
Gynecomastia (Direct excision or lipossuction)
Gynecomastia is characterized by breast augmentation in men, and is due an increase in ductal tissue, stroma, and/or fat. It can be unilateral or bilateral. It is the most common breast problem in men. Most males experience some degree of gynecomastia during their lives. Overall incidence is up to 40%. Up to 65% of adolescent boys are affected and Up to 75% of cases are bilateral.
Gynecomastia is most commonly idiopathic (of unknown cause), but in some cases, it can be associated with hereditary, hormonal or pathological disorders. Decreased testosterone levels in the neonatal period, adolescence or old age; some tumours; liver or kidney changes may be the origin for gynecomastia. Some drugs are also associated with breast augmentation in men.
There is no increased cancer risk for patients with gynecomastia.
Surgery
Underlying causes of gynecomastia must be investigated. If underlying causes are not found, and if there is no resolution of the condition in 12 months, surgery may be proposed.
Liposuction: used when gynecomastia is caused mostly by fat. Only two small incisions are made.
Direct excision
Open technique, direct resection of the gland through a periareolar incision. Mainly used when gynecomastia is caused by an excess of mammary gland or skin.
Each case is different.The best technique for your case will only be determined after careful evaluation in an outpatient appointment.
Technical points
The surgical procedure duration varies according to the volume and type of tissue to be removed (fat or breast tissue) and type of surgery performed (direct excision or liposuction). Both procedures can be performed under general anesthesia or sedation and local anesthesia. It can be performed on outpatient or inpatient basis (1 night), according to your preference.
Postoperative care
Medication
- Acetaminophen or ibuprofen for routine pain control.
- Prophylactic antibiotics (short course)
Compression vest
4 weeks
Liposuction
Serohematic drainage through surgical incisions is common during the first 3 days
Direct excision
- May be used and will be removed after drainage reduction
- Usually this happens 1 to 2 days after surgery
Activity
- Light aerobic exercise or professional activity after 4 days
- Heavy lifting after 4 weeks
Complications and surgical risks
Both techniques used for gynecomastia treatment, direct excision or liposuction, are associated with their own complications. Some are more frequent:
- Hematoma
- Seroma
- Infection
- Wound-healing complications
- Overresection or underresection