What is Gynecomastia? Symptoms, Causes, and Surgical Solutions
Gynecomastia is the enlargement and/or hardening of breast tissue in men. It is usually harmless, but in some cases, it may be a sign of an underlying health problem. This condition, which occurs due to the irregularity of female and male hormones, may not regress spontaneously unless treated. Gynecomastia surgery is generally a low-risk and satisfying procedure.
What is gynecomastia?
It is the condition of excessive growth of breast tissue in men. Breast tissue is normally present in both sexes but is limited in men. This disorder leads to an increase in breast volume as a result of the growth of glandular tissue above normal. It mostly appears bilaterally. Most of the time it does not pose any serious health problems, but sometimes it can be a harbinger of a different disease.
What causes male breast enlargement?
Breast enlargement caused by hormonal imbalances in adults can be permanent if not intervened. This picture, which can also be seen in infancy and old age, can also be triggered by some medications used. In addition, drug and alcohol use are among the triggering factors. Some health problems such as testicular cancer can also lead to growth by disrupting the hormonal balance. Another reason is weight gain due to fat accumulation (pseudo-gynecomastia). The main cause seen in the majority of adult patients is excess weight.
The growth seen due to hormonal changes during puberty can improve spontaneously during this process. If there is an underlying hormonal disorder, treatment is planned by pediatric endocrinologists. If there is no hormonal problem and no other factor is found, surgical options can be evaluated after waiting for 6-12 months.
What are the symptoms of gynecomastia?
Enlargement or swelling of the breast tissue in men is the most prominent symptom. In addition, the following symptoms can also be seen:
- Hardness felt by hand in the breast tissue
- Pain or sensitivity in and around the nipple
- One-sided or two-sided sagging
- Discharge or fluid coming from the nipple
- Dark colored appearance in the areola (area around the nipple) region
- Side findings pointing to liver or kidney disorders
Gynecomastia Degrees and Stages
In gynecomastia treatment, it is very important to know the degree (stage) of the problem to determine the correct method. This grading, known as Simon Classification in medical literature, forms the basis of surgical planning.
- Stage 1 (Mild Degree): There is a slight enlargement in the breast tissue, but no skin excess or sagging is observed. Usually, only a hard tissue is felt under the nipple. At this stage, treatment is usually possible with liposuction or simple tissue removal.
- Stage 2 (Moderate Degree - A): Breast enlargement is more prominent. There is a moderate increase in volume, but there is no sagging in the chest skin. The nipple is in its normal place. Successful results are obtained with a combination of liposuction and glandular excision (tissue removal).
- Stage 3 (Moderate Degree - B): In addition to breast enlargement, a slight excess and sagging in the skin has started. The breast tissue is prominent in a way that resembles a female breast. At this stage, just taking fat and tissue may not be enough, the skin may also need to be tightened.
- Stage 4 (Advanced Degree): The breast tissue is significantly large and serious skin sagging is present. The nipple may be directed downwards due to the effect of sagging. In patients at this stage, it may be necessary to remove excess skin and move the nipple upwards (lifting), similar to breast reduction surgeries.
How is breast enlargement in men diagnosed?
When making a diagnosis, physical examination, medical history, and additional tests are usually performed when necessary. During the examination, your doctor checks the tissue structure and the chest cage area. Diagnosis can be made if the tissue feels expanded, swollen, or hard. The condition of fat accumulation in both regions along with excessive weight is defined as "pseudo-gynecomastia" (pseudo).
During history taking; gender, age, general health status, medications used, and substance use history are evaluated. Side effects of some medications may cause this condition. When necessary, your doctor may request blood tests or imaging tests. These tests help clarify the underlying cause.
What are the treatment methods?
The treatment method to be applied should be determined according to the source of the problem, the structure of the breast tissue, and the severity of the symptoms. Options include medical treatment, surgical procedures, and lifestyle changes.
- Medication Treatment: If the source of the problem is hormone imbalance, medications can help regulate levels.
- Surgical Treatment: Usually preferred in cases where there is no underlying medical reason. This operation is the process of removing or revising excess breast tissue. It is usually performed under general anesthesia and takes a few hours. The recovery period varies from person to person but is between a few days and a few weeks.
- Lifestyle Changes: To reduce the severity of symptoms, weight control, quitting harmful habits, regular exercise, and healthy nutrition are recommended.
Modern Techniques Used in Gynecomastia Surgery
With advancing technology, gynecomastia operations can now be performed with much more comfortable and scarless methods. Different technologies are used in our clinic according to the patient's needs.
Vaser Liposuction Method
It is based on the principle of breaking down fat cells using ultrasonic sound waves. Vaser technology targets only fat cells; it does not damage vessels, nerves, and connective tissue. In this way, post-operative bruising and edema are much less, and the healing process accelerates.
Laser Liposuction Method
It is the process of melting fats using laser energy. The heat effect of the laser triggers collagen production in the lower layer of the skin. This helps to tighten the loose chest skin.
Glandular Excision (Tissue Removal)
If the cause of breast enlargement is not fat but hard breast tissue, liposuction alone may not be sufficient. In this case, a small crescent-shaped incision is made by entering from the nipple border (areola) and the hard tissue is removed.
Are there risks to the operation?
Gynecomastia surgery is generally in the low-risk group. However, as with any surgical procedure, there are some possibilities. Risks may vary according to the technique applied and the patient's structure. Possible complications may include: bleeding, infection, anesthesia reactions, temporary loss of sensation, asymmetry, or scarring.
Breast Enlargement During Puberty
This condition is common in puberty and often resolves on its own. Symptoms can usually last up to 1 year and do not require intervention. However, if the situation is causing psychological problems or social reservations, symptoms can be completely eliminated with surgical correction.
What is the frequency of occurrence?
Breast tissue enlargement can be seen in approximately 30-40% of the male population. Symptoms appear in approximately 50% of males during puberty and mostly pass on their own. Breast enlargement is observed in approximately 25% of men over the age of 50.
What is pseudo-gynecomastia?
It is the appearance caused by the fact that the breast tissue (glandular tissue) does not actually grow, but the fat ratio in the region increases. Instead of tissue, there is a swelling caused by fat accumulation. After the pseudo-