Gynecomastia: Enlarged Breasts in Men

Enlargement of breast in males is called gynecomastia. It may be due to glandular tissue or fat deposition or both simultaneously. In most of the men, having gynecomastia, have large amount of fat tissue and little amount of glandular tissue. Thus, male breast enlargement is of two types: Pseudogynaecomastia and true gynecomastia.

Pseudo-gynecomastia: Enlargement of breast with normal amount of glandular tissue but excess amount of fat tissue is called pseudo gynecomastia. It is more common cause of breast enlargement. Obese younger men and elderly males are more likely to have such gynecomastia.

True gynecomastia:
It is caused by excessive glandular breast tissue. It is not common in males. It develops due to the failure of the testicles to produce sufficient testosterone hormone. It may also develop due to alcoholism, medication, HIV infection, renal failure, treated with hemodialysis, adrenal corticosteroid hormone, secreting tumors, and certain cancers of the testes.

Only one side breast enlargement may suggest the possibility of breast tumour. Such a patient needs to undergo mammography. Drugs like amphetamines, anabolic steroids, androgens, antiandrogens (cyproterone), anticancer drugs like (e.g., cytotoxic), cimetidine, Lusulfan (myleran), clomiphene, amodarone (Cardone), domperidone, diazepam, digitalis, estrogens, isoniazid, ketoconazole, methyldopa, marijuana, nifedipine, phenytoin (Dilantin), reserpine, tricyclic antidepressants, spironolactone, vincristine may cause gynecomastia. Sometimes, the reverse is also seen. 

These tissues can be removed with the help of microcanulas without damaging muscle tissue. Rarely very dense glandular tissue requires surgery.

With liposuction canula glandular tissue is difficult to remove but fat tissue can be easily removed. If this tissue cannot be sucked by microcannula, (size gauze 12 to 16 (i.e. 2.2 mm to 1.2 mm) larger canula of size 4 mm are used. These cannulas have length of 5cm. Like liposuction, this procedure is done under local anaesthesia or general anaesthesia. First tumescent fluid is injected. After the procedure, these small holes are allowed to remain open to drain away blood tinged tumescent anaesthesia solution. 

These holes heal without obvious scar. In most of the persons, 50-90% size is reduced. Some patients have higher expectations which may be unrealistic because more removal of tissue leads to uneven results, skin irregularities, excessive scars, asymmetry.

Various Problems Of Size, Shape & Drooping Of Breasts

Some women have smaller breasts which can be increased in size by putting breast implants or injecting fat. Some women have larger breast in proportion with their figure. These breasts may cause other problems like pain in back. In such cases reduction in size and shape of too large breasts can be done. Some women have breasts which are drooped due to aging or breast feeding or weight changes. They can be benefited by non-surgical breast lift or surgical breast lift. Some women have undergone removal of breast due to disease in it. These women can have breast after putting the breast implant.

Some have drooping of the breasts due to weight loss or aging. So, they want to lift the breast up & some of them may want to increase or reduce size of that breast. Some may have bilaterally uneven size of breast. They want to increase size of smaller breast & reduction of larger breasts up to proper size. Sometimes the breast may be congenitally absent. It can be formed. If a female patient has flattened chest, optimum size of implant help a lot to improve feminine appearance of such women.

Smaller Breast Problem:
Some women have smaller sized breast. They like to increase size of their breast. Some want proportionately bigger, better and elevated breasts. Surgeon asks, how much bigger size of breast she wants? The need of extent of extra size depends upon the amount of breast tissue, shape of chest wall and weight.

Excess large breasts can cause pain in back, neck and shoulder. It limits athletic activity, routine physical activities. She faces problem of cosmetically undesirable appearances. She may not find bra that fits comfortable. Clothes do not fit well and it may cause chronic pain. Due to larger breasts, skin of lower part of the breast rubs with the skin beneath the breasts. It predisposes the fungal infection. Huge breasts affect curvature of the spine and spinal arthritis

If breasts are too large in proportion to your body frame, or if large breasts cause back pain or neck pain or shoulder pain, or physical discomfort, if heavy breast or pendulous breast with nipple are pointing downwards or if one breast is larger than the other, if larger breasts cause restricted physical activities or if women is self-conscious about the size of the breast, if larger breast causes skin irritation beneath the breast, breast reduction surgery is done.

Surgery For Breast Lift:

To raise and reshape sagging breast, breast-lift surgery procedure is done. Breast tissues and nipples are repositioned. In surgical breast lift, incision is placed around the areola. (the pigmented skin around the nipple) sometimes it may be placed below the nipple and which extends up to fold under the breast.
If the volume of breast is reduced or appears less, simultaneously breast implant can be inserted. It elevates position of the nipple.
Women should know the risk of breast surgery and keep realistic expectation. Do not expect perfection. Keep in mind that reshape of your breast improve your appearance and confidence but it will not reshape your life. To reshape your life, you need to take own efforts.

Breast Reduction Without Incision: Breast Liposuction

Tumescent liposuction of the female breasts: If percentage of fat is more in comparison to glandular tissue, Liposuction procedure can be done to reduce female breasts by 50% in size depending upon the percentage of fat tissue. It also lifts the breast to significant degree. Reduction in weight of breasts helps to the natural elastic tissue to contract and produce elevation. Thus, liposuction makes breasts smaller and elevated but does not change the shape of the breast. Thus, smaller version of the breasts is produced without surgical scars.
At our centre we use powered liposuction method.
Procedure of Liposuction to reduce breast:
Local anaesthetic solution is infiltrated with thinnest needle to minimize pain. Liposuction is done with microcannula of 1.5mm diameter to 2.7 mm diameter. Then, absorbent pads are placed around the breast. Then, these are fixed with elastic crepe adhesive tape. Breast compression garments are worn to hold the pads in place. The pressure of these garments should be optimum. If compression is less, there is risk of bleeding and if compression is too tight there is experience of pain and difficulty in breathing. Pressure of compression should be adjustable. 

During initial 15 hours of post liposuction period maximum compression is required to limit post operative hematoma and to reduce bruising. After 15 to 18 hours drainage is reduced and so compression is reduced to moderate level for 48 hours. Then, compression is kept at comfortable level to support the tissue. Small scars of liposuction of 3 to 4 millimeter size will reduce within few months. In patient of dark skin, post inflammatory hyper pigmentation develops after surgery which fades away after 2 months. Thus, recovery is rapid, with virtually no scars. Patient can return to work and routine activities within 2-3 days after the surgery.
Who should not undergo this liposuction procedure for breast reduction?
Women who have more glandular tissue than fat (e.g. thin younger women and women who have unusually larger breasts, are not good candidate for liposuction of the breasts. Those who need more than 50 % reduction in size and elevation of breasts, traditional surgical breast reduction is done. If persons has lump in breasts, excessively dense tissue in breast and family history of cancer of breasts, this procedure is not done.

Who is considered good candidate for reduction of breast by liposuction?
Women who have passed through menopause contain larger proportion of fat as compared to teenagers. So, they are good candidates for breast reduction by liposuction. Candidate should have realistic expectations. Overweight young woman (i.e. before menopause) are also good candidate if she wants less than 50% reduction of breast. The proportion of fat in the tissue of breast can be determined by mammograms. Thin young women contain more glandular tissue and least fat. So, they are not candidate for breast reduction by liposuction method. Women who have unrealistic expectation (very perfect breast of a virgin) are not good candidates for breast reduction by this method.
Those who undergo liposuction of belly & thigh area are good candidate for liposuction of breast. They get better results in reshaping breast.

Improvement Of Pendulous Breasts / Empty Breasts

Excessive pendulous breasts contain only small amount of fat & excess amount of skin area. Such breasts sags down & drop down excessively. In sagging or drooping breasts, tissue is less. Such empty breasts and pendulous breasts can be corrected by excision of the skin and insertion of breast implants.

Reduction Of Size of Areola: 
Pigmented part of skin around the nipple is called as alveolar. Alveolar can be of excess size due to genetic predisposition, stretching due to extra size of breast, or breast implants. After breast reduction, in comparison to new size of breasts, alveolar appears bigger. So, it needs reduction. Excess skin of areola can be removed with good cosmetic result. To reduce larger than desired size of alveolar incision is given around the alveolar. Excess alveolar tissue is removed. A pedicure is left. Internal purse string sutures are taken to prevent stretching of areola and the scar. Incision is sutured. The scar of such suture may not flatten in time. Significant volume removal of tissue is contraindicated with the periareolar incision. New areola is puffy, barging. Swelling, pain and bruising is minimal. One may join the light job after 2-3 days.

Breast Nipple Surgery: 
2% women have inverted nipple or shy nipple. ‘Densely inverted nipple’ prevents breast feeding. If natural secretions are trapped in such nipples, irritations and infection develops. Shy nipple is a nipple which can be drawn out by sexual stimulation or breast feeding.

Inverted nipple: 
Inverted nipple causes breast feeding problem. It reduces self-esteem. Inverted nipple may appear flat or slit like depression or patient resumes usual activities within 5 days.

Nipple reduction: 
Every year, many women reshape their ugly nipple or oversized nipples. Some women’ nipples are hanging down or folded. These can be corrected. This is minor surgery done under local anesthesia. No admission is required.


About Specialist

Dr. Pramod Hari Mahajan

Dr. Pramod Hari Mahajan is a highly esteemed Laser and Cosmetic Surgeon in North Maharashtra. With certification from the Australian Board and over 40 years of experience.
He is a skilled practitioner of advanced cosmetic and laser procedures. As a former Professor of Surgery at M. H. Medical College, Nashik. Dr. Mahajan brings a wealth of knowledge and expertise to his practice, ensuring the highest quality of care for his patients.

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Rohini Korde
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Shalini Nandurdikar
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