AESTHETIC SURGERY

Gynaecomastia, i.e. enlarged breast glands in men, most often develop during periods of changes in the levels of circulating hormones in the body, or hormonal imbalance. These fluctuations are considered natural during the neonatal period, puberty, and also in men over the age of 65. These physiological changes resolve in most cases. If this does not happen, it is necessary to seek out a specialist who is able to determine or rule out a more serious cause of gynaecomastia based on various examinations.

The cause of gynaecomastia is not exactly known. Breast – breast tissue in the male body – enlargement is associated with several causes, most commonly obesity, various endocrinological disorders, whether congenital or acquired, e.g. disorders of the thyroid gland, adrenal glands, or gonads, as well as tumours associated with excessive/insufficient secretion of hormones necessary for the normal functioning of the human body.

Another cause may be the use of certain medications – medications containing hormones – oestrogens/androgens, medications that block the action of hormones, medications for cardiovascular diseases, as well as alcohol, later liver cirrhosis, and certain drugs (heroin, marijuana). In athletes/bodybuilders, using testosterone-based products, its precursors, or other anabolic steroids also contribute to the development of gynaecomastia. Last but not least, in the case of breast enlargement in men, it is also necessary to consider the possibility of a cancer process, given the fact that approximately 1% of breast cancer is diagnosed in men.

We recognise the so-called adolescent gynaecomastia, which begins around the age of 12. It temporarily occurs in approximately 65% of adolescent boys due to the hormonal changes during puberty, and we can consider this condition to be physiological (due to an imbalance of circulating hormones). If the condition persists for longer than 1–2 years, it is recommended to seek help from a specialist.

In adolescence, it can have a negative impact on the psychosocial development of the individual; the child may be negatively accepted in the group, face ridicule, and in extreme cases, even bullying. Problems with undressing in the locker room in front of classmates or at swimming pools can lead to the boy’s isolation and skipping social activities, which can then lead to the development of depressive conditions or body image disorders.

Senile gynaecomastia occurs in men over the age of 50/65+, and is caused by breast gland enlargement along with the accumulation of adipose tissue, which is associated with increasing obesity in men. The distribution of adipose tissue is more widespread, with fat found in the arms, chest, and up to the collarbone area. Another factor contributing to gynaecomastia is sex hormones, which cause the breast gland to grow. With increasing age, there is a shift in sex hormones not in favour of testosterone production.

So-called pathological gynaecomastia – occurs regardless of the patient’s age, but also in cases where the growth of breast tissue occurs in the above-mentioned physiological period, but the clinical difficulties described below are associated with it. In this case, an examination by a specialist is recommended.

Any change that occurs suddenly is considered pathological unless diagnostic/laboratory procedures indicate otherwise. It is important to pay attention to local symptoms, such as soreness, redness, symmetry/asymmetry of the breasts, enlarged lymph nodes, as well as systemic symptoms, such as fever, sweating, weight changes, loss of appetite, fatigue, or vision/smell disorders, which may be a signal of more serious health problems.

If gynaecomastia is associated with obesity, the first step is weight loss, followed by an assessment of the condition, and after weight stabilization for at least 6 months, it is possible to proceed with surgery – removal of the breast gland with or without reduction of the skin cover.

Depending on the extent of gynaecomastia, the surgery is performed either under local anaesthesia with or without analgosedation, or in the case of a more extensive procedure, under general anaesthesia.

The surgery itself depends on several factors, such as breast size, the need for reduction of fatty tissue, glands, or even skin cover. The procedure involves removing adipose tissue by liposuction, or a combination of the techniques listed below.

If it is necessary to remove excess skin, the incisions and subsequent scars are guided so that they are hidden within the natural skin folds. Therefore, scars are as little visible as possible after healing and maturation (location of scars – around areola, IMF, vertically when a larger amount of skin cover needs to be removed, inverted T-shaped scars, ...).

The removal of the glandular tissue itself is performed through a small incision in the area of the lower pole of the nipple, approximately 1/3–1/2 of its circumference. Every surgical procedure is performed at the cost of scars, which are initially pink, then fade as they mature, and after a few months their visibility is minimal.

Postoperatively, drains are inserted into the wounds to ensure the drainage of accumulated fluid or blood in the breast tissue after surgery, thus preventing the formation of a haematoma. They are usually removed 24–48 hours after surgery.

The patient is instructed to wear a compression vest, which improves the outcome of the surgery and proper healing.

In general, the procedure has a relatively low postoperative complication score. As with any surgical procedure, there are possible complications in the form of haematoma, infection, or scar tissue formation. The surgeon will instruct and explain these in detail during your consultation. Surgery may carry the risk of decreased sensitivity in the scar area.

Recovery is quick but depends on the extent; typically, it takes few days in simple and most cases.

There are no official statistics, but the more we raise awareness about it, the more there are because it is a quite taboo topic and there is little communication.

It is a very well-tolerated surgery, usually with minimal stress on the body, with fast recovery and a significant effect on the quality of life.

Mostly very timidly because they are ashamed.

That it has been bothering them for a long time and that they have not had enough information about the procedure until now. After the surgery, they say that if they had known earlier how comfortable it was, they would have come much sooner.