What is the appropriate treatment for Grade II Gynecomastia? (photos)

Question

Hello Hello. I am 28. i have a grade II gynecomastia. The surgeons i saw said that the glandular component is rudimentary. The last Surgeon said that he will start the procedure first with liposuction and then assess whether he will need to do a surgical excision of the rudimentary gland. is this the regular sequence of treatment? should i just ask him to go ahead and remove the gland directly even its very small. i don't want to be disappointed with the result if he opts for liposuction only.

Jed H. Horowitz, MD, FACS · Answer

There are several common factors which contribute to gynecomastia. These include excessive levels of #estrogen, natural #hormone changes, use of recreational drugs or alcohol, medications and their associated side effects, and, various health conditions. Also, there are different types of #gynecomastia.Normal Gynecomastia is usually apparent in boy between the ages of 12 to 15 years old and older men 65 years old or more who experience a drop in their testosterone levels. This type of Gynecomastia takes about one to two years to regress on its own.Pure Glandular Gynecomastia is seen more commonly in body builders and is caused by steroid use. Surgical removal of the gland is required for treatment.Adult Gynecomastia – Fat deposits are apparent in the glandular tissue. This type of gynecomastia is the most common. Doctors may recommend surgery for treatment of the condition.Adolescent Gynecomastia is hereditary and usually appears in 30% to 60% of boys between the ages of nine to fourteen. Many cases of adolescent gynecomastia resolve on its own as the boy grows into adulthood. Some may choose to undergo surgery to correct the situation, this usually happens at the age of 18 or above. In severe cases in young boys, the physician and child development specialists will need to speak to the parents regarding the severity of the gynecomastia and if surgery is an option before the age of 18.Assymetric or Unilateral Gynecomastia appears in either one or both breasts at different degrees. In many cases one breast appears larger than the other. Surgery is a common treatment for this type of gynecomastia.Pseudo-Gynecomastia is composed of adipose tissue instead of glandular tissue. This type of gynecomastia can be treated with diet, liposuction or surgerySevere Gynecomastia commonly affects those who have lost skin elasticity at an older age and those who have been obese or overweight at one point in their life and lost weight may have saggy skin and breasts that are severely enlarged. Surgery is the recommended treatment for severe gynecomastia. There are three types of surgical treatment options available that treat gynecomastia. The doctor will recommend the one that is best suited to each individual case.

Larry S. Nichter, MD, MS, FACS · Answer

GYNECOMASTIA = Breast Enlargement in Men, below are some basic information to know about the procedure and if it is for you:Gynecomastia or breast enlargement in men can be corrected by a variety of plastic surgical techniques. This condition often creates a psychological poor self perception and many males of all ages do not take their shirts off because of this stigma. Candidates are men who have over-developed or enlarged breasts which may occur as the result of hormonal changes or hereditary conditions.Candidates are healthy men, whose condition cannot be corrected through exercise, weight reduction or other non-surgical treatments.  Appropriate preconditions for surgery are the stabilization of breast development (no further breast enlargement) and localized areas of excess breast tissue and fat.Intended ResultThe procedure intends to reduce the breast size and redundant breast tissue to enhance the contours of the chest.  The surgery often reduces physical discomfort associated with the area, as well as physiological and emotional dissatisfaction with the area.Procedure DescriptionGeneral, Intravenous or local anesthesia are used for this procedure depending on the severity and type of procedure(s) selected by your plastic surgeon. It is performed on an outpatient basis.  For males with very large breasts staged procedures (more than one procedure) may be required. For example, the first procedure may be liposuction, then several weeks to months later after skin contraction has occurred, a separate procedure is done to remove excess skin. By doing a staged procedure, often the final scars are less.Oftentimes, specific types of liposuction cannulas are used and often in conjunction with direct removal of excess breast glandular tissue through small incisions for mild to moderate gynecomastia. Other specific techniques can reduce the areola when needed or reposition the nipple to create the appearance of a more natural contour.

Tim Neavin, MD · Answer

Good question.  Generally, I always excise the gland.  Keep in mind liposuction removes fat, not gland. Gynecomastia is glandular tissue.  While lipo can help improve contour of the chest, excision is often required to result in an optimal correction.

Robert Oliver Jr., MD · Answer

While I'm generally underwhelmed with liposuction treatments for gynecomastia, the suggested plan of liposuction and a small direct incision of subareolar tissue looks pretty solid with the pictures you submitted. You have modest skin expansion and small amounts of excess tissue.

Michael Marion, MD · Answer

Your question is regarding the sequence of treatment for gynecomastia.  Liposuction followed by excision as needed is not an uncommon approach to the problem.  For you specifically, an examination would need to be performed to determine if the excess tissue you have is dense glandular tissue that would be difficult to remove with liposuction alone or if softer fatty tissue, liposuction may suffice.  Again, it would require physical examination to better determine.  I have had good success with initial direct excision in the office with difficult to notice scars.  Understandably you want the best result first time, but a conservative approach will allow for the best result with less chance of developing a scalloped or overresected appearance, which is difficult to treat.  Lastly, the consideration for removal of skin should be discussed.  You are young and we can hope that the stretched out skin will retract on its own, but that can't be guaranteed and you should be prepared for that as well.  Good luck.

Aamod Rao, MD · Answer

The ideal procedure will be a liposcution with  a gland removal thru a small periareolar incision.your skin will tighten over time and you will get adequate amount of lift. You will have to wear a pressure garment for  period of 3 months minimum (for best results).You can get back to work in a couple of days .

Donald W. Kress, MD, FACS · Answer

I agree with the liposuction technique although I almost always remove a small amount of gland through a smile incision of the lower areola. The more important question is whether excess skin needs to be removed. For moderated gynecomastia in a young person, you should get away without any extra excisions. I would wear a good strong support garment keeping the nipple/areola in position for at least 6 weeks.

What is the appropriate treatment for Grade II Gynecomastia? (photos)

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