Gynecomastia – male breast

About Gynecomastia – male breast

When men grow breasts ….
towards the flat and male breast!
For men, a female appearing breast means a strong psychological burden. Men very conscious of body often suffer from the stigma. Real gynecomastia must be treated by a surgical removal of the gland. The method of selection for the fake gynecomastia with the pure fat accumulation is mostly the liposuction. In case of distinctive features of gynecomastia and lipomastia as well as skin sagging, plastic and aesthetic surgery offers different reduction plastic surgery.

Gynecomastia – male breast

Types of gynecomastia

The gynecomastia refers to the unilateral or bilateral enlargement of the male breast. An enlargement of the mammary gland is detectable in over 60 per cent of newborn due to a trans-placental passage of estrogen. During puberty, the mammary glands swell in about 50-60 percent of boys usually temporarily. This pubertal gynecomastia regresses spontaneously again within one to two years. According to latest studies, pseudo gynecomastia (Lipomastie) also occurs predominantly in the Senium with over 60%.

The pseudo gynecomastia in the context of obesity is fat accumulation, which leads to the appearance of a breast augmentation. However, in addition, the mammary gland tissue is enlarged at the real gynecomastia. Mixed forms are possible. Gynecomastia often goes hand in hand with pain and feelings of tension.

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What is the cause of gynecomastia?

Cause of breast augmentation is the ratio of estrogens to androgens: if the estrogen effect predominates, the glandular tissue grows. There may be an increased responsiveness of hormone receptors of the mammary gland to female sex hormones or their stimulation by gonadotrophic hormones. Gynecomastia can be also a symptom of systemic diseases. This is to be considered in the diagnosis. The case history provides evidence of a possible drug-induced breast change.

Gynecomastia has been reported in the use of estrogen-containing hair waters. The consumption of anabolic steroids, alcohol, heroin, marijuana can also cause gynecomastia.

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On account of the Association of Gynecomastia with testicular tumor, a previous performance at the urologist is useful. The presence of an adrenal gland tumor or a pituitary adenoma should also be considered. Particularly during unilateral breast enlargements, a breast cancer must be ruled out. A sonographic control and an additional X-ray examination are recommended especially with hardened and nodular findings.

The endocrine laboratory diagnosis includes testosterone, estradiol, LH, FSH, HCGH. In addition, in case of suspicion, liver function tests, kidney values as well as tumor markers should be determined. In 50% of cases, no cause for the mamoplastia is found (Idiopathic Gynaecomastia).

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When it should be operated?

Primarily the causal therapy must be pursued according to the detailed medical history and individual diagnosis. Causative general diseases must be treated consistently as well as causative drugs must be discontinued or replaced. Drug treatment is possible in the proliferative phase by means of anti estrogens (tamoxifen or clomiphene). Danazol as anti-estrogen and weak androgen can also inhibit the growth of breast and reduce soreness. In an endocrine hypogonadism, replacement therapy can be carried out with testosterone.

The surgical treatment of Gynecomastia may be necessary if patient complains about soreness, the formation of a distinct nodule or a psychological distress due to the effeminate breast. The nursing problems and inflammatory affections of the skin, which can exist with Makromastien or sagging, also give rise to a surgical therapy. In case of puberty Gynecomastia, a wait and see observation is recommend, as a spontaneous decline is likely.

The surgical therapy of male breast should be reserved for the medical specialists of the plastic and aesthetic surgery. Just within the framework of the six-year residency training in plastic surgery, all aspects of soft tissue surgery and all the breast surgery techniques are imparted distinctly. In case of pseudo Gynecomastia with the pure fat accumulation, liposuction is the method of choice, if there is no significant sagging. The intervention is carried out depending on to sucking quantity either in local anesthesia or general anesthesia. An infiltration of the tissue should be used for better exhaust capability. Regarding barely visible stitch incisions near the armpit and chest, the "softened" fat is sucked.

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Skin rationalization with sagging skin

In case of sagging skin, a breast lift should be considered. A two-stage approach to an eventual rationalization makes sense, as after an extraction, certain tightening effect occurs and the retraction should be waited for at least six months.

If there exists sagging, plastic surgery allows various techniques of rationalization. At low to moderate grade sagging, the so-called periareolar rationalization provides good results with inconspicuous scars. Here, a ring-shaped skin area around the areola is removed superficially and the frequently enlarged areola may also be reduced. Since the diameter of the outer edge of the wound is significantly larger than the wound edge of the areola, a seam just under a strong folding of the outer edge of wound around the areola is possible. The surgical suture is multilayered. A non-resorbable recessed purse-string suture of the outer edge of the wound ensures a long lasting result of rationalization without scars widening. With proper indications and technology, initially confusing and unsightly periareolar wrinkling disappears at the latest within three months.

Stronger sagging or massive Lipomastien, which are similar to female breasts, require more extensive reduction plastic surgery. In this case, the techniques achieve the application of resection of excess tissue units, which are scars richer. In addition to a scar around the areola, at least a scar from the lower pole of the breast areola to the breast fold or a transverse scar at the level of areola is produced. Possibly another scar along the breast fold may be required for the effective rationalization so that a scar results in the shape of an inverted "T". With massive Makromastien, a reduction mammaplasty with free nipple transplantation may be necessary for correction.

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The surgical technique in a real gynecomastia

A real Gynecomastia feels often significantly rough and can be painful. A possible complete resection of the abnormal tissue is aimed at. The extraction technology can not guarantee this certainly. In addition, the histological examination of tissue is complicated by the extraction technology. A complete removal of tissue in the context of a subcutaneous mastectomy is usually very successful by a semicircular incision along the lower areola pole. The operation can be performed both in local anesthesia and general anesthesia. An infiltration of the tissue facilitates the preparation. From a cosmetic perspective, it is important to leave a layer of tissue of at least 0.5 cm thickness behind the areola to avoid the appearance of this sunken region. In the remaining preparation zone, a layer of fat of about the thickness of the subcutaneous layer of the upper abdominal region should be left. An additional liposuction of the preparation border zone optimizes the cosmetic result. Usually, the liposuction size runs along the side thorax and towards the armpits and shoulders. For areola reduction and rationalization at moderate sagging, this subcutaneous disarticulation of the mammary gland can be easily combined with above described periareolar rationalization in one sitting. For massive Gynecomastia findings, the above reduction techniques are used.

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Reimbursement possible? - Insurance providers more and more restrictive

The boundary between medical and cosmetic surgical treatment indication is often inconclusive. The decisions of the insurance providers with regards to the acquisition of treatment costs are sometimes incomprehensible. The austerity measures of the health system can appear increasingly restrictive for the reimbursement of surgical treatment.

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