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Gynecomastia (Male Breast)


What is gynecomastia? 

Gynecomastia is a common disorder and involves the development of large breasts in males. This can cause problems concerning their appearance and may affect their self-esteem. Many patients avoid exposing their chest e.g. on the beach and at the gym and they avoid wearing clothes that are too tight. Particularly in Cyprus, it may cause several psychological problems to the teenagers during the military service.

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What causes gynecomastia? 

The most common form is the so-called pubertal gynecomastia and it is caused by an imbalance of the hormones testosterone and estrogen. It occurs in about 40% of the adolescents between the ages of 13 and 17 and it is bilateral (enlargement of both breasts). In the majority, however, the problem disappears after 12-24 months. In cases where gynecomastia persists, plastic surgery may be the only option.

Taking anabolic steroids can also lead to breast enlargement and usually it remains even if the patient stops taking them.

Other rarer causes are hepatic and renal failure, medications such as diuretics, alcohol and drugs abuse. Breast cancer in men is a rare condition and it can appear in the form of gynecomastia. However, it usually appears only in one breast and it can cause some abnormalities of the skin in the area. It is also accompanied by bloody discharge from the nipple.

Do I need any investigation? 

In cases of pubertal gynecomastia, you do not need any special investigations. An experienced plastic surgeon can identify if it is a non-pathological or a hormonal problem. In such cases you will need a hormonal control. In the rare cases where there is suspicion of cancer you will need further radiological investigations.

Classification:

The classification of gynecomastia is very important for the choice of treatment. There are four stages.
  • I-minor but visible breast enlargement without skin redundancy;
  • IIa-moderate breast enlargement without skin redundancy;
  • IIb-moderate breast enlargement with minor skin redundancy;
  • III-gross breast enlargement with skin redundancy so as to simulate a pendulous female breast.

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What is the most appropriate treatment? 

Treatment depends on the extent of the problem: 
In the stage I, IIA and sometimes IIB, large breasts can be treated with a simple liposuction (the procedure is described in the next page). Fat and breast gland can be removed with this technique. In more advanced stages where there is excess skin, incisions should be done for skin removal. Depending on the problem, the incisions might be made around the nipple, under the breast or in the underarm area. In the majority of patients, the scars will fade and they will be less noticeable over time.

However, in some cases, scars do not fade completely and this can be quite a problem for the patients. For this reason it is mostly recommended to treat the problem first only with liposuction. Sometimes the skin can shrink in such a degree that no further surgery is needed. This will give the opportunity to the patient to decide at a later stage whether to proceed with skin removal or not. 

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