Gynecomastia is the medical term applied to benign enlargement of the male breast. Presentation of gynecomastia is variable. Some men have only a small enlargement of ductal tissue behind the nipple and areola, which usually fluctuates in size with ambient temperature and other stimuli. Other men have greater enlargement of ductal and glandular tissue with breasts of variable size with or without excess skin. The cause of gynecomastia is often unknown, with excess breast volume developing during adolescence or as an adult. Adolescent gynecomastia often resolves spontaneously. Growth of breast tissue is influenced by estrogens, androgens, the ratio between the two, other hormones, and hormone receptor features of breast tissue. Increased breast cell sensitivity to sex steroids may contribute. Gynecomastia can result from testicular tumors and from many drugs and medications. Body builders using anabolic steroids may develop gynecomastia that doesn’t resolve when the supplements are stopped.
Before considering surgical treatment for gynecomastia, medications that may be influencing breast growth should be changed or stopped if possible. Testicular abnormality must be excluded.
Surgery successfully resolves gynecomastia. The approach depends on the size and distribution of excess ductal and glandular breast tissue. For a small amount of nipple-areola protrusion, Dr. Laverson prefers removal of the excess in his office as a local anesthesia procedure. For breast tissue extending beyond boundaries of the areolae, general anesthesia in the surgery center is preferred. Extensive removal of all excess breast tissue is required, performed through the areola. This must be carefully performed to achieve the best result. Dr. Laverson prefers direct removal of breast tissue in most cases over liposuction. Although some surgeons treat gynecomastia by liposuction alone, the technique is best for extraction of fat rather than more dense glandular structures.
After removal of the enlarged male breast, a silicone tube drain is used for five to ten days after surgery, and a custom fitted compression vest recommended for two or three weeks (except when showering). The result is apparent quickly, but swelling slowly resolves during weeks to months.