Gynecomastia

Gynecomastia is a non-malignant abnormal development of the breasts in men. It is a frequent and normal condition among young adolescents aged between 15 and 17, but it is also an accompanying condition of obese patients. Gynecomastia in young adolescents is the result of hormonal imbalances due to age and leads to enlargement of the mammary gland. It usually causes severe psychological problems during this sensitive age and usually needs to be corrected surgically. Often, however, it reappears after a few years. In order to treat gynecomastia in the following years, it is recommended to replace part of the gland with fatty tissue. Gynecomastia in obese patients is usually fatty, with excess skin and atrophic gland. Sudden lateral swelling of the breast in men may suggest malignancy and should be examined.

It is always treated surgically. The type of procedure depends of the type of gynecomastia. In young adolescents, a subcutaneous partial mastectomy with a small incision on the lower areoral border is necessary. The procedure is simple and the patient may be discharged on the same day and can return to his normal activities on the following day. In older patients, in whom the main characteristic of gynecomastia is fatty tissue, liposuction may be enough to solve the problem. Once again, the postoperative course is simple. The patient is discharged on the same day and can return to his normal activities on the following day. Gynecomastia in obese patients, and especially after weight loss, often requires breast reduction techniques, meaning longer surgery and incisions to remove the excess skin. However, the patient may again be discharged on the same day, but will need to have the incisions redressed and the sutures removed. He may return to his normal activities right away if this is deemed necessary, although it is recommended that he rests a few days. Sudden lateral gynecomastia requires lab tests (mammography, ultrasound or even CT scan) before proceeding with surgery. In case there is fear of malignancy, a quick biopsy is necessary. A positive result requires radical mastectomy and removal of the sentinel lymph node of the armpit. Depending on the biopsy results, the type of malignancy and the hormonal receptors, the treatment may involve radiation therapy, chemotherapy, hormonotherapy, etc. It is not a major operation, so the patient may even be discharged on the same day. His discomfort will depend on the results of the tests. All breast surgeries are nearly painless and simple painkillers in the first few days may relieve postoperative pain.

Gynecomastia is encountered in 11% of young adolescents, meaning that one in every ten male adolescents may have some form of gynecomastia. It is encountered in 70% of obese patients, while one in four seeks corrective surgery. Lateral gynecomastia is quite rare. In all gynecomastias requiring removal of part of the mammary gland, histological testing of the removed parts is necessary. Accidental malignant findings are possible, but rare. In this case, the treatment may change. The results following corrective gynecomastia procedures are nearly always satisfactory. The removal of the gland without subsequent liposuction of the surrounding area may leave the impression of an imprint. If the surgery is repeated and complemented with liposuction, the problem is rectified. Breast malignancies in men usually have a worst prognosis than in women and the earlier they are diagnosed, the longer the treatment and the chances of survival.