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Gynecomastia – visibly enlarged male breasts
A distinction is drawn between actual gynecomastia and pseudogynecomastia:
Actual gynecomastia is normally caused by disturbances in the hormonal balance. In principle, one can distinguish between the following:
- the increased responsiveness of the breast tissue to the female sex hormones or
- the presence of increased quantities of female sex hormones (such as in the event of hormonal therapy for prostate carcinoma with estrogen producing testicular tumors and diseases of the pituitary gland and of the hypothalamus. An excess of estrogen which causes the breast to grow can also occur during puberty (pubertal gynecomastia).
- the diminished production of male sex hormones (such as with a hypofunction of the gonads or age-induced gynecomastia as a result of reduced hormonal production in the testicles with a simultaneous surplus of estrogen) and
- unrelated causes such as thyroid disorders and dialysis in the event of kidney failure
- intake of high concentrations of hormones in food, especially as a result of consuming meat treated with hormones
- the transformation of externally supplied testosterone (medically indicated or as an anabolic), since the body converts some of it into estrogens In the event of unilateral findings of gynecomastia, the presence of mammary carcinoma cannot be ruled out, even in men. But it is usually a benign lump (such as fibroadenoma) in the breast.
It has been described in Europe that excessive consumption of beer brewed with hops may take part in the occurrence of gynecomastia due to the phytoestrogens in the hop blossoms it contains. At the same time, the high calorie intake from the consumption of alcoholic beverages is significant (increase in body fat - what is known as "pseudogynecomastia").
Pseudogynecomastia may also occur in subjects who are markedly overweight or who have recently lost weight.
Treatment:
Liposuction via tumescent technique is normally entirely sufficient to reduce the breast. The breast liposuction can be performed in ambulant treatment under local anesthesia. The local anesthetic as well as medication to prevent hemorrhages in the fatty tissue of the breast is administered in the process. This procedure is sometimes a bit unpleasant, but not painful. You will receive a medication to promote relaxation in order to make your treatment as pleasant as possible. The fatty tissue of the breast will be removed with thin suction cannulas after a waiting period of about half an hour (time for the administered medication to take effect). This is not painful. The treatment exerts a tightening impulse on the skin of the breast. The excess skin tightens in the further progress after the operation.
A special compression shirt will have to be worn for 4-6 weeks after the treatment. This helps in keeping swelling down as much as possible and supports the skin in the shrinking process.
In cases in which the mammary gland is clearly and palpably enlarged, most of the gland should be removed as well. This requires a short incision which is carried out in the nipple area.
The breast skin only has to be tightened by operative means in a small number of cases. Should this be the case, it would result in an additional scar around the areola. This requires general anesthesia and a brief inpatient stay. In the event of severely enlarged male breasts (3rd and 4th degree according to Simon), compulsory health insurance will normally cover expenses upon presentation of a medical certificate subject to individual audit.
A brief overview:
- Anesthesia: local anesthesia
- Inpatient stay at the clinic: operation performed in outpatient treatment
- Follow-up check-up: after approximately 6 weeks
- Compression girdle: a special, inconspicuous compression shirt will have to be worn for 6 weeks after the treatment.
- Scar formation: hardly visible scar formation.
- Work ability: ready for office work after 2-4 days.
- Costs: from € 1,900.00 to € 2,600.00 depending on findings