Gynecomastia

Gynecomastia, literally feminine breast, can occur in men in the neonatal period, adolescence, adulthood and old age. In newborns, it improves spontaneously after a while due to the effect of hormones passed from the mother. In adolescence, a medium hardness and sensitive structure is formed with the effect of growth hormones and other hormones. After most of the growth is completed, shrinkage is observed. However, if there is a breast growth due to obesity, it is not expected to pass by itself.

Breasts may be enlarged due to an increase in adipose tissue or breast tissue in adult men. If the breast tissue is excessive, its sensitivity is felt more than the hard and fat tissue.
In addition to creating a cosmetic problem in men, if it is a unilateral painful mass that has recently appeared, it is necessary to undergo examinations for malignancy.

Gynecomastia Classification
Stage 1- There is a growth in the breast, but there is no sagging and looseness in the skin.
Stage 2- There is a feminine growth in the breast, but there is no sagging on the skin.
Stage 3- The lower fold line of the breast has become clear with the size of the breast. There is excess skin.
Stage 4 - The breast is as big as a woman´s breast and there is excess skin sagging on the fold.

Which surgery technique?
The main factors that determine the surgery technique are the tissue structure that causes growth and the sagging amount of the skin structure.
If there is a hard tissue that is rich in breast tissue and felt under the nipple, open surgery provides the most definitive solution. Tissues that cause stiffness and growth are completely removed. With Vaser or Laser Liposuction, hard breast tissue cannot be completely disintegrated and some tissue may remain. Open surgery is performed through a semicircular incision in the nipple. Since the stitches are in the dark area of ??the nipple, it does not cause visual problems.
Liposuction is preferred in gynecomastia due to adipose tissue increase. Approximately 5 mm holes are made on the lower side of the breast and the fat tissues are broken up by Vaser or Laser Liposuction, then the liposuction process is performed through the same holes and the broken fat tissues are removed.
In cases with stage 4 gynecomastia, it may be necessary to remove the skin structure according to the amount of sagging skin.

Pre-operative preparation;
If you have previous surgery, chronic diseases such as high blood pressure, diabetes, goiter, allergy to any drug or food, and any medications you have to use, you should definitely inform them.
Please indicate if there is breast cancer or diseases in your family.
I recommend breast ultrasonography to patients who have undergone gynecomastia surgery. Usg provides clearer preliminary information about breast tissue content. In addition, if there is a suspicious mass or growth in the breast, the tissue removed should be sent to pathology.



Hospital and Operating Room Process
Pre-operative examinations are prepared on the same day or 1 day before. You should not eat or drink anything 8 hours before the operation time. The results are evaluated by the anesthesiologist and if there is no obstacle, your operation can be performed. The patient will not feel any pain during the procedure since it is performed under general anesthesia. The average operation time is 1 hour and the time spent in the operating room will be longer after the patient is awakened and sleeped.
After the operation, you will be given antibiotics and pain medication in the ward. You will have a control examination the next day and you will be discharged on the 3rd day to be called for control.

After gynecomastia surgery, it may be necessary to install a drain to expel fluid and leakage blood between the tissues. Drains are removed on the 3rd day when the incoming amount decreases.

You should use a compression medical corset for at least 4 weeks.

Post-operative pain and return to work?
On the first day after the surgery, you may feel slight pain around the breast (drain exit points) and tension in the breast. By using the prescribed medications and removing the drain on the 3rd day, your pain will decrease and you will be able to return to your work after about 6-7 days.

Will there be any stitch marks?
In cases where open surgery is performed for gynecomastia, a semicircular incision is made on the nipple. The amount of scar left after the surgical incision depends on the patient´s tissue healing, the surgeon´s suture technique and care. Even if all patients are sewn using the same suture technique and material, the amount of scar left will differ from person to person. Age, skin color, breast size, accompanying diseases, smoking, postoperative care and hygiene are the determining factors for the scar. In the early period, the pink line-shaped suture line completes its healing after about 12 months and becomes compatible with your skin color.

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