It can occur in boys and men of all ages and is most common in infancy and adolescence and in middle-aged to older men.
Gynaecomastia is a benign proliferation of the glandular component of the male breast and is caused by an increase in the ratio of oestrogen to androgen activity.
It can be unilateral or bilateral and consists of a palpable mass of tissue with a diameter of at least 0.5 cm, usually presenting as a disc of tissue underlying the nipple.
Gynaecomastia is commonly associated with breast pain, which can range in intensity from mild tenderness or sensitivity to constant pain and tension.
Clinical Findings and Evaluation
Pseudogynaecomastia (fatty breast) is common in obese men and must be differentiated from true gynaecomastia.
In true gynaecomastia, there is usually a button of firm subareolar tissue, or less commonly a more diffuse collection of fibroglandular tissue that resembles that of the female breast.
Although frequently bilateral and symmetrical, gynaecomastia of any cause can be unilateral or asymmetric.
Men with asymptomatic, incidental gynaecomastia should not be subjected to exhaustive endocrine evaluation.
The breasts should nevertheless be examined in detail to rule out the likelihood of breast cancer.
Men with recent onset breast enlargement or who present with painful breasts require a more detailed evaluation to search for a possible underlying cause including testicular tumours.
The majority of patients with gynaecomastia require no treatment other than removal of the precipitating cause.
If it is drug-induced, it may regress if the offending medication is stopped.
Specific treatment for gynaecomastia is indicated in cases where it produces significant pain, embarrassment or emotional discomfort and therefore interfering with the patient’s life.
Two forms of treatment have been used to alleviate the development of gynaecomastia: surgery and medical therapy.
When gynaecomastia has been present for more than 2 years, medical therapy is not usually effective and surgery may be the only available option. Surgeons aim to reduce the breast size to normal contours, to eliminate painful tissue and to restore the patient’s chest to an acceptable cosmetic shape.
- hemicircumareolar or periareolar incision and preservation of the nipple.
- A circumareolar incision has also been described.
- Understandably, surgery is associated with complications,
- such as a doughnut deformity, nipple necrosis, nipple flattening, inversion
- or loss of sensation and therefore, should be performed by surgeons with appropriate experience.
- Slim Lipo can correct abnormal and excessive collections of adipose tissue
- and is regarded by many investigators as one of the most effective treatments for gynaecomastia
- as it is associated with few adverse sequelae . However, it is important to underline that liposuction is probably less effective in patients
- with true glandular gynaecomastia . Classically, Slim Lipo, a narrow cannula is inserted and used to vacuum the adipose tissue.
- The cannula is pushed then pulled through the fat layer, breaking up adipocytes and suctioning them out.
- Several variations of the basic technique of suction lipectomy have been recently introduced.
- In the tumescent (wet) technique, large volumes of fluid, sometimes as much as three times the amount of fat to be removed, are injected.
- Because the injected fluid contains an adequate amount of anaesthetic, additional anaesthesia is usually not required;
- however, the procedure takes significantly longer than traditional liposuction.
- A.L., or powered liposuction, power-assisted liposuction involves the use of a powered liposuction cannula handle
- which superimposes an additional movement to the liposuction cannula.
- That is, a smaller and different motion on top of the normal to-and-fro advance and withdrawal of the cannula.
- There are two different types of motion in powerd liposuction systems.
- The movement can be either a small to and fro motion, or it can be a partial rotation type of motion of the cannula.
More efficient removal of the fat allows the liposuction procedure to be proceeded more smoothly and more rapidly.
Greater comfort, decreased bruising, decreased swelling, and thus a more rapid recovery may also result.
In addition, more fat may be able to be removed from difficult-to-treat areas, such as those where tissue is more fibrous and fat is otherwise more difficult to remove.
It should be noted that surgical excision of excessive skin is not usually required as the skin shrinks after the removal of the underlying tissue especially in young men.