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When the man's mammary gland is enlarged, it is also referred to as gynecomastia. This can be a symptom of a whole range of illnesses. Gynecomastia, the often asymmetric, sometimes painful enlargement of the mammary gland in men, can be extremely stressful for those affected.

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Gynecomastia is understood to mean the unilateral or bilateral enlargement of the male mammary glands. 2020-03-19 Gynecomastia Treatment
Gynecomastia Treatment

The mammary glands and everything related to this topic is not at all a purely narrowly female sphere. The mammary glands of many men due to various hormonal disorders, the use of certain drugs or the presence of a tumor are significantly increased. This causes (or increases) dissatisfaction with oneself and interferes in everyday life. The name of this problem is gynecomastia.

Gynecomastia can be caused by various endocrinopathies: Klinefelter syndrome, testicular feminization, Reifenstein syndrome, castration and hypothyroidism, testicular tumors (the appearance of Leydig cells), choriocarcinoma, pituitary and adrenal tumors. Gynecomastia can be a tumor syndrome in bronchial cancer. It also occurs with cirrhosis, dystrophy from starvation, leprosy. It should also be noted the occurrence of gynecomastia in men who in the past were actively involved in sports with the subsequent abrupt cessation of classes. In the latter cases, gynecomastia can occur from a year to tens of years without causing complications. Breast growth in such cases is not a clinical danger. During puberty, estradiol levels increase faster than testosterone levels. This leads to elevated estrogen levels in relation to androgen, which can cause gynecomastia.

Differential diagnosis of gynecomastia is not difficult. Gynecomastia is a benign enlargement of the mammary glands. Therefore, the main differential diagnosis is reduced to the exclusion of breast cancer. But breast cancer in men is quite rare. To do this, produce a puncture formation followed by a study of the cellular composition. It is also possible to perform histological examination on the fact of removal of the mammary glands in order to convince that it was gynecomastia, and not cancer.

The operation can be performed under local or general anesthesia.

For local anesthesia solution of lidocaine is used, which is injected into the mammary gland and into the surrounding subcutaneous fat. This option of anesthesia is suitable for patients who want to have surgery without hospitalization.

Short-term sedation in combination with local anesthesia. During the operation, the patient is asleep, but additionally he is given local anesthesia with a lidocaine solution. After surgery, it takes about 2-3 hours to spend in the ward, and then the patient can be discharged.

General anesthesia is necessary for patients who are planning to remove gynecomastia of large volumes, as well as with lipomastia for liposuction with a lift of the nipple-areolar complex. With this type of anesthesia, hospitalization for 1-2 days is required.

Our patients have practically no big fears before surgery. In most cases, liposuction is performed and excess breast tissue is surgically removed. Therefore, most often people ask questions about scars after surgery: how do postoperative wounds heal and what scars remain after that. I can assure you that the scar remains minimal. In addition, over time, the scar fades and becomes almost invisible.

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Gynecomastia - a case for the Plastic Surgeon


As attractive breasts may be for men - they do not like to look at the feminine attribute. It is therefore not surprising that the enlarged male breast is a taboo topic. But gynecomastia, the benign enlargement of the male mammary gland, affects more men than often thought. The interest in the DGPRÄC expert chat about gynecomastia was accordingly high. Steffen Handstein answered questions about this topic. The chief physician of the Clinic for Plastic, Reconstructive and Breast Surgery at the Municipal Hospital Görlitz has many years of experience in the field of gynecomastia.

At the core of interest were breasts, which were created in combination with a strong overweight. Salopp also called "beer bosom", these breasts consist only of fatty tissue and are therefore referred to as "pseudogynaecomastia". For removal, liposuction may be sufficient - if necessary. "Often the problem is solved by simply losing weight," advises Dr. Handstein. "If there are still bothersome breasts after that, you can still perform a suction."

In most cases, however, the low masculine male breasts consist of an excess of glandular tissue and fat. But how does this happen? Often hormone fluctuations are the cause of gynecomastia, for example, directly after birth or in old age. During or immediately after puberty, according to a study suffer up to 35 percent of the conspicuous breasts. In most cases, however, the breast attachment disappears by itself.

If the breasts persist, this can be an indication of a disease. "Before informing you about breast surgery, you should first rule out any possible medical conditions that could be the cause of gynecomastia," advises dr. Handstein. Triggers can be either medication, kidney or liver disease, as well as malnutrition or, in rare cases, a cancer. Even taking drugs such as marijuana or taking anabolic steroids to build muscle may be the reasons for gynecomastia. The family doctor or urologist should exclude these triggers first. After that, it makes sense to have an idea with the Plastic Surgeon, who can discuss the possibilities of surgery. This usually requires a differently supported cut, through which the excess glandular tissue is removed.

The question of which "cup size" a male breast is no longer "normal", could not be answered flat rate. "Size varies greatly from patient to patient", explains Dr. med. Handstein. But even if the breasts are not bothersome, a possible underlying disease should be excluded.

Plastic surgeons help with gynecomastia


"More and more men are reaching us, who have problems with their breasts, a veritable odyssey to the operation behind them. Apparently, the patients do not know who is the appropriate contact for breast cancer or gynecomastia, the enlarged male breast," says Univ.-Prof. Dr. Dr. H. c. Raymund E. Horch, President of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC). "The certified breast centers, which are often used for primary breast cancer treatment in gynecology in Germany, provide women with access to quality-assured therapy. Men understand that going to the gynecologist is rather difficult for understandable reasons. "In both cases, Plastic and Aesthetic Surgeons are the appropriate partners for surgery. As is often the case in plastic and aesthetic surgery, cooperation with other specialists in cancer is fundamental.

Gynecomastia - the female breast at the man. In the run-up to surgical treatment of gynecomastia, possible diseases should be ruled out by the family doctor or urologist. An enlargement of the breast could be caused by diseases of the pituitary gland or the ingestion of medications. "Nobody helps if the cause of gynecomastia remains untreated," explains Prof. Horch. A distinction must be made between gynecomastia, in which the mammary gland and adipose tissue increased, and pseudogynaecomastia, which consisted chiefly of adipose tissue. "In the first case, the mammary gland and excess fat is removed with the scalpel, in pseudogynecomastia, however, depending on the severity of the extraction of the fat is possible," says the plastic and aesthetic surgeon. Any reimbursement of costs must be requested in advance from the statutory health insurance funds. "So far, gynecomastia can not be cured with medication. A reduction is only possible through surgical measures," explains Prof. Horch. It surprised the plastic surgeon that the treatment figures for this procedure remained stable for years, although the obesity increases significantly. For example, plastic surgeons in Germany treated around 4,200 patients with gynecomastia in 2014, and about 4700 in 2012 and 2011 respectively.

"Compared to gynecomastia, male breast cancer is a much rarer phenomenon," reports Prof. Horch. According to the Cancer Information Service, 620 men are diagnosed every year, equivalent to about one percent of all breast cancer patients. "The surgical treatment is very similar to the treatment of gynecomastia. Since the male breast tissue is usually not so pronounced, usually the entire mammary gland is removed here. This procedure, known as 'andromastectomy', usually has a good cosmetic result and ensures that the tumor tissue is actually removed, "explains Prof. Horch. The interdisciplinary cooperation is essential. So could possibly be done oncological treatment. "Specialists in plastic surgery are specially trained for the surgical treatment of diseases of the male breast and as a starting point for those affected a right address."

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