Marisa Marques

Gynecomastia

(surgery on an outpatient basis or an internment day on average)

Gynecomastia is caused by an increase in ductal tissue, stroma, and/or fat in the male breast. Most frequently, the changes occur at the time of hormonal changes: infancy, adolescence, and old age. Gynecomastia is present in almost 66% of adolescent boys and the incidence rises again in older men (older than age 65 years).

The most common cause for gynecomastia is idiopathic but the reasons may be hormonal or hereditary.

If the disorder is mainly caused by fat and less breast tissue, the correction can be done by liposuction. In the case of a gynecomastia caused mainly by breast tissue proliferation, a size reduction operation is necessary. In this case the breast tissue is removed, and if necessary the bigger areola is corrected to give a more masculine look. In more severe gynecomastia skin resection is almost always required.
 
Postoperative care
The operation can be done in ambulatory care, or as an out-patient. The patient is advised to wear tight compression garments for 6 weeks after the surgery. Normal athletic activities may then be performed.
 
Complications
 
Acute complications
The rate of complications correlates directly with the amount of tissue resected.
Hematoma: The most common early complication after gynecomastia surgery is hematoma. Postoperative closed suction drainage decreases the incidence of this complication.
Fat necrosis: When this complication occurs, the patient notes a palpable hardness of the breast. Small areas of fat necrosis can be managed conservatively, especially if there is no skin necrosis. If skin and fat necrosis is extensive and associated with infection, surgical debridement and topical and intravenous antibiotics are required.
 
Chronic complications
Underresection: Is the most common long-term complication of gynecomastia surgery. This is particularly common in liposuction cases, when a residual mass of tissue is not removed.
Overresection in the nipple areola: Can result in a saucer-type deformit that is difficult to correct. Loose skin is usually not considered a complication if it is part of the operative plan. Occasionally, loose skin occurs in an unexpected manner, and surgical excision is required.


Be sure to consult the Contextualization and Awareness links