Gynecomastia

Aesthetic concerns are one of the major problems of not only women but also men. One of the problems of many men is gynecomastia, which means female type breast growth. The breast tissue in men also consists of fat and breast mass like the breast tissue in women. Breast development in the men is not always due to disease finding. The most common causes of gynecomastia include an unknown etiology or obesity.

How should the operation decision be given?
First of all, the reason of gynecomastia should be diagnosed to proceed with the operation decision. In gynecomastia, which is observed around 15 years of age known as the adolescence period, according to the results obtained by having some tests, the patient should be informed that the current situation will regress spontaneously within 1-2 years and the follow-up would be the right approach. Therefore, adolescence is the lower limit for gynecomastia operation at the age of 18 years. The age of 18 years, which is the end of the puberty, is the lower limit for gynecomastia operation. Surgical decision can be taken for breast developments, which is not related to a certain disease other than adolescence and continues for more than 1 year.

What are the surgical techniques?
After the causes of gynecomastia are investigated, the operation technique and anesthesia to be performed, the grade and the type of gynecomastia is decided by considering the patient’s request and determining whether the gynecomastia is unilateral or bilateral, whether the breasts are different in size and whether there is a palpable mass during breast examination.
The structure of the breast may be fat-based, predominantly breast-tissue or may contain both fat and breast tissue which is called mix type.
Breast ultrasonographic imaging and examination before surgery may give a rough idea. Even if only a laser liposuction is sufficient in a fat-weighted gynecomastia, a surgical mass excision or a laser liposuction along with an excision may be more accurate in gynecomastia that is breast-tissue-weighted and mix types. Surgical excision is performed by cutting approximately 2.5 cm from the lower edge of the colored part of the breast tip, and this incision may become unclear within 6 months to 1 year.
Gynecomastia is divided into three classes according to its grade. In grade 1, a slight breast growth without excess skin occurs. In grade 2, a medium-sized breast growth occurs with or without an excess skin. In grade 3, there is an extensive breast growth with significant excess skin. Especially in cases where excess skin is observed, the type of surgical procedure is determined according to the patient's preference.

Postoperative process
After gynecomastia operations, there is always some excess skin. However, while the skin can collect itself as much as it can in cases where laser liposuction or surgical excision is performed, in some cases the excess skin can be removed in the same session or at least 6 months later.
Recent studies indicate that usually a multi-stage surgery is preferred and that the excess skin may not be removed immediately in the first operation in order to prevent scar or leave a minimum scar especially in moderate skin loosening. Skin saggings which are not too much but rather slight after surgery are often tightened over time, usually due to the special properties of the tissues and the special corset used post-operatively. Due to the healing ability of the scar at the nipple, the laser liposuction entry holes become obscured over time, and the operation is almost performed without scar. In consideration of the patients who still have a slight skin loosening, excess skin can also be removed by small local procedures at least 6 months after surgery. However, especially in severe gynecomastia, since the skin will also be removed during breast reduction, these scars will decrease over time while the initial scars of surgery are apparent.

Surgery duration and type of anesthesia
The average duration of operation is 1-2 hours. The surgery can be performed by local, general or sedative anesthesia. Post-operative pain can be relieved with simple painkillers.