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Enlarged Male Breast Tissue

Gynecomastia is an enlargement or swelling of breast tissue in males. The breast tissue is bigger than normal and causes an abnormal protrusion. The enlargement causes embarrassment and negative psychology for young adults and teens. It makes them avoid situations where shirts have to be removed especially in swimming pools.

Testosterone is the male hormone and estrogen is the female hormone. Estrogen causes the enlargement of breasts in females. Males produce a small amount of estrogen and females produce a small amount of testosterone. gynecomastia is most commonly caused by increased male estrogen levels that are too high or are out of balance with testosterone levels. In some persons, there is only fat deposition without gland enlargement, called Pseudo Gynecomastia (False Gynecomastia)

Gynaecomastia normally happens in males in 3 stages of life

  • At birth – this is because of the maternal estrogen that is transferred to the child. This usually settles in the first few months of life.
  • At Puberty(around 11-12 years): the enlargement is usually bilateral and mild tenderness is present. In 90% of individuals, this breast enlargement will reduce or disappear by 17 years of age.
  • In old age (> 60 – 65 years ): About in 4 men will have Gynaecomastia in this age group.

Gynaecomastia is classified Depending on the breast enlargement, and the Nipple Areola position.

Stage 1:
Minimal breast enlargement
Stage 2a:
Moderate breast enlargement without skin excess
Stage 2b:
Moderate breast enlargement with skin excess
Stage 3:
Large breast enlargement resembling female breast

There are many other conditions that can cause gynecomastia. These include:

  • Obesity
  • Lack of proper nutrition
  • Tumors in the testicles or adrenal glands
  • Liver disease
  • Hyperthyroidism
  • Hypoandrogenism
  • Hypogonadism
  • Kidney failure

Certain drugs can also cause gynecomastia, including:

  • Anabolic steroids for improved athletic performance
  • Estrogens
  • Finasteride for enlarged prostate
  • Spironolactone,digoxin,amiodarone, and calcium channel blockers
  • Cimetidine and proton pump inhibitors for heartburn
  • Diazepam for anxiety
  • Ketoconazole for fungal infections
  • Metronidazole for bacterial infections
  • Human chorionic gonadotropin for fertility problems

Once a Gynaecomastia diagnosis is established, surgery is the most common and widely accepted treatment option.  If the person has had stable breast enlargement for more than 1 year without any complaints, and the general clinical examination is normal, then no specific evaluation will be required. In persons with gr III gynecomastia, recent enlargement, unilateral breast enlargement, Nipple discharge, feminine body habitus, appropriate further evaluation will be required.

Frequently Asked Questions

  • Surgery is the established treatment for Gynaecomastia with predictable and consistent results.
  • Medication, hormonal and fat burner pills won’t work or have a higher complication and recurrence rate.

It is generally done under general anesthesia and under local anesthesia in selected cases. Through a small incision on the lateral side of the chest, a fluid (Tumescent) is injected into the breast. This fluid reduces the bleeding and also has a numbing effect. Through the same incision, a specialized instrument (cannula) connected to the suction apparatus is inserted and the fat is sucked out. once adequate fat is removed, then a hemi circle incision is made along with the Nipple areolar complex and the glandular component is excised. the same procedure is done on the other side and all measures are taken to achieve symmetry.

Workout will never reduce the size of the glandular tissue. It could reduce the overall body fat and can minimally reduce breast enlargement. But at the same time, it can cause hypertrophy/enlargement of the underlying muscle, making Gynaecomastia more obvious than before. Many patients opt for surgery after a failed attempt with workouts.

Benefits of Minimally invasive surgery over traditional surgery

  • No visible scar
  • Uniform skin tightening
  • 45 mins procedure | Same-day discharge
  • Resume work in 2 days
  • No recurrence
Traditional surgery Liposuction Assisted Gland excision (Minimally Invasive)
Scar Long and visible scar Small scar and not obviously visible
Blood loss More Relatively less
Pain More Less
Recovery Delayed Quick
Early return to routine
Contour Non uniform Mostly uniform
Skin tightening Asymmetrical Symmetrical

Usually, 18 years is the recommended age for surgery but in some cases, patients can go for surgery before this age also.

The result of Gynecomastia surgery is permanent. Taking care of self with diet and exercise will help sustain the results achieved.

Generally, the procedure takes 1.30 to 2 hours. If the patient is comfortable, discharge can be done on the same day.

This depends on the type of work you do and the extent of the male breast reduction procedure. Usually, it’s between 1 to 2 days, but healing time varies for each individual and should be discussed with your surgeon.

  • Like any other surgery complications like bleeding, Haematoma, Infection can occur in 1-2 % of patients. Some complications that are specific to Gynecomastia surgery are:
  • Seroma: a collection of fluid under the skin
  • Asymmetry: difference in the size and shape of both the breast. Even in the majority of normal individuals, asymmetry of the breast exists. Mild asymmetry after can occur in many patients but doesn’t need any corrective surgery. If there is any major difference, then an additional [procedure will be required for correction
  • Nipple deformity
  • Unsightly scar
  • The first dressing is usually done after 24- 48 hours. The drain tube, if placed during surgery will be removed during this dressing.
  • The sutures will be generally removed by the 7th to 10th
  • Better to avoid strengthening/gymming activities for a minimum of 2 weeks
  • Can take bath after the first dressing
  • Usually, there will be some skin excess in the initial period, which will gradually settle over the next 3- 6 months
  • A compression garment will aid in skin contouring.
  • The patient has to wear a compression garment for a minimum of 6 weeks. This will help in reducing the edema, preventing the formation of seroma, and also contouring the skin. This compression garment is applied immediately after surgery or after the first dressing.

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