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Male Breast Reduction (Gynecomastia) gynecomastia

lipomastiaWhat is Gynecomastia?

Gynecomastia, a condition of over-developed or enlarged breasts in men, is common in men of any age. It can be the result of hormonal changes, heredity conditions, disease or the use of certain drugs.

Many men suffer from the problem of enlargement of the breast. That limit their abilities for wearing of certain types of cloths or enjoy the sport of swimming. Others suffer from sham with their wives or lack of self-confidence among their friends. So problem of gynecomastia is a real problem that need to be eliminated surgically.

Gynecomastia may be present:
- Excess localized fat or - Excess glandular tissue development or - A combination of both excess fat and glandular tissue
- unilaterally (one breast) or - bilaterally (both breasts)
- First Degree or - Second Degree or - Third Degree
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Anatomy of Male Breast?anatomy of male breast

To understand and get rid off this problem, you must first know the anatomy of the male breast. The normal male breast has a contour made by muscle, glands, fat, and skin.

The Breast is a modified gland under the skin looks like a large sweat glands and is characterized by the growth in female to be the factory of milk (breastfeeding). These glands of the breast under the skin covered by fat tissues. They also are rested over the chest muscles (the pectoralis muscles).

There can be glandular tissue that can range from a very small to quite large mass. Contour of the chest comes from the underlying elements. Muscle shape is important for the shape of the breast, exercise can be important to improve the "male look" by improving the tone of the muscles.

Excess fat or gland especially along the lower breast can make the chest have a "female" contour. Diet and exercise can help with generalized fat, but cannot be directed to the specific shape of the chest fat.


What are The Causes of Enlargement of Male Breast (Gynecomastia)?

Male breast tissues for several reasons:
- hormonal changes at puberty (Physiological Gynecomastia) and the use of hormonal steroids, growth hormones and amino acids to augment the muscle without doctor supervision in the gyms,
- Genetic causes
- Some of the diseases as chronic liver diseases or medications that are used permanently (as Metronidazole, Cimetidine, Finasteride, Diazepam, Steroid abuse, Digoxin)
- Obesity and fast food abuse.
- Alcohol abuse
- Some medical conditions as Gilbert's Syndrome and Klinefelter's Syndrome

Especially with the onset of puberty, the accumulation of fat occurs in this region, whether through glands or around it and proliferation of the glandular tissues.
Then by eighteen or elimination of the cause, the hormonal proliferated glands loss their hormonal support, so they will shrink and become fibrosis. This Fibrotic mass will trap the fatty tissues in between and the mass continues in that mode the rest of life.

This Fibrosis changed only to enlarge by accumulation of fat outside the cluster, and may be less after diet regimens and sports as a result of burning those outer fats, but the fibrotic glands remain constant.


What are The Types and Degrees of Gynecomastia?

Gynecomastia can be classified into three types:
- Excess localized fat
- Excess glandular tissue development
- A combination of both excess fat and glandular tissue

Gynecomastia can be:
- unilaterally (one breast)
- bilaterally (both breasts)

site of gynecomastia


Gynecomastia can be classified into three Degrees or grades: (according to enlargement and sagging of the skin)
- First Degree: there is a simple breast hypertrophy.
- Second Degree: there is enlargement of the breast with less than five centimeters projection with or without skin sagging (advanced second degree).
- Third Degree: similar to the female breast in terms of size and shape.

degree of gynecomastia


These classifications help in choosing the ideal surgical technique to eliminate this problem.

N.B. There is no medical treatments for the treatment of gynecomastia, only in the early stages before the eighteen years such as tamoxifine. But the surgical procedures will be the only available option after this age (18 years)


Is it right for me?

This procedure is a good option for you if:
- You are physically healthy and of relatively normal weight.
- You have realistic expectations.
- Your breast development has stabilized (age more than 18 years).
- You are bothered by the feeling that your breasts are too large.

Surgical correction of gynecomastia is best performed on:
- Men whose condition cannot be corrected through alternative medical treatments
- Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing
- Men with a positive outlook and specific goals in mind for improving the physical symptoms of gynecomastia


How is Treatment of Gynecomastia performed?

During first consultation in El Rouby Clinic, you should have real reasons and desired results because the results may be elimination or reduction of the breast size. Dr. Mohamed El-Ruby will explain the steps, results and costs accordingly.
You can also see pictures of similar cases to imagine the final results shape. You'll be informed also about the complications that may occur, and summarized in some swelling and bruising which will disappear within a week after the surgery, or accumulation of some fluid under the skin.

- The Procedures usually takes one to one and half hours.
- It Could be under Local anesthesia with sedation or under General anesthesia.
- Gynecomastia management is performed in a hospital after laboratory investigation for general checkup

Treatment of first and second degree:

- An one cm incision is made between the skin of the areola (dark skin) and normal breast skin (light skin). Therefore, the surgery does not leave any scars.
- We will start to do liposuction (by laser, Smart-lipo or traditional methods):
- The traditional means: injection of hyperosmolar fluids which are absorbed by fat cells to explodes these cells and liquefied fat will be sucked out.
- The laser or Smart-lipo means: use of a needle laser to break down fat cells and then liquefied fat is sucked out.

- Through the same opening the glandular tissues is withdrawn as a piece.

steps of gynecomastia



Treatment of third-degree and advanced:

- Similar to the previous method in terms of liposuction till removal of the glands, but we will do a donut circular excision to remove the sagging skin.

3rd grade gynecoamsatia



What is After?

After any of the two techniques, a corset-VEST- will be applied to avoid haematoma and swelling.
After complete recovery within two hours you can get out of the hospital and the practice of your normal life.

- After three days of operation, the first follow-up visit and then you can takes your shower.
On the fifth day, the stitches will be removed.
- The Vest remain for 6 weeks at least to prevent accumulation of tissues in treated area again. After that, some massage of the treated area will be needed to get the final results within the third month after the operation.

Will there be scars? Any surgical treatment to correct gynecomastia will require incisions. While most incision lines are concealed within natural contours, some may be visible and are a necessary result of breast reduction surgery.

The results will be long-lasting. The final results of breast reduction in men are permanent in many cases.


How much will gynecomastia surgery cost?

Although price is a factor when deciding on surgery, the most important factor is that you feel you are getting a good quality, natural-looking result from the procedure.

Gynecomastia costs are variable according to the degree, type and the used technique. Usually the cost is ranging from 1500 to 2500 U.S. dollars. Most medical insurance providers do not cover the procedure.


FAQ when considering undergoing Gynecomastia management?

Q - What is the type of anesthesia, and when I can return to normal life?
A - According to your preference and the technique, General or Local anesthesia, and you can practice your normal life 2 hours up to few weeks.

Q - What are the symptoms that may occur in the first five days after gynecomastia treatment procedures?
A - Soreness which could be managed by pain killer’s medications and there may be edema or swelling of the chest skin.

Q - What are the guarantees that the success of the process?
A - There is no doubt that the followers of the medical instructions and close follow up visits are the main factors for the success of any surgical procedure. If not, the process to achieve the agreed outcomes before, the process repeats at reduced cost after 6 months.

Q - When can we get the final results?
A - The final results is achieved after the first three months.

Q - Is the chest area seems naturally?
A - Yes, without any obvious scars especially in first and second degrees.

Q - What is ideal age for surgery?
A - It could be done at any age after 18 years.

Q - If you are not Egyptian, What is the minimum period for follow up?
A - Five days.

Q - What are the contraindications of Gynecomastia procedures?
A - There are no absolute contraindications but the patients should inform their surgeons about any allergies, serious medical conditions, and medications they may be taking. Smokers should stop smoking 2 weeks before surgical procedures to promote the healing process.

Q - Where will the Gynecomastia surgeries be performed?
A - In hospital.

Q - Is there any non surgical solution to reduce enlarged male breast?
A - No, the surgical liposuction of fatty element and excision of glandular and skin element is the only reliable solution for gynecomastia.

Q - How much does Gynecomastia surgery cost and what elements factor into that cost like hospital fees, anesthesia, and so on?
A - Ranging from 1500 to 2500 U.S. dollars. Medical insurance dose not cover this procedures.

Q - What is the surgeon’s level of experience in performing Gynecomastia surgery?
A - Consultant or Doctoral in Plastic surgery.

Q - What percentage of patients experience complications with fat injection procedures?
A - 2 - 3%


Summary of Gynecomastia surgeries:

The time of the procedure: from one to two hours.
Type of anesthesia:
local anesthesia with sedation or General.
Location:
hospital without postoperative hospital stay.
Expected Side effects:
Temporary swelling and bruising.
Recovery time:
return to work after 2 hours and the final outcome within 3 months.
Cost:
according to procedure ranging from 1500 to 2500 U.S. dollars.
Results: Permanent results.