Gynecomastia

Gynecomastia is unilateral or bilateral female type breast tissue growth in men. If there is no hormonal disorder in puberty, breast tissue growth and sensitivity in breast area are normal and temporary. Depending on the degree of growth, it can create severe self confidence issues in men. Male patients complain of not being able to swim in the sea because they are embarrassed by the appearance of their breasts, especially in summer, some are even uncomfortable while wearing a t-shirt. According to some studies, it is present in 50% of the male population in various degrees. When the breast growth is due to weight gain, not growth of breast tissue, it is called pseudo gynecomastia or false gynecomastia. Generally, the cases we see in the clinic are mostly pseudo-gynecomastia cases and are usually categorized as fat in the breast. Surgical technique to be applied also varies depending on the type of the gynecomastia case.

90% of gynecomastia cases are idiopathic, which means it has an unknown cause. However, hormonal irregularities, eating habits, drugs, alcohol use, liver and thyroid diseases, steroid use and breast masses can cause gynecomastia.

Treatment shall be planned depending on the cause of the issue. For this reason, in real gynecomastia patients, hormonal tests, some blood tests, breast ultrasound and the patient are asked to be evaluated by the endocrinology. If the cause is hormonal, surgery should not be performed and hormonal treatment should be planned an endocrinologist. Gynecomastia cases with an unknown cause are true candidates for the surgical treatment.

Depending on the technique to be performed in small gynecomastia, operation can be performed via local anesthesia or with sedation. I find it more convenient in terms of patient comfort, to operate under general anesthesia under hospital conditions, especially in patients who will undergo liposuction and pull-through surgery.

The operation usually takes about 1 to 1.5 hours.

As  I apply local anesthesia to the operated area at the end of the surgery, the patient spends the first night quite comfortably. Afterwards, pain control is provided with painkillers.

Although it is rare to see numbness due to liposuction or breast tissue removal after the surgery, if it happens, the anterior chest wall and nipple sensation shall return within 3 months.

I use dissolving sutures for both liposuction and incisions on the nipple border in surgery. For this reason, we do not need to remove stitches from the patient after surgery. If the patients were operated in the morning, they are discharged on the same day in the evening or the next day. Since the incisions are taped with sterile water-proof dressings, the patient can take a shower the next day. The patient wakes up with a corset on to be used for 1 month after surgery. It will be wise not to do heavy exercises other than walking for the first 2 weeks and it is best to avoid exercises where with many arm movements until the first 6th week. In the first 6 months, the patient may feel stiffness in the chest wall and under the nipple and this fades away over time.

A 3-day resting period will be enough after the operation.

After the operation, fattening due to weight gain may increase again.

The most common problem that can be experienced in the long term period is the inadequacy of breast tissue reduction. Another problem might be the irregularities that may occur after liposuction. These problems are extremely rare under safe hands with proper planning.