Introduction to Gynecomastia

The shyness in some adolescents is not always psychological, but sometimes is due to physical inadequacies. Man boobs or gynecomastia is one of the difficult situations a person faces especially when going to hostels. Adolescents with very small ones are mainly counselled and in a good number of them, it will subside by the time they are 18 years old.

Surgical correction is the cornerstone of the treatment when reversal is not obtained with medication. I remember my second year in surgical residency training where a young lad with bilateral gynecomastia was operated upon. The incisions looked like the Greek alphabet "Omega'' and extended onto the chest skin on either side of the nipple and areola. The gland and the fat around it was removed. But even with time, there was a 'stepping' and an operated look for the patient. Thankfully, those days are long gone.

As plastic surgeons, we were taught that gynecomastia is an overgrowth of the breast gland with or without fat around. Breast growth with only fat is called lipomastia. But in these people also the physical inadequacies are there. Some are able to overcome them with diet and exercises.

Diagnosis and Treatment Approaches for Gynecomastia

It is very easy to identify gynecomastia with just a physical examination. In case there is still any doubt, a simple ultrasound can help clinch the diagnosis.

At Amrita, gynecomastia is initially diagnosed with clinical examinations. Sometimes, ultrasound (USG) and blood investigations are conducted to check for hormonal abnormalities. Gynecomastia is graded into 1, 2A, 2B, and C grades based on the position of the nipple and the presence or absence of excess skin. Grade 1 and Grade 2A are treated with liposuction and gland excision using a 6 mm incision, usually at the border of the areola and skin. The liposuction ensures a uniform skin thickness and eliminates the prominent inframammary fold. The procedure extends from the collarbone to the edge of the rib cage and from the midline to the lateral chest wall.

High-definition liposuction is performed for individuals desiring a chiseled, masculine look. All areas needing good definition, such as the borders of the pectoralis major and deltoid muscles, receive very superficial liposuction. This technique is also applied in the midline of the abdomen. Fat is harvested from the lateral chest wall using syringe liposuction, filtered, and injected under the borders of the pectoralis major muscle to achieve a well-shaped chest wall. There are no separate incisions for the liposuction, which helps avoid symmetric scars and an operated appearance.

Specialized Techniques for Grade 2B and Grade 3

In grade 2B cases where there is an excess of skin, Radio frequency energy is delivered through an Embrace RF Bodytite machine, which gives a good shrinkage of the skin. Here also the same 6 mm incision is usually adequate. Sometimes, skin taping is also done to lift up droopy nipples. It is placed for a week or two.

In grade three gynecomastia, we perform liposuction followed by doughnut excision of the skin and sometimes the excess of the areola. Special sutures are used to prevent scar widening.

Manual lymphatic drainage is started on the second day and continued for 10 days. All patients wear pressure garments for a month. In people who get high-definition liposuction contours are enhanced with a sponge kept under the pressure garment for a week. Lifting of heavy weight is not to be done for 3 weeks and pressure garments are to be worn for one month. Exercises may be started after 6 weeks. 80% of the swelling goes off in 3 weeks and the final result is seen after 3 months.