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Gynecomastia Surgery Procedure
Based upon Wikipedia, the free encyclopedia
Gynecomastia, or gynaecomastia, is the development of abnormally large mammary glands in males resulting in breast enlargement, which can sometimes cause secretion of milk.
The term comes from the Greek gyne meaning "woman" and mastos meaning "breast".
The condition can occur physiologically in neonates (young babies), in adolescents, and in the elderly. In adolescent boys the condition is often a source of distress, but for the large majority of boys whose pubertal gynecomastia is not due to obesity, the breast development shrinks or disappears within a couple of years.
The causes of common gynecomastia remain uncertain, although it has generally been attributed to an imbalance of sex hormones or the tissue responsiveness to them; a root cause is rarely determined for individual cases.
Gynecomastia occurs in approximately 50% of all men in different forms, ranging from excess breast or fat tissue to the development of female glands.
In some cases, changes in lifestyle or diet can reverse gynecomastia, and in 90% of adolescents the condition disappears within a month or two. For all others surgery is the only option for correction.
Causes of Gynecomastia
It can develop in adolescents as early as age twelve as a result of hormonal changes. It can also be caused by drug, diet, and lifestyle induced hormonal shifts.
Men taking anabolic steroids often suffer from gynecomastia as testosterone levels in the body rise dramatically, causing the body to respond by producing enzymes that turn excess testosterone into estrogen.
Increased age and weight can also contribute to the development of excess breast and fat tissue.
Physiologic gynecomastia occurs in neonates (young babies), at or before puberty and with aging. Many cases of gynecomastia are idiopathic, meaning they have no clear cause.
Potential pathologic causes of gynecomastia are:
• Medications including hormones;
• Increased serum estrogen;
• Decreased testosterone production;
• Androgen receptor defects;
• Chronic kidney disease;
• Chronic liver disease;
• HIV; and
• Other chronic illness.
Gynecomastia as a result of spinal cord injury and re-feeding after starvation has been reported. In 25% of cases, the cause of the gynecomastia is not known.
Medications cause 10-20% of cases of gynecomastia in post-adolescent adults. These include cimetidine, omeprazole, spironolactone, Imatinib Mesylate, finasteride and certain antipsychotics. Some act directly on the breast tissue, while others lead to increased secretion of prolactin from the pituitary by blocking the actions of dopamine (prolactin-inhibiting factor/PIF) on the lactotrope cell groups in the anterior pituitary. Androstenedione, used as a performance enhancing food supplement, can lead to breast enlargement by excess estrogen activity. Medications used in the treatment of prostate cancer, such as antiandrogens and GnRH analogs can also cause gynecomastia. Marijuana use is also thought by some to be a possible cause; however, published data is contradictory.
Increased estrogen levels can also occur in certain testicular tumors, and in hyperthyroidism. Certain adrenal tumors cause elevated levels of androstenedione which is converted by the enzyme aromatase into estrone, a form of estrogen. Other tumors that secrete hCG can increase estrogen. A decrease in estrogen clearance can occur in liver disease, and this may be the mechanism of gynecomastia in liver cirrhosis. Obesity tends to increase estrogen levels.
Decreased testosterone production can occur in congenital or acquired testicular failure, for example in genetic disorders such as Klinefelter Syndrome. Diseases of the hypothalamus or pituitary can also lead to low testosterone. Abuse of anabolic androgenic steroids (AAS) has a similar effect. Mutations to androgen receptors, such as those found in Kennedy disease can also cause gynecomastia.
Although stopping these medications can lead to regression of the gynecomastia, surgery is sometimes necessary to eliminate the condition.
Repeated topical application of products containing lavender and tea tree oils among other unidentified ingredients to three prepubescent males coincided with gynecomastia; it has been theorised that this could be due to their estrogenic and antiandrogenic activity. However, other circumstances around the study are not clear, and the sample size was insignificant so serious scientific conclusions cannot be drawn.
Diagnosis
The condition usually can be diagnosed by examination by a physician. Occasionally, imaging by X-rays or ultrasound is needed to confirm the diagnosis. Blood tests are required to see if there is any underlying disease causing the gynecomastia.
Prognosis
Gynecomastia is not physically harmful, but in some cases can be an indicator of other more dangerous underlying conditions. Growing glandular tissue, typically from some form of hormonal stimulation, is often tender or painful. Furthermore, it can frequently present social and psychological difficulties for the sufferer. Weight loss can alter the condition in cases where it is triggered by obesity, but losing weight will not reduce the glandular component and patients cannot target areas for weight loss. Massive weight loss can result in sagging tissues about the chest, chest ptosis, or drooping chest.
Treatment: non-surgical
Treating the underlying cause of the gynecomastia may lead to improvement in the condition.
Patients should talk with their doctor about revising any medications that are found to be causing gynecomastia; often, an alternative medication can be found that avoids gynecomastia side-effects, while still treating the primary condition for which the original medication was found not to be suitable due to causing gynecomastia side-effects (e.g., in place of taking spironolactone the alternative eplerenone can be used).
Selective estrogen receptor modulator medications, such as tamoxifen and clomiphene, or androgens or aromatase inhibitors such as Letrozole are medical treatment options, although they are not universally approved for the treatment of gynecomastia. Endocrinological attention may help during the first 2-3 years.
Treatment: surgical
After the above non-surgical options, however, the breast tissue tends to remain and harden, leaving surgery the only treatment option.
The surgical methods include:
• Liposuction;
• Gland excision;
• Skin sculpture;
• Reduction mammoplasty; or
• Combination of these surgical techniques.
The surgical procedure
Usually performed in a doctor's office or surgical suite as an outpatient procedure, gynecomastia surgery can be done with the use of a local or general anesthetic.
Once the patient is properly anesthetized, the surgeon makes a small incision just below the areola. Excess breast tissue is surgically excised from the area and fat is removed with the use of liposuction. The incision is then closed and the patient is detained until the effects of the anesthesia wear off.
Recovery
After surgery you will be fitted with a compression garment or ace bandages to support the breasts while they heal. The recovery process is usually not a short one. Patients should take their time when thinking about returning to normal activity, and are usually told to ease back into their daily routine gradually. In many instances patients will wait between one and three weeks before returning to work.
Complications
Most instances of complications stem from surgeon error and patients trying to do too much after surgery. The most serious complications include:
• Hematoma (collection of blood);
• Asymmetry;
• Infection;
• Change in position or shape of the nipple; and
• Wound separation.
More common complications include:
• Numbness;
• Swelling;
• Bruising, and
• Scarring.
Who can be a candidate?
Men who have developed larger, female-like breasts and have not been able to alter this problem with diet and lifestyle changes can be candidates for surgery.
Average costs
Including costs of anesthesia and other necessary equipment and medications costs can average $2,000 to $6,000 or more, depending on the clinic and the geographic location.
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