Gynecomastia is the medical name of female type breast growth in men.
The difference of breast growth in men and women
There is basically no difference between the male and female breasts from the newborn period to the onset of adolescence. As a result of the effect of elevated hormones levels with the onset of adolescence in girls, breast growth begins in girls about 1 to 2 years before the first menstruation. The androgen / estrogen imbalance in males does not allow the mammary gland to grow.
Causes of breast growth in men?
Most gynecomastia occurs during adolescence. In adolescence, 35-65% of men have gynecomastia problems. This ratio decreases to 8% in the late adolescence period. However, with advancing age, the incidence of gynecomastia increases again to 30%.
This type of juvenile gynecomastia in adolescence is caused by a deterioration in hormone physiology or excessive sensitivity in the mammary gland. Growth of mammary gland structures for hormonal reasons generates increased connective tissue and edema. These individuals come to the doctor because of breast swelling, pain, suspicion of cancer and because they are bothered by their appearance.
Breast growth in men is often encountered without any cause. However, there are many factors that can cause this: diseases with reduced testosterone production (Kleinfelter Send., Orhiectomy …), diseases in which estrogen production increases (testicular tumors, adrenal tumors), obesity, diseases that impair liver function, thyroid dysfunction, renal failure, Some antidepressant medications, Anabolic steroids (anabolan, primabolan, sustanon ..) taken during bodybuilding, some stomach medications (containing cimetidine), use of alcohol, marijuana and heroin use may cause breast growth in men.
The difference in breast growth in adolescence and breast growth in adulthood ?
In adolescents, 90% of breast growths, observed in 35-65% of men, return to normal. It is usually the growth of the mammary gland rather than fat accumulation. Breast growths encountered in 35% of men after adolescence usually do not improve spontaneously. There is an increase in fat mass rather than growth in the mammary gland.
Things that men with breast growth complaints need to do
If there is mammary gland growth in men, the reasons for this should be investigated before surgery. If any cause is detected the growth of the mammary gland should be treated initially by eliminating the cause. However, if a healthy adult has long-term gynecomastia, it is not necessary to carry out extensive studies.
If the growth of the mammary gland is unilateral without any pain, it should be investigated more carefully. A mammography should be performed and a biopsy should be taken if necessary.
If no cause is found for breast growth, the patient should be given an ultrasound after the examination in order to determine the type of breast growth and whether it is caused by adipose tissue or mammary gland tissue.
Planning the Treatment of breast growth in men
75% of the mammary gland growth seen in adolescents returns to normal with no treatment or drug treatment, within the first 2 years, 90-95% return to normal within the first 3 years. Therefore, if there is a gynecomastia in the adolescent period, it is not correct to perform surgery immediately. However, if there is growth in the breast due to excess fat, there will be no benefit in waiting.
5-10% of gynecomastia in adolescence does not return to normal. The solution is surgery if there is no shrinkage in the mammary gland although it is expected. Bilateral breast growth after adolescence should be treated with surgery whether the reason is the growth of the mammary gland or the increase of fat in the breast, waiting is pointless.
Before surgical treatment
It is very important for smokers to quit smoking before and after the operation to prevent tissue death due to deteriorated blood circulation in the breast tissue. Furthermore, in order to minimize the risk of postoperative bleeding, patients should stop taking aspirin and vitamin E 10 days in advance and should not use them for 1 week after surgery if the doctor does not have any other recommendation.
Surgical treatment of breast growth in men
Breast growth in men is divided into 3 degrees in terms of surgical treatment:
- Degree: There is a mass gathered under the areola. This mass is generally a solid structure and has low fat accumulation. No excess skin has been generated.
- Degree: There is a general breast growth that extends outside the areola, the borders are unclear and adipose tissue is increased. Even though the skin has been somewhat extended, it is not enough to require removal.
- Degree: There is also a general lipoidosis that extends to the armpit as a continuation of the breast growth. There is a high volume of skin that warrants surgical removal.
However, these degrees mentioned in literature are not so important in practice. The boundaries between these degrees are uncertain and should be evaluated in each case without making generalizations.
I prefer general anesthesia for gynecomastia surgery. However, if the problem is small, sedation assisted local anesthesia may be preferred. Surgery usually takes 1-3 hours.
I apply 3D Laser lipolysis or Vaserlipo if the growth of the mammary gland is in the form of fat accumulation rather than the growth of the mammary gland and there is no excess skin. A very small incision is made to enter the vaser and emulsify the fatty tissue and tightened the skin with the laser. In patients with increased mammary glands and fat tissue, I remove the breast tissue by entering through the nipple after vaserlipo or 3D laser lipolysis application without cutting the breast. The patient can go back to work on day 3. After the application, the patient should use the corset for 2-3 weeks depending on the state of excess fat.
Breast growth is treated by surgical reduction of the mammary gland if the growth is caused by the mammary gland, it is solid in structure or rich in fat, the nipple sags and there is excess skin. Any excess skin is removed. If the nipple is sagging, it is moved to where it should be. No serious scars are left after breast growth operations if the growth is solid but there is no surplus skin. However, if an operation is carried out to for breast growth with excess skin and to replace a sagging nipple, a scar similar to the one in women who have had reduction mammaplasty will remain. The patient can return to work on the 7th day. If stitches have been made they shall be removed on the 4th -5th day.
Postoperative risk of infection and blood accumulation due to bleeding is very low. Rarely, asymmetry due to size difference between both breasts may require retouching (re-operation). In cases where the sagging nipple is moved, tissue loss known as necrosis and / or loss of sensation in the nipple may occur.
In summary :
- 90% of mammary gland growth seen in adolescents returns to normal spontaneously.
- Breast growth encountered after puberty usually does not improve spontaneously.
- The mammary gland should be investigated if it is unilateral and pain is absent (Mammography, ultrasonography, biopsy if necessary)
- Studies are not necessary if mammary gland growth is bilateral and has been present for a long time.
- It is the first choice to wait for male mammary gland growth in adolescence or to apply medical treatment. Surgical treatment should be carried out on 5-10% of patients in this period.
- Waiting in the post-adolescent period of male breast growth usually does not give results. Surgical treatment is the first choice for nearly all of the patients in this period.
- Methods for the treatment of breast growth in men: 3D laser lipolysis, Vaserlipo and open surgery are used.