Gynecomastia Surgery in Chandigarh

Gynecomastia or male breast enlargement is a condition that is difficult to hide. If you have an enlargement of the breast area, and if it is greater than 0.5 centimeter (cm) in diameter, you could possibly have gynaecomastia. To confirm the diagnosis, you should visit a certified plastic surgeon who would rule out any other condition and make a diagnosis for you. The doctor would take a detailed history, examine your chest and body and if required would ask you to undergo some blood tests or a mammogram.

Gynaecomastia presents with just a lump of fatty tissue under the nipple and usually has no symptoms. Generally, there is no pain associated with it. However, sometimes it might be accompanied by mild tenderness and breast sensitivity and may cause the areola (dark skin around the nipple) to increase in diameter.

But if you experience intense pain or other symptoms like nipple discharge, you must visit a plastic surgeon immediately so that other medical issues can be ruled out.

In most of the cases, male breast enlarges without any obvious cause, and this is called ‘idiopathic’ gynaecomastia.

It could, however, be a manifestation of hormonal imbalance – particularly between male hormone ‘testosterone’ and female hormone ‘oestrogen’. Males normally produce estrogen in very small amounts but when they produce it in higher amounts leading to an imbalance in male versus female hormones, breast tissue growth is stimulated. As men age the ratio between male/female hormone production naturally decreases contributing to this imbalance.

Consumption of certain medications, antibiotics, anabolic steroids also could contribute to it. Additionally, when milk, eggs or meat are contaminated with estrogen or estrogen-like substances, consumption of these could put you at high risk. We all keep hearing of unscrupulous estrogen injections to dairy cattle as well as the steroid fed poultry in areas where this industry is not regulated.

Obesity itself could lead to gynaecomastia.

Although, Gynaecomastia (male breast enlargement) can develop at any time, there are three specific age groups where the prevalence of gynaecomastia is higher:

Neonatal gynaecomastia- It is common for male neonates (less than 1 month old) to present with slight swelling below the nipple. This is mostly asymptomatic and occurs as a residual effect of conversion of androgens to estrogen by placenta. It is temporary and usually subsides within 2-3 weeks and needs no treatment.

Pubertal gynaecomastia- Boys in the teenage group (between 10-15 years), commonly present with a sudden growth in the breasts. It is usually due to the hormone imbalance triggered by puberty. Most often this type also resolves naturally within 6 months to two years, as the chest of the growing boy expands. In 20 percent of individuals, the condition can persist even after they turn 17 years old. If it persists beyond adulthood, it is more likely to persist. This is when you must consult a plastic surgeon who can determine whether it is true gynaecomastia or pseudo gynaecomastia.

Senescent gynaecomastia – As men get older, the ratio between male and female hormones begins to decrease because of decrease in testosterone (male hormone) levels over time. As a result, the female hormones become more dominant. This problem is compounded by weight gain or use of certain medications.

There can be two types of gynaecomastia depending upon the tissue makeup of the breast swelling:

True Gynaecomastia: This can either be ‘Pure glandular’ gynecomastia (in which enlargement of the breast is because of proliferation of fibrous breast tissue or glandular tissue) or ‘Mixed’ gynecomastia (in which enlargement of the breast is because of both excess of fatty tissue and fibrous breast or glandular tissue).

Pseudo gynaecomastia: This is false gynaecomastia in which fatty tissue main cause of enlargement of breast tissue.

Clinically, Gynaecomastia is graded based on the size of breast tissue and presence or absence of excess skin:

• Grade 1 small breast enlargement without any excess skin over the chest

• Grade 2a moderate breast enlargement without excess skin over the chest

• Grade 2b moderate breast enlargement with extra skin over the chest

• Grade 3 marked breast enlargement with extra skin over the chest, sometimes mimicking female breast ptosis.

In the case of Pubertal Gynaecomastia (which presents at 10-14 years of age) the breasts may regress naturally, without any intervention, within two years. This happens as the chest expands towards end of puberty and when hormone levels return to normal.

Adolescent boys with Pseudo-Gynaecomastia (that presents with obesity) would certainly respond to diet control and exercise. It usually subsides as the chest cavity grows and muscle builds up with exercise. We always suggest patients of pseudo-gynaecomastia to pursue some kind of active sport. Coolsculpting is another treatment option in this case as it freezes the fat by cryolipolysis, eventually leading to permanent reduction of fat cells in the region.

 For a True Gynaecomastia, the simple answer is NO! Although following a healthy diet and exercise regime is strongly recommended for overall good health, it doesn’t do too much for decreasing gynecomastia. This is because the excess breast/glandular tissue cannot be burnt by dieting or exercise. Eliminate the foods that increase estrogen production and avoiding medications that may cause gynecomastia as a side effect would certainly help in preventing it from growing further. But once Gynaecomastia is established, male breast reduction surgery is the only recommended treatment.

The ideal candidate for Gynaecomastia surgery would be one:

• Who is experiencing psychological trauma and social issues with the size or appearance of his breasts
• Who is well past the teenage years (considering that pubertal gynecomastia can resolve over time).
• Who has been on diet and exercise but seen no further reduction in the severity of Gynaecomastia despite having a good fitness profile.
• Those who are not on any medications or supplements that are known to cause gynecomastia, considering that medication induced gynecomastia can resolve with discontinuation of these medications.
• Those who do not have any life-threatening illnesses or medical conditions that may affect tissue healing
• Those who are nonsmokers as smoking also affects tissue healing
• Those who are physically healthy and have a relatively normal weight

Gynaecomastia is a benign (non-cancerous) growth of male breast. The presence of gynecomastia itself does not increase the risk of breast cancer in men, as indicated by several clinical studies.

That said, less than one percent of all breast cancer cases do develop in men and older men are at a higher risk than younger men. Gynaecomastia could also be a symptom of certain cancers or illnesses, but this is very rare. Therefore, all men should be aware of its possibility and should immediately report to their doctor, should they see any new lump, asymmetrical growth, any nipple discharge or skin changes on the breast or nipple.

Many medications or drugs could cause gynecomastia as a side effect. These could include anti-androgen drugs used to treat prostate enlargement or prostate cancer, anabolic steroids used for body building, some AIDS medications, some anti-depressants, some heart medications some antibiotics or some cancer-chemotherapy agents. Drugs used for substance abuse like such as marijuana or heroin could also lead to Gynaecomastia. It could also be triggered by seemingly harmless supplements, that could possibly have hormone-like effects.

In case your gynaecomastia is drug induced, it could, in some cases become less severe with stoppage of the causal drug. But more often than not, once the gynecomastia is established, it doesn’t completely regress unless corrective male breast reduction surgery is performed.

Hormonal tests are not recommended before surgery unless there are clinical signs of hormonal abnormalities.

If you have any medical condition or are on any medications, you should inform your plastic surgeon. Sometimes additional tests and a medical clearance for surgery might be required. If you are on platelet inhibiting drugs like Aspirin, the surgeon might ask you to stop taking it a few days before surgery.

It is also important to quit smoking at least three weeks prior to surgery and to continue to abstain from it well until the tissues have healed. Smoking interferes with wound healing and abstaining is important to avoid postoperative complications related to healing.

Various techniques may be used for breast reduction depending on the type of gynaecomastia. It could be treated with liposuction, surgical excision (removal of tissue) or lipo-excision (which includes both).

• Liposuction : In cases where gynaecomastia is primarily the result of excess fatty tissue, liposuction alone is enough to achieve a good result. This surgery was done until a few years ago to treat cases of pseudo-gynaecomastia. But these days, this surgery is no longer needed because a good result can be achieved by the non-invasive procedure, Coolsculpting.

Liposuction involves infiltrating tumescent anaesthesia into the tissue and then inserting a cannula (a hollow tube) through a button hole incision on each side. The cannula is moved back and forth, in a controlled manner to loosen the liquefied fat, which is then sucked out using vacuum suction. The results of this procedure would depend on age and skin elasticity of the patients. Younger men with good skin tone would get a better result than older ones with lot of skin laxity.

• Excision (surgical removal) : This is recommended when gynaecomastia is because of excess of glandular breast tissue or when excess skin needs to be removed to give an optimal result. Excision is also required when the areola size is larger and needs to be reduced or when nipple repositioning is required. An incision, approximately 2-3cm is made near the areola and surgeons generally try to hide the incisions at the margins of the areola, taking advantage of color difference of color between areola and rest of the chest skin. Almost 90% of the glandular tissue is removed to give the breast a flatter masculine contour. 10% of the breast tissue is left under the areola to prevent the ‘donut deformity’ or the ‘crater deformity’ which is a sunken appearance of the chest due to over aggressive excision.
• Lipo-excision : Most commonly, this combined procedure is performed, wherein, liposuction is combined with excision of the glandular breast tissue. This is done when gynaecomastia has both elements- fatty and glandular and therefore both need to be removed to achieve a proper male contour of the chest.

The surgery takes about one to two hours and we advise the patients to stay in the hospital overnight. Before the anaesthesia, the surgeon will do the markings on the chest. This is important as the contours of the chest change in the lying down position. Depending on the extent of surgery, sometimes the surgeon might leave a surgical-drain to prevent collection of excess blood and fluid in the tissues. This is usually removed after a couple of days.  

Gynaecomastia or male breast surgery can be done under general anaesthesia, IV sedation, or local anesthesia. The choice depends on the patient’s choice and the extent of surgery. Generally, when Lipo-Excision is performed, general anaesthesia is preferred.

• Total recovery: Although total recovery after Gynecomastia surgery usually takes a 4-6 weeks, you’ll notice a more contoured chest profile immediately after your procedure. As the tissue swelling subsides and the scars begin to shrink and fade, the final results begin to show. This could happen anywhere between 3 months to 6 months, depending on individual tissue healing. In a year’s time, completely heal to the point where the scars are no longer visible. In hands of a qualified cosmetic plastic surgeon, gynecomastia surgery leads to dramatic improvements in the chest contour with minimal risk of scarring.
• Bandages & compression garments: In the immediate postoperative period, you would be required you to wear an elastic compression garment around your chest (above the bandages), after the surgery, in order to minimize the chances of swelling and bruising. You would be required to wear it for about 6 weeks postoperatively as it helps in chest reshaping. Bandages if any, are removed in one or two days.
• Bath: You should be able to take bath after removal of dressing. Before that you could sponge yourself using a wet towel.
• Pain & medication: For a few days following gynecomastia, you may feel some discomfort that can be controlled with pain medication. You would also be required to take antibiotics for seven days.
• Suture removal: The sutures used in the nipple area are generally dissolvable and wouldn’t need to be removed. But the sutures around the key hole incisions used for liposuction would need to be removed after a week.
• Rest & exercise: You would be required to take complete rest for at least two days. Typically, our patients can return to office work in 8 to 10 days and after two to three weeks they can perform light activities but strenuous exercises like pushups or weight bearing, must be avoided for 6-8 weeks.
• Driving: It might be uncomfortable to wear a seatbelt for a 2-3 weeks. Therefore, your driving might be restricted until then.

If you are overweight and intend to lose weight, it would be a good idea to wait for surgery until you have achieved your intended goal. The surgeon would be able to give a better result after you have achieved a stable weight. But if you are unable to achieve your target weight and gynaecomastia is causing you emotional distress, thus preventing you from going to the gym, you could undergo the surgery first.

• It is common to see minor complications like Swelling, Bruising, Pain, Discomfort and Numbness after the surgery. These are usually temporary and subside within 1-2 weeks after the surgery.
• Rare complications include bleeding (hematoma), fluid accumulation (seroma), persistent numbness, persistent pain, infection, contour and shape irregularities of the breast, breast asymmetry, loose skin, fat necrosis (death of fatty tissue in the breast), or crater deformity (due to aggressive breast tissue excision). Although a good surgeon takes due care to avoid these complications, they may still occur even in best of hands.
• More serious risks like damage to deeper tissue or cells can be caused by an inexperienced surgeon. Choosing a well-qualified and experienced surgeon is therefore imperative to reduces these risks.