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Gynecomastia is derived from two Greek words that mean “female breast” and is a term applied to men with overdeveloped breast tissue. This condition is quite common and occurs to some degree in over half of adolescent boys and persists in as many as one third of adult men.
It usually occurs on both sides and is sometimes larger on one side or the other. It typically presents as a diffuse tissue enlargement that is centered behind the nipple.
Gynecomastia must be distinguished from enlarged pectoral muscles that develop through athletics and weightlifting activities in young and middle-aged men. Sometimes both conditions coexist. Pectoral muscle enlargement can make mild gynecomastia appear more severe. There is no specific treatment for enlargement of the pectoral muscles although cessation of specific exercises such as push-ups, bench press, and chest flys can eventually result in decreased muscle volume and definition through atrophy. Fatty enlargement of the breasts that occurs in much older men can simulate gynecomastia or, like pectoral muscle enlargement, make a mild condition appear more significant.
Prominent nipples can sometimes co-exist with gynecomastia or be the sole reason for seeking treatment. Nipple size can be reduced but can result in a loss of nipple sensation. Prominent nipples are a different matter than the enlarged areola size that commonly accompanies gynecomastia. Fortunately, the diameter of the areolas shrinks when the underlying breast tissue is removed. No specific remedy is necessary beyond this to restore the small areolar diameter characteristic of normal men.
Most adolescents are driven to seek treatment for gynecomastia because of embarrassment in gym class or at the beach, and older men often because of self consciousness when wearing thin shirts during warm weather outdoor activities. Fortunately most cases of gynecomastia can be effectively treated and the results are permanent.
Gynecomastia is usually treated with a combination of liposuction and direct excision of breast tissue under the nipple area. The incisions are made along the lower half of the areolar circumference at the junction between the dark and light skin. These scars usually fade with time and are rarely conspicuous. Surgery is performed under general anesthesia.
Postoperative pain is typically low grade because surgery involves only the superficial tissues and not deeper structures such as muscle where there tends to be more pain fibers. Oral pain medication is sufficient to control discomfort for the first few days. The chest is wrapped with a wide ace bandage after surgery that is worn for the first week. Moderate swelling does occur but bruising tends to be mild in most cases. It is possible to return to work in a week or sometimes less. Exercise can begin after a few weeks and gradually increase in intensity.
Complications are rare. Bleeding or infection can occur with any surgery but are particularly unusual in gynecomastia surgery. Numbness of the skin in the treated area can occur and this can include the nipple itself. It is possible for numbness to be permanent. While every effort is made to make the breast area as flat and smooth as possible, minor irregularities, asymmetry, or residual gynecomastia may become evident months later. If a touch-up procedure is indicated it is usually not performed until one year after the original surgery in order to allow complete healing and softening of the tissues to occur. Most revisions are short procedures that do not cause prolonged swelling, discoloration, or restriction of activities.
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