Gynecomastia – What is it?
Gynecomastia (male breasts, male breast enlargement) is a benign proliferation of breast tissue in men. Gynecomastia (male breasts, male breast enlargement) is a surprisingly common problem in our Caribbean practice of Plastic Surgery and Cosmetic Surgery at Trinidad Institute of Plastic Surgery – between 4% and 69% of teenagers in puberty and 32% and 65% in adult males, depending on the author, suffer from excess of breast tissue. Clients from many of the surrounding Caribbean islands (Barbados, Jamaica, Haiti, St. Vincent and the Grenadines, St. Lucia, Granada, Martinique) and surrounding countries (Guyana, Venezuela) have come to Trinidad Institute of Plastic Surgery to have this often vexing problem taken care of.
The cause of gynecomastia (male breasts, male breast enlargement) is a relative or absolute imbalance between estrogens and androgens during puberty, which favors the growth of breast tissue stimulated by estrogens. This phase of growth usually lasts anywhere between 1-2 years. At the end of puberty follows the phase of fibrosis, where more and more breast tissue is replaced by connective tissue. Fibrosis in gynecomastia (male breasts, male breast enlargement) also implies irreversibility: The fibrotic tissue is less responsive to hormones. Thus even with a clear preponderance of androgens improvement in the appearance of gynecomastia (male breasts) is minimal – without surgical treatment it is and remains too large.
In a certain percentage of clients the hormonal imbalance is due to an underlying cause, especially internal medicine problems (liver disease, kidney disease, thyroid disease, certain medications), lifestyle habits (alcohol, marijuana) or in rare cases, the male breast enlargement is sign of an underlying tumor (hormone-producing gonadal or adrenal tumors or breast cancer in men) .
Gynecomastia – What to do?
Gynecomastia (male breasts, male breast enlargement) should therefore at least be subjected to scrutiny with respect to the possible causes. Whether it will then be operated in the event of idiopathic gynecomastia (no underlying cause found) in adults remains the decision of the client. Adolescents during puberty have a good chance that with the end of puberty gynecomastia (male breasts) will come to an end as well without further surgical therapy.
The surgery for the correction and treatment of gynecomastia (male breasts) depends on the severity of the problem, like so many other issues in plastic surgery. My standard operation (and also those of many other plastic surgeons) consists of a combination of direct excision of the fibrotic breast tissue and liposuction to equalize the tissue thickness of the area under the nipple (now devoid of most breast tissue) to the rest of the chest wall. The small incision around the lower half of the circumference corresponds to the so called periareolar incision used thousands of times per day worldwide for breast augmentation in women and in my experience heals very well in African-American, Caribbean and Indian dark skin types, and virtually never represents a problem in fair skin types such as Caucasians or Asians.
In about ten percent of my clients is gynecomastia (male breasts) so large that a formal breast reduction much the same way it is done in women becomes necessary to reduce the skin envelope at the expense of correspondingly longer scars. Alternatively, sometimes a combination of direct excision with liposuction can be attempted with a concomitant level of uncertainty (will the skin retract enough ?) but potentially shorter scars.
Like many other cosmetic / aesthetic surgery procedures, treatment of gynecomastia (male breasts, male breast enlargement) results in high client satisfaction, improved body image and psychological well-being.
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