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Gynecomastia Details Beverly Hills

Gynecomastia Characterizations
Gynecomastia is characterized by:

  • Excess localized fat
  • Excess glandular tissue development
  • A combination of both excess fat and glandular tissue
  • Gynecomastia may be present unilaterally (one breast) or bilaterally (both breasts)

Due to various reasons, some men develop their female-like breasts (gynecomastia) as a result of excess tissue and fat in the chest area when the male is having hormonal changes. It is usually first noticed during the adolescent years when up to 65 percent of 14-year-old boys have enlarged breasts, according to the American Academy of Family Physicians. This is largely due to the fluctuations in sex hormones that occur during puberty and normally the excess breast tissue disappears without treatment in two years in 75 percent of these boys and within three years in 90 percent of them.

Gynecomastia may occur in one or both breasts and starts as a small lump beneath the nipple, which may be tender. The breasts often enlarge unevenly. Gynecomastia is usually a benign (non-cancerous) condition that may be caused by many different hormonal changes, or, in some cases, the cause may be unknown. The changes in hormones usually include an increase in estrogens or a decrease in androgens (testosterone). Among older men, gynecomastia often results from decreasing levels of the male sex hormone testosterone, which diminishes with advancing age. In addition, men experience an increase in body fat with age and a resultant rise in the ratio of the female sex hormones (estrogens) to the male sex hormones (androgens). In some cases, the appearance of fat on the chests of men and boys is not gynecomastia, but pseudogynecomastia, a condition that may resolve with diet or exercise. By contrast, true gynecomastia will not improve with diet and exercise.

Sometimes, the symptoms of gynecomastia may resemble other medical conditions or problems that must be ruled out in order to make a diagnosis.

Diseases that may cause enlarged breasts include:

  • Any conditions that interfere with normal testosterone production
  • Some tumors, such as those involving the testes, adrenal glands, or pituitary gland
  • Hyperthyroidism (the thyroid gland produces too much thyroid hormone)
  • Kidney failure
  • Liver failure and cirrhosis
  • Malnutrition
  • Breast cancer
  • Lung cancer
  • Congenital Syndromes

Once a definable medical reason is ruled out, surgical techniques can be applied very effectively to remove your breast fullness.

Gynecomastia Techniques
The techniques used by Dr. Moelleken to treat gynecomastia depend upon the quality and quantity of your excess tissue and skin. The two methods most commonly used in breast reduction for men include suction lipectomy in which your breast tissue is tapered for a natural look and endoscopic surgery where a tiny incision is made in your chest to insert a small, flexible tube with a light and a camera. In some cases, liposculpture is helpful in removing the fibrous fat and breast tissue that develops in the male chest. If the breast tissue is too dense and firm, occasionally a small incision hidden around the areola is necessary in order to remove it and when the skin is very loose and thin and will not likely tighten up after tissue removal, an excisional skin procedure may be necessary. Plastic surgery to correct gynecomastia is technically called reduction mammaplasty, and it reduces breast size, flattening and enhancing the chest contours. In severe cases of gynecomastia, the weight of excess breast tissue may cause your breasts to sag and stretch the areola (the dark skin surrounding your nipple). In these cases, the position and size of the areola can be surgically improved and excess skin may be reduced.

During your consultation, Dr. Moelleken will discuss the following procedures with you and help you choose the procedure to provide the best optimal outcome for your situation.

The options include:

  • For pseudogynecomastia, men liposuction or liposculpture of the pseudogynecomastia is used to remove the fatty tissue by suction using a negative pressure source (pump or syringe). This technique is usually performed with the tumescent method to decrease bleeding.
  • For true gynecomastia, tissue cannot be suctioned and has to be removed by surgical excision. Usually performed through the lower part of your areola (between the pigmented part and the skin,) this procedure will normally leave inconspicuous scars.
  • For a combined pseudogynecomastia (fatty tissue) and true gynecomastia (breast tissue,) the treatment of choice is a combination of surgical excision and liposuction for better breast contour.

For treatment of severe gynecomastia, if you compare the male breast to the female breast size (A, B, C, D, DD, etc.,) there are a few modalities of treatment available:

  • Periaureolar (incision around your nipple aureola complex) male breast reduction: this procedure is meant for mild to moderate reductions. This can be compared to size A and B in women.
  • Classical breast reduction with superior or inferior flaps: this is for larger breasts (C, D) and leaves an inverted xTx incision and periaurieolar incision and is used rarely.
  • Vertical incision breast reduction that results in a vertical subareolar scar (not horizontal scar) in large breasts: this is new and promising alternative.

Gynecomastia Procedure
Your initial consultation with Dr. Moelleken will require your complete medical history so you should be prepared to provide the necessary information. Dr. Moelleken will examine your breasts and a breast x-ray may be recommended to determine how much fat and glandular tissue is contained in your breasts. This information will help Dr. Moelleken plan the best procedure for your needs and the consultation is also an opportunity for you to ask all of your questions and express any concerns. Dr. Moelleken will give you specific instructions of what to do before your procedure including, proper diet, taking certain vitamins and medications, and stopping cigarette or other smoking for at least two weeks prior to and after your procedure. It is imperative that you follow his guidelines as smoking decreases circulation and impedes healing.

Your breast reduction surgery will be an outpatient procedure, performed at Neo Surgical Center. The surgery takes approximately one hour, although individual factors may increase the length of the procedure. You will be sedated and Dr. Moelleken will use either general or local anesthesia, which will be decided during your surgery planning consultation.

Depending on the previously chosen technique, Dr. Moelleken will make an incision in an inconspicuous location; either on the edge of the dark skin around your nipple or in your underarm area. Through the incision, he will cut away the excess glandular tissue, fat, and skin from around your areola and from the sides and bottom of your breast. If Dr. Moelleken has determined that liposuction will be used in conjunction with excision to remove excess fat, the cannula, which is a slim, hollow tube attached to a vacuum pump, will be inserted through the incisions. In a reduction involving greater amounts of excess tissue, larger incisions may be necessary resulting in more noticeable scars.

If Dr. Moelleken has determined that your gynecomastia consists primarily of excessive fatty tissue, he will consider liposuction/liposculpture as the appropriate surgical technique for removal of this tissue. At the edge of your areola or in your underarm area, he will make a very small incision, less than a half inch in length, and insert the cannula. Dr. Moelleken will move the cannula through the layers beneath your skin, breaking up the fat and suctioning it out. In cases where large amounts of tissue have been removed, it may be necessary for excess skin to be removed as well so the remaining skin will adjust to fit your new breast contour. Occasionally, a small drain will be inserted through a separate incision to relieve excess fluids. Upon completion, your incisions will be covered with a dressing and your chest may be wrapped with an elastic bandage to hold your skin firmly in place.

Gynecomastia Recovery and Results
It is normal to feel some discomfort for a few days after your procedure and this can be controlled with prescribed medication. You should arrange to be driven home after your surgery and have someone help you manage for a day or two if necessary. Bruising and swelling may occur and you will most likely be instructed to wear an elastic pressure garment around the clock for at least two weeks then at night for several weeks until you heal. Any extreme swelling will resolve in the first few weeks but it may be three months or longer before your true result is visible. While you are waiting for this outcome, it is important to begin to resume normal activity. You should walk around on the day of surgery and return to work within a day or two after the procedure. You should avoid sexual activity for approximately two weeks and strenuous exercise for three weeks. You must avoid any activity or job that risks a blow to your chest area for at least a month. You should avoid exposing your scars to the sun for at least six months because sunlight will darken your scars permanently.

Gynecomastia surgery will greatly improve your appearance but it is important to remember that individual results are unpredictable. Before undergoing any plastic surgery procedure, Dr. Moelleken encourages his patients to discuss their expectations candidly so realistic expectations will be recognized. The results of the procedure are significant and most patients are extremely satisfied with their improved physique. As with all surgery, although rare there are possible risks and these will be discussed during your consultation.

Causes of Gynecomastia
There are dozens of known contributing factors to the development of gynecomastia.

Some of these include:

  • Obesity
  • Alcohol
  • Marijuana
  • Steroid Abuse
  • Thyroid disease
  • Testosterone deficiency
  • Specific medications; digoxin (a heart medication), spironolactone (a diuretic), cimetidine (a stomach medication), and others.
  • Liver or kidney failure
  • Chronic kidney disease
  • Tumors in the testicles, stomach, or pituitary gland
  • Trauma
  • Congenital syndromes present at birth
  • Natural aging
  • Some prescription medications and medication containing estrogen
  • Use of herbal testosterone additives
  • Klinefelter Syndrome
  • Gilbert’s Syndrome
  • Puberty
  • Testicular hormone production irregularities

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