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Gynecomastia is overly developed breast tissue in males. Though it is medically benign, gynecomastia can cause significant psychological discomfort. Men with gynecomastia may be viewed or view themselves as not completely masculine. In an attempt to disguise their shame or embarrassment, they sometimes attempt to hide this condition by avoiding exercise, swimming and other activities. Although gynecomastia cannot be resolved through diet and exercise programs, Dr. Sreekar can effectively remove the enlarged breast tissue through his advanced award winning gynecomastia surgical procedure (Scroll down for Video).

Gynecomastia generally appears during puberty. Sometimes this condition normally disappears by the time a boy reaches adulthood, in some cases however the excess breast tissue remains. The use of certain medications, such as antidepressants, high blood pressure drugs and anabolic steroids, has also been linked to gynecomastia.

Irrespective of the exact cause of gynecomastia, this condition can be resolved through male breast reduction surgery. As a highly experienced gynecomastia surgery expert, Dr. Sreekar uses two techniques to eliminate the excess tissue – liposuction and sculpting with special surgical instruments. The procedure includes the use of small liposuction incisions and then removal of the excess breast tissue. These are combined in one procedure called Lipo-Excision. This technique no longer needs postoperative drains or a prolonged recovery. Gynecomastia surgery typically requires two hours to complete, and is done on a day care basis.

(The photograph is of a Bangalore based model. He graciously let us use his photograph after the surgery.)

 

Clinically gynaecomastia is graded as follows:

Grade 1 : Small enlargement, but without excess skin over the chest
Grade 2a: Moderate enlargement, without excess skin over the chest
Grade 2b: Moderate enlargement with extra skin over the chest
Grade 3 : Marked enlargement with extra skin over the chest.

Treatment depends on the grading of enlargement.

Grade 1 men can be treated with liposuction alone with very good results. Such surgeries are simple day care procedures with fast recovery.

Grade 2a men require a procedure called lipo-excision wherein, liposuction of the chest is combined with removal of the breast tissue. Here the chest is contoured to match a normal chest using liposuction and then the breast tissue is removed using a 2-3cms incision near the areola. Around 90% of the breast tissue is removed to give the chest its normal male contour. Removing 100% of the breast or doing aggressive liposuction can lead to a sunken chest appearance (also called crater deformity). Such complications should be avoided when dealing with gynecomastia. Other rare complications include asymmetry, scar complications, collection of blood in the operated areas and bruising. Sometimes a drain (a plastic tube) may be placed at the operated site to drain out any collected fluid or blood. It is usually removed by the 2nd day after surgery.

Grade 2b men also can be treated with lipo-excision alone in >90% cases. Some may require another surgery after about 3-6months for skin tightening to tackle the excess skin.

Grade 3 generally always requires skin tightening.

Following any gynecomastia surgery, pressure garments (Compression garments) are advised to prevent collection in the operated cavity and for better adherence of skin to the chest. All gynecomastia surgeries can be done on day care basis with admission for 9-10 hours only. Watch the videos at the bottom of the page for more clarity.

 

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Summary of Gynecomastia Surgery

Duration of Surgery: 2-3 hours
Admission: 9-10 hours on day care basis
Need of follow-up: Once or twice
Need of suture removal: No
Cost: Rs.55000 plus taxes pressure garment and medicines: Total around Rs. 63000-65000

Recent Abstracts & Updates from Scientific Journals regarding Gynecomastia

 

  1. Surgical Strategies in the Treatment of Gynecomastia Grade I-II: The Combination of Liposuction and Subcutaneous Mastectomy Provides Excellent Patient Outcome and Satisfaction.
    Schröder L1, Rudlowski C1, Walgenbach-Brünagel G2, Leutner C3, Kuhn W1, Walgenbach KJ4.

    Breast Care (Basel). 2015 Jul;10(3):184-8.

    Abstract

    BACKGROUND: Gynecomastia (GM) is a benign condition with glandular tissue enlargement of the male breast. GM is classified into 4 grades of increasing severity. We describe a series of GM grade I-II, diagnosed, treated surgically and analyzed regarding feasibility, complication rate, and satisfaction.

    METHODS: From 2005 to 2012, a chart review was performed for 53 patients. Preoperative examination included endocrine and urological examination and exclusion of other pathological conditions. The surgical technique consisted of liposuction through an inframammarian-fold incision and excision of the glandular tissue by a minimal periareolar approach.

    RESULTS: A total number of 53 male patients with 104 breasts were available for analysis. By liposuction, a median of 300 ml (range: 10-1000 ml) was aspirated from each breast and 25.1 g (range: 3-233 g) gland tissue was resected. Surgery lasted between 25 and 164 min per patient (median: 72 min). 2 postoperative hemorrhages occurred (n = 2, 3.8%). 2 patients underwent re-operation due to cosmetic reasons (n = 2, 3.8%).

    CONCLUSIONS: This analysis demonstrates that treatment of GM grade I-II can easily be performed by liposuction combined with subcutaneous resection of the glandular tissue as a minimally invasive and low-impact surgical treatment with a low rate of complications and excellent patient satisfaction. Preoperative work up is important to rule out specific diseases or malignancy causing the GM.

    Note from Dr Sreekar Harinatha: This study further validates the efficiency of liposuction and excision (removal) as the mainstay of treating gynecomastia.

     

    2.  Trends in the Surgical Correction of Gynecomastia.
    Brown RH1, Chang DK1, Siy R1, Friedman J2.
    Semin Plast Surg. 2015 May;29(2):122-30.
    Abstract

    Gynecomastia refers to the enlargement of the male breast due to a proliferation of ductal, stromal, and/or fatty tissue. Although it is a common condition affecting up to 65% of men, not all cases require surgical intervention. Contemporary surgical techniques in the treatment of gynecomastia have become increasingly less invasive with the advent of liposuction and its variants, including power-assisted and ultrasound-assisted liposuction. These techniques, however, have been largely limited in their inability to address significant skin excess and ptosis. For mild to moderate gynecomastia, newer techniques using morcellation and endoscopic techniques promise to address the fibrous component, while minimizing scar burden by utilizing liposuction incisions. Nevertheless, direct excision through periareolar incisions remains a mainstay in treatment algorithms for its simplicity and avoidance of additional instrumentation. This is particularly true for more severe cases of gynecomastia requiring skin resection. In the most severe cases with significant skin redundancy and ptosis, breast amputation with free nipple grafting remains an effective option. Surgical treatment should be individualized to each patient, combining techniques to provide adequate resection and optimize aesthetic results.

    Note from Dr Sreekar Harinatha: This comprehensive review study analyzed the various treatment methods of gynecomastia. The paper showed that surgical removal in combination with liposuction is the mainstay of managing all grades of Gynecomastia.

     

    3. A systematic review of literature on psychosocial aspects of gynecomastia in adolescents and young men.
    Rew L1, Young C2, Harrison T3, Caridi R4.
    J Adolesc. 2015 Aug;43:206-12.
    Abstract

    Gynecomastia represents a serious psychosocial challenge for many adolescents and young adult males, but short of surgery, little attention has been given to this concern. The purpose of this paper is to report findings from a systematic review of the literature about psychosocial correlates, psychosocial interventions, and quality of research evidence about young males with gynecomastia. From an initial 233 published papers, 10 studies were identified and reviewed. Five were descriptive case studies and included no statistical analyses. The other studies were all conducted with small samples. Despite the limited evidence, findings suggest that many young men suffer emotional distress concerning gynecomastia, but this distress has received few interventions beyond surgical removal of the breast tissue. Future studies are needed to address this problem more fully so that more aggressive measures such as frequent assessments of the physical and psychosocial aspects of the condition can be done by healthcare professionals.

    Note from Dr Sreekar Harinatha: Gynecomastia has various and often under assessed psycho-social aspects. The patients suffer from depression and emotional distress which is very often overlooked.

     

    4. Gynecomastia: A systematic review.
    J Plast Surg Hand Surg. 2015 Dec;49(6):311-8.
    Fagerlund A1, Lewin R1, Rufolo G1, Elander A1, Santanelli di Pompeo F2, Selvaggi G1.
    Abstract

    BACKGROUND: Gynecomastia is a common medical problem presenting in nearly a third of the male population. Treatment for gynecomastia can be either pharmacological or surgical. Patients with gynecomastia often experience affected quality-of-life. The aim of this systematic review was to analyze the quality of evidence of the current literature in relation to different treatment modalities and Quality-of-Life in patients with gynecomastia.

    METHODS: A systematic search of the literature was performed in PubMed, Medline, Scopus, The Cochrane Library, and SveMed+ in accordance with the PRISMA statement. All searches were undertaken between September-November 2014. The PICOS (patients, intervention, comparator, outcomes, and study design) approach was used to specify inclusion criteria. Methodological quality was graded according to MINORS. The quality of evidence was rated according to GRADE. Data from the included studies were extracted based on study characteristics, participants specifics, type of intervention/treatment, and type of outcome measures into data extraction forms.

    RESULTS: A total of 134 abstracts were identified in the literature search. Seventeen studies met inclusion criteria, 14 concerning treatment and three concerning Quality-of-Life. All studies were non-randomised with a high risk of bias and very low quality of evidence according to GRADE.

    CONCLUSIONS: Several different surgical methods have been described with good results, minimal scars, and various levels of complications. Traditional surgical excision of glandular tissue combined with liposuction provides most consistent results and a low rate of complications. Pubertal gynecomastia may safely be managed by pharmacological anti-oestrogen treatment.

    Note from Dr Sreekar Harinatha: This comprehensive study evaluated the various aspects of gynecomastia surgery. It concluded that surgery is the modality of treating all gynecomastia. However, there is a role of hormonal management along with surgery in the minority with proven hormonal issues.

     

     

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