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Gynecomastia or male breasts is basically enlarged breast tissue that usually occurs in boys and men. It is caused by an imbalance of the hormones estrogen and testosterone. This can either affect one or both breasts. Here, Dr. Jagjit Bahadur Ratti (Dr. J.B Ratti) MBBS, MS, a Senior Consultant in Cosmetic Surgery will be explaining what causes gynecomastia and the treatment provided for it.
What are the causes of gynecomastia? How much has the percentage increased in men in the past years?
On an average, 25%-30% of boys tend to develop gynecomastia. This incidence is prevalent all over the world. However, increasing obesity among young boys is causing the incidence to rise.
Childhood obesity has become a major concern in recent times due to unhealthy lifestyles. Many urban children are very fond of fast foods that are high in calories. Fast foods, in joints opened in almost all commercial centres, which are easily available coupled with decrease in physical exercises and less outdoor sports, are the reasons for more and more children becoming obese.
Excess fat in the body produces more estrogen. This hormone delays puberty in boys and causes feminine changes to happen. The most visible and embarrassing change is formation of small or sometimes large breasts.
What are the treatment options available?
The only treatment for gynecomastia is surgery. There is no other treatment. Exercise and diet control through lifestyle management may reduce the size of breasts marginally only if there is excessive fat in them. But, it has absolutely no effect on mammary glands.
Medical treatment which includes drugs like Tamoxifen or Danazol have been used by some physicians with dubious results. They do not reduce the size of well-formed breasts.
What does the doctor assess before performing the surgery?
Surgery is the only treatment for gynecomastia. The surgeon assesses the size, skin tone, history of significant weight loss, any previous surgery, fitness for undergoing surgery and patient's expectations.
Have there been any advancements in the gynecomastia surgery?
Normally, surgery for gynecomastia is done under general anesthesia with admission in hospital. In the traditional way of surgery there may be long incisions, significant bleeding and chances of revision of surgery are high.
On the other hand, the advent of Tumescent Awake technique, totally under local anesthesia had brought about a sea change in its management.
For gynecomastia, the best technique for surgery is Tumescent Awake Technique, Totally under Local Anaesthesia. True, the Tumescent technique must be performed under local anesthesia. It is one of the very significant advancements in anesthesia. It has revolutionized the safety profile of surgery. Patients remain awake and conversant while the surgery is in progress or he may go to sleep. There is no pain or discomfort throughout the surgery.
Surprisingly, when this surgery is done under tumescent awake local anesthesia, quite often there is virtually no pain even after the effect of anesthesia wears off. An operation under tumescent local anesthesia (AWAKE-SURGERY) is the safest and best way of doing male breast reduction surgery. Patients remain alert, fully mobile and can go home immediately after the surgery.
Can gynecomastia be prevented?
So far, there is no way it can be prevented. Hormonal imbalance happening at puberty in boys cannot be predicted.
What is the surgery cost?
Cost of surgery depends on several factors that are assessed by the surgeon. They are size of gynecomastia, presence of sagging or not sagging, technical difficulty due to size of areola, any previous surgery that complicates the anatomy, history of weight loss which may cause changes in the aggregation of tissues, any additional liposuction of sides of chest required or not, hospital or nursing home expenses, anesthesia expenses, duration of stay in hospital and the overall expectations of the patient.
Therefore, cost can be told only after a physical examination and assessment by the surgeon.
What are the challenges or after effects that the patient faces?
Patients suffering from gynecomastia are usually young boys. They are already in a state of variable degree of depression. Their expectation from surgery is usually, completely normal looking flat chest. 'Better-than-before' results are not acceptable to them.
Therefore, expertise of the surgeon matters a lot. If a patient must undergo another surgery for less than expected results, it can be truly very unsettling for the boy.
On the other hand, a well performed surgery can be transformational for the boy. It will take him out of depression, restore his self-confidence, restore his focus on studies and he will again find joy and happiness in the company of his friends in parties or in the swimming pool.
The posture of walking also changes, from drooping to erect. Many of these boys are so enthused that they find renewed confidence in exposing their chest. There are innumerable cases where boys previously suffering from embarrassing gynecomastia, go on to build muscles and develop their chest like body builders.