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Gynecomastia

Abnormal and excessive enlargement of male breasts.. This may be distressing to many men because gynecomastia can be referred to as “man boobs.” Most men avoid taking their shirts off and avoid bathing suit season.

What types of gynecomastia are there?

There are four types of gynecomastia:

  1. True Gynecomastia: True enlargement of male breast glandular tissue.
  2. Pseudo-gynecomastia: Excessive fatty breast tissue. Excessive number and size of fat cells or adipocytes is the culprit.
  3. Excessive skin of breasts: The problem here is a large excessive envelope of stretched skin. This type of gynecomastia is common after excessive weight loss and may be referred to as “hanging man boobs.”
  4. Combination of all of the above: Stretch marks are commonly associated with any or all of the above types of gynecomastia.

 In the end, what is the goal of a gynecomastia procedure?

A single, safe procedure that reduces bulky breasts and tightens, lifts and firms the skin. The end goal is to enhance the definition of the chest area.

What causes gynecomastia?

In the case of true gynecomastia, the problem is almost always a result of a long lasting hormonal imbalance where the level of female hormone estrogen is higher than it should normally be. With other forms of gynecomastia, hormonal abnormalities may or may not play a role. Obese males, however, usually have a contributing metabolic or hormonal disorder.

What is adolescent gynecomastia?

During adolescence, young males may have transient increases in levels of testosterone with a corresponding increase in estrogen levels, leading to glandular tissue hypertrophy. This is physiologic and not pathologic process. This short term condition usually resolves spontaneously in few months or few years. However, it may become distressing when it persists past two to three years.

What is drug induced gynecomastia?

Many drugs may stimulate gynecomastia in males. The most notorious drugs associated with gynecomastia are alcohol, marijuana and heroin. Anabolic steroids, such as exogenous testosterone, is another cause of true gynecomastia. Substance induced gynecomastia usually, but not always, resolves after cessation of the substance abuse but definitely reappears if substance usage is resumed. Certain blood pressure and heart medications, and ulcer drugs such as gastric acid inhibitors, may also cause gynecomastia.

Who can benefit from a surgical procedure aimed at reducing appearance of gynecomastia?

Those who are self conscious of their appearance and desire to reduce the size of their breasts can benefit most.

Treatment options

Various surgical procedures may be used to treat gynecomastia, utilizing ultrasonic or laser technology along with traditional surgical techniques. They are as follows:

1) Liposuction: Tumescent liposculpture is normally best for pseudo-gynecomastia, when only excessive fat removal is required.

2) LASER Liposuction: Also known as “Smart Lipo,” LASER liposuction is a technique that combines tumescent liposculpture with the use of Tri-Flex and blended mode lasers to not only dissolve the fat cells, but also to shrink the overlying skin. This technique is appropriate for patients that have excessive fatty deposits along with some loose skin.

3) VASER Liposuction: This “high definition liposuction” utilizes the power of internal ultrasonic VASER probes to break the dense fibrous tissues and disrupt the fat cells for optimal liposculpture results.

4) Thermi-RF: This procedure, which utilizes radio frequency energy, is used in conjunction with tumescent liposculpture to further tighten the loose skin envelope. This procedure is especially effective if excessive laxity of the skin is a problem. During the Thermi-RF procedure, a very thin probe is introduced under the skin through two or three tiny, inconspicuous incisions that are no larger than a needle point. The probe heats the undersurface of the skin via radio-frequency energy. The result is controlled skin retraction and tightening.

5) Excision of Breast Gland: Breast gland excision is a surgical procedure, during which a direct excision of abnormally large and excessive breast glandular tissue is performed. It may be accompanied by resection of redundant skin envelope around the breast. This is the final answer for true glandular gynecomastia.

The goal of all the aforementioned procedures is to diminish the “man boob” look and reduce the size of a male breast, along with contour and enhance chest definition. Surgical scars may slowly retract and become faint but will remain, hence, as all other cosmetic surgical procedures, the methods above are aimed at improvement and not perfection.

What other procedures can enhance a gynecomastia result?

J-Plasma is a new, innovative treatment that is proving to be an excellent compliment to traditional gynecomastia surgery. J-Plasma is the latest skin tightening technology, which is performed after the liposuction (on the same day) of the male breasts. This add-on procedure further tightens the skin and shrinks overlaying, loose skin of the chest. The end result is a desirable, masculine contour of the male chest.

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Dr. Leon Forrester Tcheupdjian

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