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Gynecomastia (Male breasts)

Excision of Gynecomastia (Male breast)

Gynecomastia refers to an enlargement of the male breast caused by benign proliferation of the glands ducts and stromal components including fat. It is the most common form of breast swelling seen in adolescent males. During pubertal development, gynecomastia can develop as a result of transient relative imbalances between androgens and estrogens. Pubertal gynecomastia is self-limited in 75 to 90% of adolescents and regresses over 1 to 3 years. However it may cause significant psychological stress and depression in adolescents. For boys with persistent gynecomastia that is causing substantial tenderness or embarrassment a tailored approach of close follow-up and use of anti-estrogen drugs may be recommended. These drugs block the effects of estrogens in the body and can reduce the size of the breasts somewhat. It appears that pharmacological therapy of persistent adolescent gynecomastia is reasonable effective if given early in the course of the disease and more successful in cases with small or moderate breast enlargement. However, neither of these drugs is universally approved for the treatment of gynecomastia because the risks and benefits have not been studied completely. Surgical approach may be needed under special conditions for cosmetic reasons.

Classification:

Grade I: Small enlargement without skin excess
Grade IIa: Moderate enlargement without skin excess
Grade IIb: Moderate enlargement with minor skin excess
Grade III: Marked enlargement with excess skin, mimicking female breast ptosis

Surgical Treatment:

The most commonly used technique is subcutaneous mastectomy that involves the direct resection of the glandular tissue using a periareolar or transareolar approach with or without associated liposuction. Skin resection is needed for more advanced cases.

In grade I, the enlargement is caused solely by glandular proliferation without adipose accumulation. Surgical correction involves mammary adenectomy performed by a semicircular inferior periareolar incision. Liposuction is not required. Grade II is characterized by excessive glandular tissue and local adiposity. In these cases, liposuction and surgical excision must be combined in the same operation. Mammary adenectomy without liposuction leads to unsatisfactory outcomes, with an uneven surface or asymmetry. In grade III, the operation begins with liposuction and is followed by glandular excision with periareolar removal of the tissue. It is necessary to detach the excess skin to obtain a good chest silhouette. The hallmarks of grade IV are severe ptosis and a large amount of redundant skin. One of the techniques for reduction mastoplasty is used to remove gland and skin and flatten the chest outline.

Traditional or Vaser liposuction technique are helpful in those patients with considerable fat deposition in the breast during the removal of the glandular component. The aim of surgical treatment is to achieve a normal appearance of the masculine thorax with the smallest possible scar. Surgical treatment of gynecomastia requires an individualized approach.

The most frequent early complication following surgical management of gynecomastia is hematoma. Seroma, overresection with saucer-type deformity, underresection, unappealing scarring and infections are also observed. Patients and their parents or guardians should be well informed about possible risks, as some complications are managed surgically.