Gynaecomastia surgery is carried out under a general anaesthetic and can be performed on a day case basis or may require a one night stay in hospital. There are various techniques to perform this operation. One approach is to make a half moon incision around or below the nipple, and then excess breast tissue, fat and/or skin is removed. Another method is the use of liposuction. A small incision is made under the nipple or towards the armpit. Using a fine cannula (a thin metal tube), the excess breast tissue and fat are broken up and suctioned away. Once the procedure is complete, any incisions are closed with sutures. Your plastic surgeon Dr. Emre Gönen,MD will advise which is the most appropriate technique in your case.
After gynaecomastia surgery you are likely to have some pain/discomfort, swelling and bruising in the chest area. These are temporary and should subside after the first few weeks. It may take several months for your chest shape to settle.Dr. Emre Gönen,MD will advise you as to how long you are required to wear your supportive compression garment and whether it is to be worn day and night.
You must avoid strenuous exercise, heavy lifting and swimming for four to six weeks after surgery. You should only resume driving when you are confident that you can safely perform an emergency stop without experiencing discomfort.
The length of time you will need to take off work will depend on your type of employment but is usually a minimum of one week.
CAUSES of GYNAECOMASTIA
Common causes
- Idiopathic (no other diagnosis found) is most common
- Drug therapy is the second most common cause. Many drugs are implicated, and different drugs result in different modes of gynecomastia development. Some of those more commonly involved include:
- Estrogens and estrogen-like drugs: oral contraceptives, diethylstilbestrol, estrogen-containing cosmetics, estrogen-contaminated foods, phytoestrogens, marijuana, digoxin
- Drugs that cause enhancement of endogenous estrogen formation, either by increased aromatase activity or increased precursors: clomiphene, gonadotropins, hCG administration, anabolic steroids (usually illicit), testosterone replacement therapy
- Drugs that cause inhibition of testosterone action/synthesis: cimetidine, ranitidine, ketoconazole, metronidazole, spironolactone, alkylating agents (eg, cisplatin, busulfan), etomidate, anti-androgens (eg, flutamide, cyproterone acetate), finasteride, heroin, methadone, alcohol
- Drugs with unknown mode of action: methyldopa, calcium-channel blockers, statins, captopril, tricyclic antidepressants, diazepam, penicillamine, isoniazid, phenothiazines, amiodarone, phenytoin, omeprazole, highly active antiretroviral therapy (HAART) for HIV
- Testosterone deficiency: Klinefelter syndrome (XXY), hyperprolactinemia, anorchia, defects of testosterone synthesis, pituitary/hypothalamic failure, testicular failure (due to trauma, mumps, orchitis, renal failure, granulomatous disease)
- Androgen resistance: complete or partial testicular feminization
- Increased estrogen production: testicular tumors, ectopic hCG production (germ cell tumors, bronchogenic carcinoma), true hermaphroditism (from ovotestis), feminizing adrenal tumors (adenoma or carcinoma)
- Enhanced physiologic conversion of testosterone to estrogens: liver disease, adrenal disease, starvation, thyrotoxicosis, increased extraglandular aromatase activity (eg, obesity)
Serious causes
- Testicular cancer
- Bronchogenic carcinoma
- Liver failure/cirrhosis
- Renal failure
- Feminizing adrenal carcinoma
Associated disorders
- Alcohol abuse
- Drug abuse
- Liver failure, hepatic cirrhosis
- Renal failure
- Cardiac failure
- Thyrotoxicosis
- Starvation/recovery from malnourishment
- Adrenal disease (adrenal adenomas/carcinomas)
- Complete or partial androgen insensitivity
- Testicular failure from chemotherapy, radiation, mumps, Klinefelter syndrome
- Testicular tumors
- Bronchogenic carcinoma
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