Gynecomastia or male breast, it is a common problem among adult men. It is most commonly seen by plastic surgeons when a man presents with enlarged breasts due to cosmetic and social concern. Often mistaken for cancer it is just an excess enlargement of a male breast (and yes men have breasts too).

The cause is usually idiopathic which in lay terms means ‘without a reason’. Such cases after clinical evaluation do not necessitate thorough investigations. Rarely, the enlargement of breasts can be due to other causes like hormonal disturbances, drug intake and tumors. In any male patient with breast enlargement, male breast cancer must be considered because 1% of all breast cancers occur in men. There is no increased risk of breast cancer in patients with gynecomastia when compared to the unaffected male. The exception is patients with Klinefelter syndrome. These patients have an approximately 60 times increased risk of breast cancer.

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 6-8 hours only.

For appointments call

Dr Sreekar Harinatha at 09902223733 or email at drsreekarh@yahoo.com