Gynaecomastia

Gynaecomastia is a condition when one or both of the male breasts increase in size. We most frequently come across this condition in young men during puberty or on the other hand in elderly men. Pathological increase in breast size occurs through growth of the actual mammary gland and/or localised multiplication of the fat tissue.

Who is a suitable candidate for surgery?

Any patient with hypertrophic mammary glands on one or two sides or with localised accumulation of fat in the breasts is a suitable candidate for the operation. Another condition is the absence of serious overall diseases, which could for example make it impossible to perform the procedure under general anaesthesia. On the contrary, obese men whose excess fat tissue on the breast is caused by simple corpulence are unsuitable candidates.

How does consultation take place?

The overall state of health and any possible contraindications to the procedure are ascertained in terms of consultation. After examination of the local finding, it is determined whether the condition is suitable for surgical resolution and which technique will be used in terms of the operation. The patient is familiarised with surgical procedure, the course of the post-operative period, the scope of scarring, post-operative care and possible complications. The type of anaesthesia used and scope of the surgical procedure depends on the local condition, i.e. the size of the mammary glands, amount of fat tissue in the area of the breast and the elasticity of the skin. The most frequent procedure is subcutaneous mastectomy or removal of enlarged mammary glands without the need for skin correction. The procedure is suitable for patients whose mammary glands are not too big and whose skin is sufficiently elastic. The operation consists in making of an arched incision on the lower edge of the areola, from which almost the whole mammary gland is removed. Only a small disc of this is left under the areola so the areola does not sink below the level of the surround skin. In most cases the size of the areola does not need to be reduced. Once the excess gland has been removed the size of the areola is corrected spontaneously. In patients with a greater accumulation of fat in the area of the mammary glands, it is possible to combine subcutaneous mastectomy and liposuction. A condition for performance of this procedure is sufficient elasticity of the skin. In the case of some patients, gynecomastia can be resolved using only liposuction without the need to interfere with the mammary gland. In the case of really large breasts, not only the actual mammary gland must be removed and the areola reduced, but the excess skin must also be removed. A greater scope of scarring is left after such an operation. According to the type of operation, this may be merely a scar around the whole of the areola or around the areola and a scar in the shape of an upturned “T” under it, or scar around the areola and a horizontal scar several centimetres under it. Elastic underwear, wearing of which is an integral part of post-operative care for most procedures, is also tried during consultation. It is always necessary to inform the doctor of all medicines which the patient uses. This especially relates to medicines which affect coagulation.

Essential pre-operative examination

Examination by an endocrinologist may be required in the case of gynecomastia. Apart from standard pre-operative examination before a procedure under general anaesthesia, which is performed by a general practitioner approximately seven to ten days before the procedure, no special examination is necessary. Pre-operative examination is not required before procedures performed under local anaesthesia.

Stay in the hospital

At least overnight stay in the hospital is necessary in the case of more difficult procedures, which are performed under general anaesthesia. Patients mostly spend only one night in the hospital. Photo documentation is created before every operation. Prevention of thromboembolic diseases by injection of preparations and equipping the patient with elastic tights goes without saying in the case of procedures performed under general anaesthesia. The length of the actual operation can differ greatly according to the level of affliction and according to whether this is a one-sided or two-sided operation. Most operations take about one hour.

Post-operative care

Post-operative pain is not usually great and reacts well to regular analgesics. Too much physical activity is not recommended in the period immediately after the operation. Showering is possible after two to three days. If it is necessary to wear elastic underwear, this is mostly not necessary for longer than four weeks. Lubrication and massage of scars is an important part of post-operative care.

Complications

Complications are infrequent after gynecomastia operations. Early post-operative complications include hematomas or accumulation of blood in the wound. Small amounts of blood are not a problem – they are absorbed spontaneously. Larger hematomas sometimes need to be sucked out via the skin through a needle. From the list of later complications in the case of larger-scale procedures, we must above all mention asymmetry and possible unevenness. Changes in sensitivity of the areola may occur. These changes are mostly temporary and subside fully within a few weeks or months. In some cases however, the change in sensitivity can be permanent. Later complications include the creation of hypertrophic scars (wide rigid scars that protrude above the level of the skin).