Introduction 

The common male problem in an Aesthetic clinic, Gyanecomastia, is truly Pseudogynaecomastia with only fatty tissue and minimal glandular tissue. The condition is a part of the co existing Obesity disorder and is rarely, a standalone entity. The treatment options shall include an approach to answer the issue of obesity as a whole, not rest contented with surgical removal of the enlarged breasts alone. What is seen and what is treated is just a tip of the iceberg. 

Gynaecomastia, an innocuous condition, that affects 35-70% of male population immediately after birth, during adolescence and old age is rarely brought to notice as the sufferer makes all attempts to hide it as the condition brings with it a sense of shame and pain in public places and mental suffering. Herein starts the search for the treatment. Medical and multifaceted surgical options evolved over centuries with the current opinion being fat removal by anyone form of liposuction and the gland removal by direct excision. Gynaecomastia, is increased breast tissue in males composed of glandular and fatty tissue. 

Physiological gynaecomastia of puberty that normally regresses with age tend to stay back being sustained by the modern lifestyle changes. Processed foods and environmental pollution of air and water, the cosmetics used on the body like deo odorants, perfumes and toiletries, synthetics and chemicals have contributed to explosions of generalised obesity. With this generalised obesity, the tendency to hold back excess fat in the breast developed. This clearly shows the reason for higher incidence of (pseudo) Gynaecomastia of late. Hormonal imbalance due to reasons stated above, aggravate the situation. Gynaecomastia is part of the generalised obesity and it is more fat and little gland. 
However, this condition does not have any harmful effect on the body, but it can cause distress emotionally. Men may lose their self-confidence and they can be psychologically affected by this.

What Causes Gynaecomastia?

It is a type of hormonal imbalance that results in the growth of the male breast tissues. The ratio of oestrogen v/s androgens gets altered and causes the enlargement of the breasts. For this condition to occur, the amount of oestrogen increase in the body, or the amount of testosterone drops. Sometimes it can be the combination of both.

There are certain diseases that may contribute to gynaecomastia and they are as follows:

Kidney diseases

Liver disease

Drop in testosterone levels

Certain medications such as methadone, medications for HIV or treating prostate cancer

Certain tumours caused in male sex organs such as cancer of the Leydig cells or the Sertoli cells resulting in deprivation of androgen levels

Conclusion: 
True Gynaecomastia that requires surgical treatment is not so uncommon. What is commonly believed to be gynaecomastia is truly Pseudo gynaecomastia with a co exiting clinical picture of obesity, high BMI, sedentary life and wrong lifestyle. Surgical treatment by laser liposuction under Tumescent Anaesthesia gives very good results with high patient satisfaction and negligible post operative complications. Gland fragmented with laser can be extricated thro  same entry point without sub areolar incision.

Gynaecomastia (Enlarged Breasts In Men): Causes and Treatments

Swollen breast tissues in men or boys caused by hormonal (testosterone and estrogen) imbalances is called gynecomastia. Both breasts or one breast, can be affected by gynecomastia. At any point in life, from birth to puberty, even in adulthood, you might develop gynecomastia. Most of the times, gynecomastia is caused by hormonal imbalances, but there might be some underlying causes as well.
Gynecomastia is normally not a serious condition, but it can be difficult to deal with the pain and embarrassment.

It can be cured with surgery or medication, if it doesn't go away on its own.

Symptoms and signs of gynecomastia include:

Enlarged glands in the breast tissue
Tenderness in the breast
The causes that trigger gynecomastia include:

Hormonal changes: Testosterone and estrogen control the sexual development in men and women respectively. Estrogen is not a hormone that only women produce; men produce it too. When the production of testosterone and estrogen are thrown out of balance, gynecomastia occurs.
Medication: Certain medications such as anabolic steroids, androgens, HIV/AIDS medicines, antibiotics and chemotherapy can cause gynecomastia.
Drugs and alcohol: Substances such as alcohol, marijuana, amphetamines, heroin and methadone cause gynecomastia.
Health condition: Certain factors, such as aging, hypogonadism (hormonal disorder), hyperthyroidism (overactive thyroid gland), tumors, kidney failure, cirrhosis, liver failure, malnutrition and starvation can lead to gynecomastia.
Herbal products: Essential oils derived from plants such as lavender or tea tree, used in lotions or shampoos, have weak estrogenic actives. They have been said to cause gynecomastia.
Gynecomastia can be cured either with medication or surgery. Surgical options for gynecomastia are, however, limited.

Treatment

There is no definitive medical treatment. The main answer for Gynecomastia is -SURGERY. It is a daycare procedure in most situations. It is done by a Surgeon, usually, a Plastic surgeon does a better job. 

Anesthesia- Either Local or General anesthesia is given to make it painless. 

Procedure-Through a small incision in the areola, the swelling is removed by both Liposuction of the Fat part and Excision (removal) for Breast gland part. As the incision is through the areola, the final scar is hardly visible. In extensive swellings, skin also needs to be removed, where in a scar around the areola border is visible. 

Recovery- usually can go back to work in 2-3 days time.

Treating Gynecomastia (Enlarged Breasts in Men) With Surgery

Men also suffer from breast enlargement, medically called gynecomastia. This usually happens when the levels of female sex hormones, in the affected male, overshadow the male sex hormone levels.

Gynecomastia is different from fat accumulation in the male upper chest. It is typically characterised by an increase in the glandular tissue, which can produce milk.

Lots of adolescent boys suffer from male breast enlargement due to the adolescent hormonal surge, though, the condition can present in men at any age. Adolescents lose the breast enlargement typically in periods ranging from 6 months to a year. Beyond this period, a man with enlarged breasts has to seek medical intervention for treatment.

Typically, gynecomastia occurs due to certain medications like for renal failure and hypertension. It can also be caused due to conditions like hyperthyroidism or kidney failure, liver cirrhosis or problems with testes which causes changes in hormones in the male body.

Treatments-

Whatever be the reason, gynecomastia is a deeply distressing condition for men of all ages. Treatments are available, both surgical and medicinal and they help especially surgery.

Male Breast Reduction Surgery- Facts

Surgery for male breast reduction can be performed safely and successfully on teenagers and adult men alike.

In male breast reduction surgery, the surgeon makes an incision around the nipple and removes the excess glandular tissue and fats causing the appearance of the breast. This is the only effective treatment for gynecomastia that has long-lasting, if not permanent, results. Male breasts may also appear due to excess fat in the upper chest. Liposuction is generally very effective in treating this. The surgeon removes fats and some glandular tissue and then sculpts a new chest contour that looks natural for your body.

More severe cases of gynecomastia may require more than this. The surgeon has to then go for something called  surgical tissue excision  to achieve optimal results. Older males with gynecomastia with sagging skin also require tissue excision. This technique allows the surgeon to remove a major chunk of glandular tissue and/or skin that cannot be successfully removed by mere liposuction.

If you are planning to go for breast reduction surgery, find the best cosmetic surgeon. This will go a long way in you getting the best results and minimise scars.

Also be prepared for the after-effects of the surgery. Even though it is typically performed as an outpatient procedure using general anaesthesia or local anaesthesia with sedation, you must be prepared for soreness and swelling. Recovery time is usually a week and a patient is often given a compression garment to wear for the first few weeks after surgery to support the healing breast tissue. Also, be prepared to be off exercise for a month or so after surgery.

Can Surgery Help Reduce Enlarged Breasts In Men?

Most men, about 60%, see some development of breast tissue in their lifetime. This growth could be round, symmetrical and occurs bilaterally. This growth of breast tissue in males is medically known as gynecomastia.

Causes:

The most common cause is an imbalance between the oestrogen and androgens, with excessive oestrogens leading to the growth of breast tissue.
Excessive use of anabolic steroids
Obesity
Unknown reasons
It can affect men of all ages, and if this presents as a serious problem, then surgery is the most definitive form of treatment.

Surgical options: There are two major options available for correcting gynecomastia   liposuction and excisive surgery.

Liposuction:

Done either under local sedation or under general anaesthesia depending on the extent of the tissue proliferation
A small incision is made either in the armpit or around the areola
Excessive fat tissue and breast gland tissue are suctioned out
The chest contour also is altered at the same time, if desirable
Post-surgery, the person is made to wear a compression garment for the first few days
This helps in keeping the tissue in place and also helps reduce swelling
Healing takes about a couple of weeks  time, depending on the person s overall health status and the extent of surgery.
Excisive surgery:

This is done when the extent of gynecomastia is more severe
These people would have sagging, stretched skin around the breast area
More amount of fat and glandular tissue can be removed through excision
This is more often done under general anaesthesia
The incision is often done around the areala (dark portion around the nipple) so it is concealed or along the natural creases which are formed due to excessive breast tissue
Excessive breast tissue is removed and the incisions are closed
There could be swelling, pain, bruising, and higher chances of post-surgical infections
Recovery will take about ten days to two weeks
Refraining from exercise is often advised for up to 2 weeks
Benefits:

Restore a masculine appearance
Shorter surgery
Faster recovery
Minimal or invisible scars
Almost immediate results that can be dramatic
Improved confidence and self-image
After the surgery:

Surgery is definitely a sure way to remove the male breast tissue, it is almost a permanent treatment for this condition.
It is very important to get a trained, experienced surgeon for the procedure
It is important to follow post-op instructions including pain management, infection control, and recovery
If it was caused by use of steroids or obesity, lifestyle modification is essential to prevent recurrence

Enlarged Breasts In Men - Surgery At Your Rescue!

Gynecomastia is basically swelling of the breast tissues in boys and men. This is usually caused due to an imbalance of the hormones, estrogen, and testosterone. Gynecomastia can affect either one or both the breasts, sometimes in an uneven manner. Newborn babies, boys who go through puberty along with older men might develop this condition as a result of normal changes in the levels of the hormone.
It is not necessarily a serious problem but men might find it difficult to cope with this condition. This condition can go away on its own. In case, it persists, consultations with a cosmetic/plastic surgeon can be of great help.
Before looking at the tips from a cosmetic/plastic surgeon to come out of this problem, let us briefly talk about the symptoms and causes related to Gynecomastia.

Symptoms- 
There are certain signs and symptoms, which suggest that men could well be suffering from gynecomastia. They include the likes of:

Swelling of the breast gland tissue
Pain
Tenderness
Nipple getting discharged in either one or both the breasts
Causes -
Gynecomastia is usually triggered by a decrease in the amount of the hormone testosterone compared with estrogen. Different things can alter the hormonal balance like:

1. Natural hormonal changes

2. Several medicines including:

Anti-androgens used for treating enlarged prostate, prostate cancer
Anabolic steroids
Medicines for AIDS
Anti-anxiety medicines
Tricyclic antidepressants
Antibiotics
3. Consumption of alcohol
4. Heroin and other such drugs
5. Several health conditions like Hypogonadism, Hyperthyroidism, Kidney failure, Live cirrhosis, etc.

Tips From Cosmetic/Plastic Surgeon-
Consultation with Cosmetic/Plastic Surgeon can let men have useful tips as to the treatment as well as prevention of Gynecomastia. They include the following:

Liposuction Treatment can be an ideal way to get rid of this problem. It removes fat from the breast but leaves behind the breast gland tissue in its place. The treatment involves making two or more small incisions through narrow tubes get inserted into the chest region. The tube gets moved around gently to loosen up the excess fat tissue, which is then sucked out. The treatment involves less amount of scar.
Cosmetic/Plastic Surgeon can advise patients that there are iatrogenic causes behind this problem like side-effects from any medicine or health issues like an overactive thyroid or tumor.
Mastectomy can be another effective method of treatment. It is performed endoscopically and thus has a quicker recovery time. A patient can stay at the hospital for a few hours and go back. This involves less amount of scarring.
Cosmetic/Plastic Surgeons can also go for another extremely effective method in their hands to take care of this problem of Gynecomastia. It is the Excision Technique. This is recommended where glandular breast tissue or excess skin must be removed to cure this. The patterns of incision would vary depending on the specific conditions and patients  surgical preference.


All You Must Know About Gynecomastia!

Gynecomastia is a condition where the tissues of the breasts swell in a boy or men. This is caused by the imbalance of testosterone and oestrogen. It might affect one or both the breasts depending on the level of hormonal imbalance. Although not considered as a serious condition, Gynecomastia can be a difficult condition to cope up with. There are multiple treatment options and surgery is one of them. In many cases, this condition goes as abruptly as it appeared. For cases that are complicated and difficult to get rid of, doctors suggest a medical procedure get rid of the condition.


Symptoms of Gynecomastia:
Some common symptoms of Gynecomastia include tenderness of breasts, swollen breast gland, pain in the breasts, discharge from the nipple etc.


Causes of Gynecomastia:
There could be many causes of this disease. If the condition is witnessed in babies, it could well come from the mother due to an overdose of oestrogen. Gynecomastia also appears during puberty resulting in the breast to swell up. The condition can again crop up after the age of 50 due to hormonal changes.
Certain medications can be a reason of Gynecomastia. Some of the common medications include certain antibiotics, anti-anxiety related medications, chemotherapy shots, HIV patients receiving HAART, cardiovascular medications such as Lanoxin, anabolic steroids etc.
Certain drugs such as heroin, alcohol, methadone, marijuana, Amphetamines etc.
Certain health conditions such as hypogonadism, hyperthyroidism, liver cirrhosis, ageing, certain tumours, failure of the kidney malnutrition etc.


Risk Factors Of Gynecomastia-
Certain risk factors of gynecomastia include older age, use of certain steroids, adolescence and other medical conditions such as Klinefelter's syndrome, tumour related to hormonal fluctuation and disease related to thyroid.
Diagnosis:
A doctor typically checks the history of drugs along with the health condition of the patient. He might also take a look at the health of the extended family. A careful tissue evaluation of the genitals, breast and abdomen are done. This is followed by a physical exam followed by prescribing certain tests such as mammograms, complete blood work, CT scan, biopsy of the tissue, MRI scan etc.


Treatment:
Most people suffering from Gynecomastia see a significant regression with periodic treatment. If however the condition arises from an underlying cause such as cirrhosis and malnutrition, a doctor suggests 2 option- medications and surgery:


Medications: Certain medications that are known to be helpful for breast related cancers are known to be effective in this condition. Some common examples of these drugs include evista, arimidex and soltamox.
Surgery: Only after exploring all medical options a doctor suggests surgery. There are 2 procedures namely mastectomy and liposuction. The latter removes the fat cells of the breast and the former removes the breast gland tissue.     


Gynecomastia - Is Surgery The Best Option?

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