What is Gynaecomastia?

Gynaecomastia is the benign enlargement of the male breast (usually occurs in both breasts but can also occur unilaterally) and can take place at any age. Clinically is defined as the presence of increased glandular tissue extending concentrically beyond the nipple. Gynaecomastia should be differentiated from pseudogynecomastia (lipomastia), which is manifested as fat deposition without glandular proliferation, despite the fact that both conditions may co-exist.

Gynaecomastia is a condition that may cause emotional distress as well as affect male self-confidence. Some men may avoid some physical activities or even avoid finding a partner because they are ashamed of their problem.

The main causes of Gynaecomastia are the following:

• obesity or sudden weight fluctuations
• hormone disorders
• heredity
• use of certain medicines or substances

Rare causes of Gynaecomastia may be related with:

• organic liver disease (cirrhosis)
• organic kidney disease
• genetic thyroid conditions
• testicular tumours, adrenal gland tumours, breast tumours
• Kleinefelter Syndrome

Th Plastic Surgeon who specializes in gynaecomastia correction techniques, through clinical examination and preoperative check, should recognize the cause and the extent of gynaecomastia in order to offer the best result.

Who is a good candidate for Gynaecomastia?

Candidates for a gynaecomastia are the following:

• men where gynaecomastia is not the symptom of an underlying disease
• men who are bothered by the feeling that their breast is extremely large
• men whose breast growth has been stabilized
• men whose condition cannot be corrected with alternative therapies
• men who do not use medicines or substances that cause gynaecomastia
• men who have relatively normal weight
• men with realistic expectations

In addition, teenagers may benefit from gynaecomastia surgery although they should be aware that since their breasts continue to grow, a re-operation may be necessary.

What to expect at your first appointment

At your first appointment, you will discuss:

• what exactly is your concern in the appearance of your breast and if gynaecomastia surgery is the appropriate treatment for you
• your past medical history, if you are on any medication, vitamins or other herbal supplements (including steroids), if you have any allergies or any other operations in the past
• if you have family medical history related to the occurrence of gynaecomastia

Afterwards, Dr Karmiris:

• will evaluate your general health condition and any other risk factors
• will ask for diagnostic test in order to exclude potential causes of gynaecomastia
• will examine you and will take all the detailed measurements from your breast size and shape and he will evaluate your skin quality and positioning of nipples
• will take preoperative photographs
• will discuss with you all possible surgical options, depending on your case
• will discuss with you all possible results and risks or potential complications, as described in the international literature
• will discuss with you about the anaesthetic plan

Preoperative check:

Preoperative check includes mainly blood tests, chest X-ray, electrocardiogram (ECG) and any other specialized tests, depending on the case.

Also, it will be necessary to stop smoking preoperatively and immediately post-op, as well as avoid taking aspirin and any anti-inflammatory medicine, since they increase the risk of bleeding.

The surgical procedure:

In most cases, the surgical procedure is performed under general anaesthesia. If gynaecomastia takes place due to the presence of fatty tissue (lipomastia) liposuction technique should be used. In this way, 2-3 small incisions of almost 5mm are made to the patient and a special tube (liposuction cannula) is inserted. Following infiltration, excess fatty tissue is removed through vacuum suction with controlled motions.

If breast has excess glandular tissue, it can be excised through a crescent shaped incision at the border of regular skin and nipple.

If excess skin coexists, the operation is performed through a circular incision around the nipple.

In cases of severe gynaecomastia with coexisting nipple drooping, more incisions may be necessary in order to achieve an optimal result.

Dr Karmiris will explain you the whole surgical procedure in detail and he will recommend the ideal method for you.

Post operatively:

Immediately after the operation, you will have medical gauze or bandages on the incisions which will be reduced gradually. If drains have been used, they will be removed the next day. You will need to wear a post-op compression garment in order to reduce oedema and prevent a haematoma during recovery.

In the vast majority, patients are discharged on the same day. Dr Karmiris will give you particular instructions on how to take care of your wounds, what medication you should take and when you will be seen for a follow up.

Risks and safety information

In general, the treatment of gynaecomastia is a safe, painless and effective surgical procedure, which is performed with great success. However, like any other operation, it has some risks, as well as potential complications that every patient should be aware of and should understand fully, before entering the operating room.

The most important potential complications are the following:

• bleeding or haematoma in about 1% of patients
• wound infection
• risk of poor scaring
• altered nipple sensation
• asymmetry
• general risks from anaesthesia, such as deep vein thrombosis (DVT), cardiac or pulmonary complications

Dr Karmiris will explain you, in detail, the whole surgical procedure and will answer any questions related to that.