CAUSES

While the term Gynecomastia, in Greek, means "a woman's breast", this condition is, ironically, used to characterize men. Commonly, (30-40%) this condition appears in adolescent boys around the age of 12 and can last about 2-3 years. In about 10% of the male population this condition persists as a stigma throughout their life. Lack of treatment might cause feelings of inadequacy and shame.

"Bitch-tits", commonly seen in athletes, results from the abuse of anabolic steroids. When testosterone levels rise very rapidly in the body (from exogenous injections), the body responds by producing enzymes that turn the "extra" testosterone into estrogen by a process called aromatization. The higher testosterone level provides short-term gains in bulk and strength. However, the resulting increase in estrogen level often causes long-term changes in the breasts. Gynecomastia may occur after the very first steroid injection in some, while it may require multiple injections in others. Gynecomastia, many times, is also a dose related phenomenon.

Other causes of gynecomastia include obesity, aging, tumors, genetic and familial predispositions, chronic liver disease (as with alcoholism), drug-induced as with antiacids, diuretics, cardiac medications, marijuana, Valium, and many others.

In rare cases, gynecomastia turns into cancerous growths. It may then produce painless nipple discharges and ulcerations. In some areas of the Middle East and the Horn of Africa, such incidence might climb to more than 6% of the gynecomastias.

The plastic surgeon encounters 3 types of gynecomastia:

  • Increased size of female-like glandular tissue (also known as true gynecomstia)
  • Increased fatty tissue
  • A combination of the above.

 

The first situation is commonly seen in athletes and bodybuilders. The second situation is seen in adolescents, obese individuals, and the elderly. The treatment of long-term gynecomastia still remains surgical.

PRESENTATION

The patient with true gynecomastia complains of a hard lump under the nipple, often expanding towards the inside and the outside of the breast. It varies in size and texture; it can be painful or tender and occasionally presents a nipple discharge.

Excess fatty tissue sometimes accompanies true gynecomastia and adds to the bulk of the growth.

TREATMENT MODALITIES

Surgery remains the treatment of choice for true gynecomastia. Glandular tissue has to be surgically excised, while fatty tissue can be remover by liposuction. In some cases, a combination of excision and liposuction has to be employed.

Surgery is carried out through 1" to 1½" incision into the lower limit of the areola (at the border of the pigmented skin). The resulting scar is usually inconspicuous. Liposuction can be accomplished through the same incision and occasionally through another incision in the armpit.

In over 200 cases, I have rarely used drains or compression garments. Routine follow-ups include a suture removal visit in 5-7 days. Training can normally resume in 2-3 weeks, in a gradual manner.

The most commonly used surgical technique usually results in the need for additional surgeries since most surgeons do not remove all the underlying breast tissue. I have developed a surgical technique that has almost eliminated the need for additional surgery. My motto is, "Let's get it correct the first time so that we can minimize your time under the proverbial knife!"