Gynecomastia

Types of gynecomastia

The gynecomastia refers to the unilateral or bilateral enlargement of the male breast. An enlargement of the mammary gland is detectable in over 60 per cent of newborn due to a trans-placental passage of estrogen. During puberty, the mammary glands swell in about 50-60 percent of boys usually temporarily. This pubertal gynecomastia regresses spontaneously again within one to two years. According to latest studies, pseudo gynecomastia (Lipomastie) also occurs predominantly in the Senium with over 60%.

The pseudo gynecomastia in the context of obesity is fat accumulation, which leads to the appearance of a breast augmentation. However, in addition, the mammary gland tissue is enlarged at the real gynecomastia. Mixed forms are possible. Gynecomastia often goes hand in hand with pain and feelings of tension

What is the cause of gynecomastia?

Cause of breast augmentation is the ratio of estrogens to androgens: if the estrogen effect predominates, the glandular tissue grows. There may be an increased responsiveness of hormone receptors of the mammary gland to female sex hormones or their stimulation by gonadotrophic hormones. Gynecomastia can be also a symptom of systemic diseases. This is to be considered in the diagnosis. The case history provides evidence of a possible drug-induced breast change.

Gynecomastia has been reported in the use of estrogen-containing hair waters. The consumption of anabolic steroids, alcohol, heroin, marijuana can also cause gynecomastia.

When it should be operated?

Primarily the causal therapy must be pursued according to the detailed medical history and individual diagnosis. Causative general diseases must be treated consistently as well as causative drugs must be discontinued or replaced. Drug treatment is possible in the proliferative phase by means of anti estrogens (tamoxifen or clomiphene). Danazol as anti-estrogen and weak androgen can also inhibit the growth of breast and reduce soreness. In an endocrine hypogonadism, replacement therapy can be carried out with testosterone.
The surgical treatment of Gynecomastia may be necessary if patient complains about soreness, the formation of a distinct nodule or a psychological distress due to the effeminate breast. The nursing problems and inflammatory affections of the skin, which can exist with Makromastien or sagging, also give rise to a surgical therapy. In case of puberty Gynecomastia, a wait and see observation is recommend, as a spontaneous decline is likely.
The surgical therapy of male breast should be reserved for the medical specialists of the plastic and aesthetic surgery. Just within the framework of the six-year residency training in plastic surgery, all aspects of soft tissue surgery and all the breast surgery techniques are imparted distinctly. In case of pseudo Gynecomastia with the pure fat accumulation, liposuction is the method of choice, if there is no significant sagging. The intervention is carried out depending on to sucking quantity either in local anesthesia or general anesthesia. An infiltration of the tissue should be used for better exhaust capability. Regarding barely visible stitch incisions near the armpit and chest, the “softened” fat is sucked.