COSMETIC PROBLEMS OF THE BREAST
11:8 Gynecomastia:Enlarged breasts in men (males)
What is gynaecomastia?
Enlargement of breast in males is called gynaecomastia. It may be due to glandular tissue or fat deposition or both simultaneously. In most of the men, having gynaecomastia, have large amount of fat tissue and little amount of glandular tissue. Thus, male breast enlargement is of two types: Pseudogynaecomastia and true gynaecomastia.
Enlargement of breast with normal amount of glandular tissue but excess amount of fat tissue is called pseudo gynaecomastia. It is more common cause of breast enlargement. Obese younger men and elderly males are more likely to have such gynaecomastia.
It is caused by excessive glandular breast tissue. It is not common in males. It develops due to failure of testicles to produce sufficient testosterone hormone. It may also develop due to alcoholism, medication, HIV infection, renal failure, treated with haemodialysis, adrenal corticosteroid hormone, secreting tumours and certain cancers of testes. Only one side breast enlargement may suggest possibility of breast tumour. Such patient needs to undergo mammography. Drugs like amphetamines, anabolic steroids, androgens, antiandrogens (cypoterone), anticancer drugs like (e.g. cytotoxic), cimetidine, Lusulfan (myleran), clomiphene, amodarone (cardorone), domeperidone, diazepam, digitalis, oestrogens, isoniazid, kotaconazole, methyldopa, marijuana, nifedipine, phenytoin (dilantin), reserpine, tricyclic antidepressants, spironolactone, vincrystine may cause gynaecomastia. Sometime 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 easily removed. If this tissue cannot be sucked by microcanula, (size gauze 12 to 16 ( i.e. 2.2 mm to 1.2 mm) larger canula of size 4 mm are used. These canulas 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.