndrome, removal of testicles – diseases following high estrogen; Testicle tumors, suprarenal gland tumors – being overweight – renal impairment – cirrhosis – hemodialysis – hyperthyroid – hypothyroid – liver tumors – hermaphroditism – long term medication use ( alcohol, amphetamine, cimetidine, tricyclic anti-depressants, marijuana, anabolic steroids etc)… Trauma and radiation in the testicle may cause testicular hypo-function.
Adult mumps infection can lead to testicular atrophy, hypogonadism and gynecomastia. Leptomonas infection can directly cause gynecomastia. Spinal cord injuries may cause testicular dysfunction and cause gynecomastia in 10%. Malnutrition and bad diet, weight gain in extremely skinny people can also lead to gynecomastia.
There are gynecomastia cases caused by beta hCG production of tumors in lung cancer. There are reported cases of transient gynecomastia in HIV infections. Rarely, there have been gynecomastia cases (less than 10 actual cases reported) caused by the conversion of androgens to estrogen as primary but the nature of this conversion is still unknown. There is 20% risk of gynecomastia in alcoholism.
Gynecomastia Surgery
Because gynecomastia may be caused by various reasons, some tests should be performed before the decision is taken. A drug the patient uses or hormonal imbalance may cause gynecomastia. In rare cases, stopping the use of the medication or hormonal therapy depending on age may make the surgery unnecessary. Performing these tests is essential to prevent problems such as re-growth in breast tissue after surgery.
In the past, the fat or breast tissue would be cut and removed with the help of a tweezer-like device in gynecomastia surgeries, but with developing technology, it is now possible to withdraw this layer by inserting a small tube into the fat layer in the breast. (Liposuction).
Pre-Surgery
The patient should share all the drugs and medications he is using with his doctor prior to surgery as some drugs may interact with anesthesia or have side effects. In particular, aspirin and derivative drugs should be discontinued at least one week prior to surgery.
Smoking should be laid off for a long time before and after surgery as it affects the wound healing process negatively. Complaints such as cold and sore throat should be reported to the doctor before the operation. Eating and drinking should be discontinued for 6 hours before the operation.
The doctor may require some tests to decide whether the surgery should be performed by local or general anesthesia. A companion may be needed to help the patient after the operation.
Surgery
The doctor gives the necessary medication and prepares the patient for surgery. After the patient has passed out, the doctor draws a surgical map on the chest showing where the surgical incisions are going to be made and where the tissues are going to be removed from.
A half-moon incision on darker area on the breast called aerol is made and the fat and tissues are removed from here. The operation lasts for 1 to 3 hours according to the degree of gynecomastia.
Post – Surgery
After surgery, the chest is wrapped with bandages. Depending on the advice of the surgeon and the method of anesthesia, the patient may be discharged on the same day or be admitted to the hospital for 1 day. There is no noticeable pain due to painkillers.
The use of antibiotic medication during the time that the doctor will determine is important to avoid infection. A few days after the operation, the patient can return to work without moving his arms too much and not doing tiresome work.