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Gynecomastia

What is gynecomastia?

Gynecomastia is an aesthetic problem known as the growth of breast tissue in men. It is a condition where actual growth is seen in breast tissue, but in most patients, breast tissue growth is usually accompanied by an increase in adipose tissue.

Another definition of gynecomastia is pseudogynecomastia, which is usually characterized by an increase in only adipose tissue in the male breast. Gynecomastia can particularly be seen in the following three stages of a male’s life:

1) Enlarged breasts can be seen in baby boys after birth.

2) Hormonal irregularities in puberty can cause breast enlargement.

3) Decrease in testosterone with advancing age can cause the breasts to enlarge.

Apart from these, the most significant cause of this condition nowadays is the accumulation of adipose tissue in the breasts due to overweight, leading to the appearance of gynecomastia.

What are the causes of gynecomastia?

While intake of certain drugs, genetic factors, advancing age and chromosomal diseases can be rated among the causes of gynecomastia, the most common cause today is overweight.

Especially unhealthy diet and processed foods are nowadays among the most common causes of gynecomastia. The nutritional habits and lifestyle brought by modern life have increased the number of people diagnosed with gynecomastia.

Who is at risk for gynecomastia?

Individuals with certain chromosomal diseases are at particular risk for gynecomastia. Apart from these diseases, every man who has an unhealthy diet and adopts a sedentary lifestyle is at risk for gynecomastia.

What are the symptoms of gynecomastia?

The main symptom of gynecomastia is palpable swelling under the nipple and enlargement of the breasts accompanied by fat deposition.

In order to talk of gynecomastia, this growth must have lasted for more than 1 year. In male teenagers hitting adolescence, palpable swelling may occur under the nipple, but this swelling softens and disappears over time.

In some patients, gynecomastia can be accompanied by enlargement of the brown area around the nipple, which we call areola.

This enlargement gives the breast a feminine appearance. Along with enlargement of the breast, enlargement of the areola is another reason causing disturbance to patients.

How is gynecomastia diagnosed?

Most patients with gynecomastia apply to us, complaining of breast enlargement. Most of these patients also have increased fat deposition in their abdomen and waist, in which case it is important how long the complaints have existed.

One of the tests that must be done to diagnose gynecomastia is hormone tests. Patients whose hormone tests show abnormalities should be referred to the endocrine diseases department. In this type of patients, gynecomastia will disappear without the need for surgery once their hormonal problem is solved.

A breast ultrasound must be made to image gynecomastia. Breast ultrasound can easily tell us the tissue content of the breast. Breast ultrasounds usually show an increase in both breast tissue and adipose tissue.

Individuals whose hormone levels are unproblematic and have ultrasound results compatible with gynecomastia are suitable candidates for gynecomastia surgery.

What are the treatment options for gynecomastia?

Gynecomastia treatment options can be classified in two group namely surgical gynecomastia treatment and liposuction. In fact, liposuction is an integral part of every gynecomastia surgery.

Vaser (ultrasonic liposuction) liposuction is the first choice for me in all kinds of gynecomastia, especially when treating gynecomastia rich in adipose tissue.

Vaser technique has a pretty good effectiveness in gynecomastia treatment. Vaser is effective on both adipose tissue and breast tissue in gynecomastia patients. While Vaser melts and liquefies fat tissue, it also breaks down the breast tissue and allows it to be easily removed by liposuction.

I prefer power assisted liposuction (Microaire) to remove breast and adipose tissue liquefied with Vaser. In this way, I aim to obtain surgical results comparable to weight loss, without any irregularity.

After having treated the patient with Vaser and Microaire, I check whether there is any excess skin. If I think that the patient will have excess skin, I definitely use J plasma for skin tightening.

J plasma is a technology that has helped us to considerably reduce skin removal procedures, notably in gynecomastia. In most patients, excess skin can be easily treated with J plasma and very good results are obtained.

The combined use of Vaser, Microaire and J plasma has become the gold standard for me in gynecomastia surgery. The combination of these three techniques is used in almost all Class A centers across the world.

How is gynecomastia surgery done?

Gynecomastia is an operation that takes 1.5 hours and is performed under general anesthesia. The operation is started with fluid insertion into the breast area to reduce bleeding and pain. This liquid facilitates the melting of fat in the breast area easily during Vaser application.

Melted fat and breast tissue are then removed by power assisted liposuction. Any remaining palpable breast tissue under the nipple is removed through a half-moon incision around the nipple. Afterwards, J plasma is applied to tighten the skin.

An exception to this surgical method is gynecomastia surgery performed on patients who have lost lots of weight by their own efforts or as a result of gastric bypass surgery, in which case the remaining breast tissue and excess skin are removed surgically.

After the operation, the incision is closed in such a way that will leave a scar only under the patient’s breast. Gynecomastia surgery can be performed alone or combined with other operations used for male body shaping.

Since it is performed under general anesthesia, patients must stay in the hospital for one night after surgery. At the end of surgery, shapewear is put on the patient which they are advised to wear for 6 weeks postop. Patients can return to their normal life within 1 week at the latest.

What should patients pay attention to after gynecomastia surgery?

Patients can go home or to their hotel the day after operation. I advise patients not to use their arms too much for the first few days after surgery. Heavy use of the arms shortly after surgery can both increase pain and cause bleeding in the breast area.

As with any surgery, I recommend avoiding smoking for 4 weeks before and after gynecomastia surgery. I see my patients 2 days after they leave the hospital and do their controls. Another follow up appointment is scheduled for the post op 6th week.

Can gynecomastia heal without surgery?

If caused only by hormonal factors, drug intake or any other evident underlying cause, gynecomastia can subside or even fade away completely if that cause is eliminated.

Likewise, if overweight is the only cause of gynecomastia, it may subside or even completely fade away in some patients after weight loss. In all other cases, surgery is usually the go-to method to treat gynecomastia.

Can gynecomastia progress?

If the underlying cause of gynecomastia is overweight, the breasts will continue to grow as the patient continues to gain weight. There is no definite limit to it. Stretch marks may occur, especially in rapidly occurring gynecomastia.

These stretch marks can cause the skin to sag after weight loss. Even though the breast shrinks in volume, sagging is inevitable due to excess skin and patients will still need surgery to correct it. In cases like this, patients must be careful from the moment they start gaining weight and reduce their weight gain as much as possible.

If at that stage no stretch marks have occurred and the quality of skin has not deteriorated, gynecomastia can be solved with liposuction with minimal scarring.

Is there an age limit for gynecomastia surgery?

In gynecomastia surgeries performed for aesthetic purposes, patients must be over the age of 18. Furthermore, another critical point is that about one year should have passed since the diagnosis of gynecomastia.

Why is Vaser Liposuction preferred in gynecomastia surgeries?

Other liposuction methods can be used in gynecomastia surgeries as well. Yet, Vaser liposuction is very effective in gynecomastia. The first operation for which Vaser was approved was gynecomastia surgery. Hence, very satisfying results are obtained in gynecomastia surgeries performed with Vaser liposuction.

What are the most common operations combined with gynecomastia surgery?

Gynecomastia occurs usually due to adiposity and is in most cases accompanied by increased fat deposition in other areas of the male body. These are the abdomen and waist circumference.

Therefore, gynecomastia surgeries are most often performed in combination with Vaser liposuction surgery on the abdomen and waist region. Nowadays, there is an increasing number of patients who want body contouring with high-def ( high definition) liposuction to be performed together with gynecomastia treatment.

In these patients, liposuction surgery can be performed on gynecomastia, the waist and abdomen. A more muscular appearance can be given to the abdominal region with six-pack surgery. Also, fat injection can be applied to the shoulders and arms for a muscular appearance.

Another option is to create a muscular chest through fat injection into the chest muscle in the same session as gynecomastia treatment. Given today’s changing body perception, all these surgeries can be done in a single session for a full body contouring.

Can gynecomastia surgery be performed under local anesthesia?

If the patient’s breast enlargement is rather minor and if the area to be treated is not too large, the operation can be performed under local anesthesia. General anesthesia is preferred in all other cases or in combined surgeries involving other body parts.

Do patients need to wear shapewear after gynecomastia surgery?

Patients are advised to wear shapewear for 6 weeks after this surgery. Shapewear not only prevents the accumulation of blood and body fluids in the site of surgery, but also facilitates the skin’s adaptation to underlying tissues.

Shapewear should be worn be as continuously as possible, especially during the first 2-3 weeks, while in the following 3 weeks, it will be enough if shapewear is worn only while sleeping.

How long after gynecomastia surgery can patients take a bath?

Patients can take a bath/shower 2 days after surgery. They need to take off their shapewear before taking a bath and put it back on after.

Can gynecomastia surgery be performed in all seasons of the year?

The surgery can be done in any season. What patients should consider here is the requirement to wear shapewear after surgery, which can be challenging for patients if the weather is very hot.

How long after gynecomastia surgery can patients do sports?

Patients can start exercises not involving their arms 2 weeks after surgery. They need to wait about 6 weeks before they can start doing sports without restriction.

How long after gynecomastia surgery can patients return to normal life?

This is not a very painful surgery. Male patients do not experience much pain after liposuction, so patients can move easily after surgery. Patients are advised to take things easy for about a week, which means that they can return to normal life 1 week after surgery.

Patients may experience pain in the chest area if they use their arms too much in the first 2 or 3 weeks after they return to normal life. Gynecomastia surgery does not cause much restriction in the lives of patients apart from this.

Can breasts grow back after gynecomastia surgery?

Breasts will not grow back as long as patients can maintain their current weight. However, if the patient gains weight, there may be an increase in adipose tissue and the breasts may grow back, in which case patients may need to be operated again.

It should be noted that surgeries done for a second or third time may be more challenging and painful than the first one, which is why I try to explain to my patients in as much detail as possible everything they should pay attention to after their first surgery.

Is gynecomastia surgery under insurance coverage?

Since gynecomastia surgery is a type of plastic surgery, it is not covered by insurance in most cases.

Yet, if a patient has a diagnosis of gynecomastia confirmed by a doctor’s report and ultrasound imaging, it may happen in some cases that their insurance company excludes this condition from the category of plastic surgery and provides coverage for it.

What is the price for gynecomastia surgery?

Gynecomastia surgery prices may vary according to the surgical techniques to be applied and the combinations of surgery to be performed.

Gynecomastia Prices 2022

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