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Gynecomastia

Breast development can be observed in males prior to the occurrence of the gender in the womb. Males’ mammary glands are not noticeable. They are small and underdeveloped. When the breast tissue starts to develop in males similar to females, Gynecomastia is seen.

Gynecomastia can be observed in a single breast or both breasts, generally depending on specific reasons. It is seen in males very often. Males’ Gynecomastia problem mostly creates a strong depression which can influence their whole lives.

This condition which is very influential on males’ psychology initially starts in nipples. Later, it causes a hard and swollen structure around the breast. A large majority of Gynecomastia cases are seen on a single breast and only half of the cases are effective on both breasts.

Generally, gynecomastia has become a very common disorder both for young and old males. The occurrence rate of the disorder is 30% and it is very high. In some cases, gynecomastia, which is confused with pseudogynecomastia in obese patients, has many differences with pseudogynecomastia.

As it emerges on the glandular tissue, and not on the fatty tissue as seen in pseudogynecomastia. In rudimentary cases, the disease can be stopped by some medications. Gynecomastia is divided into three types: Glandular Gynecomastia, Fatty Gynecomastia, and Mixed Gynecomastia. It may have originated since the babyhood or it may develop later depending on some medical problems.
Mostly, gynecomastia is not a disorder which causes serious results, however, it sometimes causes in ache and pain in patients. The problem of gynecomastia observed during the adolescence period may recover within 1 to 2 years. That is why doctors do not recommend surgical treatments for gynecomastia occurred during the adolescence period.

Medical treatment is preferred for children under 18 years of age who suffer from psychological depression. When gynecomastia is observed at younger ages, it creates psychological stress. Since it causes a feminine appearance, patients suffering from gynecomastia apply to treatment methods directly. Gynecomastia is accepted to be a recoverable disease through medical or surgical treatments in which nutrition and weight loss have an important role as well.

Gynecomastia surgeries can be performed under local or general anaesthesia. Liposuction can be added into the process, if necessary. If breasts are extremely large, the direct removal of the excess tissue is accompanied by the excess skin removal.

What are the Symptoms of Gynecomastia?

Since gynecomastia is a problem seen on the breast tissue, it may be seen on a single breast or both breasts. The most common symptom of gynecomastia is the swelling seen around the nipple. This swelling seen around the nipple usually starts with the enlargement of the nipple. And in addition to this swelling, the last symptom is a discharge problem.

Breasts start to enlarge in time and an increase in discharge may be observed. Although not all patients having gynecomastia feel pain, pain is also seen among the symptoms. Patients suffering from gynecomastia feel firmness around the breast when touched. There may be some eruption in and around the nipple. Especially eruptions that originate from the nipple may extend to the whole breast periphery.

There may be dark-coloured bleeding in the nipple and increased tenderness may cause tingling of the breast. In some cases, especially patients, who do exercises, have swelled chest muscles and may confuse this with gynecomastia and consult doctors.

The case of swelled chest muscles is not the same as the swelling of the breast tissue. Obese patients are seen to confuse the problem of enlargement and sagging of their breasts due to the fat accumulation with gynecomastia. However, it is not related to gynecomastia. In obese patients, breasts are enlarged due to fat accumulation and after some time, gravity causes weight to turn into breast sagging. The breast tissue caused by gynecomastia is rigid and looks like a female breast.

How is Gynecomastia identified?

Gynecomastia is the problem of swelling of the breast tissue in males. There are various reasons for this problem. How is it identified? Is it hard to diagnose gynecomastia?

Actually, the basic reason for this problem is the swelling of mammary glands. In fact, if there is a problem of enlargement apart from this, it is mandatory to consult a specialist.

Normally, if a person wants to identify whether he is encountering a gynecomastia problem, he should have an attentive look at himself in the mirror. In fact, if an abnormal enlargement is observed, the person should suspect a gynecomastia problem.

In the second phase, the breast area should be strained and controlled once again and whether an enlargement exists should be checked. The more adipose tissue is felt when touched, the more gynecomastia, in other words, breast enlargement, should be suspected.

What are the reasons for Gynecomastia?

Although gynecomastia usually shows enlargement, swelling, and tenderness due to hormonal disorders during adolescence, gynecomastia problems occurring during this period are not permanent. The condition that does not change after the adolescence period should be referred to gynecomastia and be evaluated in this direction.

It is normal to have hormonal gynecomastia if the patient is not in the adolescence period. Especially, it may be often observed in patients who have had weight problems during the adolescence period. It is usually unknown why hormonal gynecomastia develops in a patient.

In general, the reasons behind the disease are; a decrease in the amount of testosterone, an increase in the amount of oestrogen, and other diseases caused by these two conditions. In some cases, the use of harmful substances such as alcohol and heroin may be the reason behind gynecomastia. Serious diseases such as lung diseases, thyroid gland malfunction, and kidney failure cause the formation of gynecomastia.

Obesity constitutes the most efficacious infrastructure for gynecomastia, causing an increase in the amount of oestrogen and an enlargement is observed in the breast size. Gynecomastia in newborn babies is caused by the placental transition of oestrogen to the baby. This is recovered within 2-3 weeks after birth.

A decrease in the male hormone secretion in old age may cause the problem. Especially elder males having weight problems have a higher risk of encountering gynecomastia. In some cases, used medications may cause gynecomastia.

In which age range is Gynecomastia seen?

It is possible to encounter gynecomastia disorder at all ages. Especially in newborn babies, the increase in oestrogen transiting from mothers causes breast enlargement problems. However, it is usually recovered in a few weeks.

Besides this period, it is probable to be seen between 13 to 15 years of age, known as the adolescence period. the gynecomastia disorder for this age group shows differences depending on the development of the child within 1 to 2 years.

Gynecomastia is seen less at the age of 17 -considered as the development completion period- compared to younger children. However, the decrease in the number of male hormones in the following years may cause the disease to develop. For the majority of mature people, the probability of gynecomastia is higher.

It is probable to have enlargement on both breasts for older patients. Gynecomastia seen at older ages causes pain and tenderness on breasts.

What are the medications that cause Gynecomastia?

  • Primobolan: Especially people interested in sports aim at increasing the intensity of their muscles and use this medication- the greatest cause behind the breast enlargement- to reach their target in a short time. The majority of gynecomastia seen on athletes is observed on people who use medication supplements targeted to develop muscles in a short time.
  • Cimetidine (Medication for Stomach): The long-term use of this medication which has a confirmed side effect that is breast enlargement, increases the rate of encountering with gynecomastia.

  • Sustanon: It is possible to encounter the breast enlargement problem in the long-term usage of Sustanon-one of the most used medications- which has androgynous effects. The medication which is more effective in fast muscle development compared to Primobolan is very popular among athletes.
  • Antidepressant Medications: Gynecomastia formation- breast enlargement- is seen as a side effect in some of the medications recommended by doctors and used accordingly in patients with psychological problems. These medications should not be used alone and should be consulted a doctor when side effects are observed.
  • Anapolon: The use of this medication triggers a rapid weight gain and an abnormal acceleration of muscle development. This medication is one of the most potent medications among steroids and is the most dangerous one. This medication which supports the abnormal muscle growth causes breast enlargement.

What are the methods used in Gynecomastia surgeries?

jinekomasti ameliyatlarında hangi yöntemler kullanılır_4Gynecomastia surgeries can be basically divided into two; the surgery with a need for skin removal and the surgery without a need for skin removal.

Especially the 80% of the cause for gynecomastia is the accumulation of fat in the chest. In the other 20%, there may be an increase in the breast tissue in the chest area and a different technical application is required in such surgeries.

According to the stage of gynecomastia, the treatment method which can be applied especially in the first 4 stages is the vaser liposuction treatment. In the vaser liposuction method -one of the most advanced liposuction methods in today’s technology- the adipose tissue is fluidized with the help of sound waves by stretching a peripheral area of 2 mm surrounding the breast, in the so-called ultrasonic liposuction system the adipose tissue fluidized by sound waves is then taken out by aspiration through special channels. In this way, the accumulated adipose tissue in the breast is emptied.


The outward image of the breast, called Gynecomastia, is returned to a normal male breast shape.


Adipose tissue

jinekomasti ameliyatları

The adipose tissue taken out with this method would not occur if the person does not gain excess weight such as 30 kilos or more. Even if 30 kilos are gained, it would not return into its old shape like a female breast, but a normal fat accumulation will occur. For this reason, gynecomastia surgeries are one of the most successful and long-lasting surgeries.

In addition, if the patient has dominance of the breast tissue, it can be identified with the help of ultrasound whether it is formed of the adipose tissue or breast tissue prior to the surgery.

In gynecomastia formed of the breast tissue, the breast tissue can be removed completely from the approximately 2cm area by entering from the lower part of the nipple and gynecomastia can be recovered this way.

In some patients, both the breast tissue and an accumulation of adipose tissue around the breast are present. In these patients, first, the area that can be minimized is reduced by vaser liposuction, and the remaining breast tissue is removed from a very small area in the nipple by stretching.

Whether a combined treatment or normal treatment will be performed can be revealed by preoperative ultrasound techniques.

Patients who have excess skin

jinekomasti ameliyatlarında hangi yöntemler kullanılır_5The advanced phase of gynecomastia, having an appearance similar to a female breast is treated in patients who have excess skin in particular. This is especially seen in patients who have undergone severe weight loss, or those who have undergone sleeve gastrectomy and have lost 40 to 50 kilos.

There is a plenty of excess skin and a highly sagging breast image. In these patients, there is a need for extensive removal of the skin. Depending on the structure and appearance of the patient’s body, breast enlargement is corrected in male patients by a combination of skin removal and removal of the existing tissue.

After gynecomastia surgery, if the surgery was successful and performed well, results will last a lifetime.

How is Gynecomastia classified?

This disease is divided into stages in itself and the problem is eliminated by treatment methods according to the stages. The initial stage of gynecomastia is called the first stage; in the first stage no sagging or laxity problem is seen, the existing breast enlargement is not wide.

In the second stage following the first stage of gynecomastia, the breast looks exactly the same as a female breast. In the second stage, the sagging problem is not experienced. In the third stage, a surgical intervention in the breast enlargement is compulsory. The fourth stage as the last stage is the most advanced level of the disease in which the breast really looks like a big female breast.

What is Glandular Gynecomastia?

In general, glandular gynecomastia means a real breast tissue secretion. In this type of gynecomastia, a rigid breast tissue is prominent. The aesthetic appearance of men is extremely poor. Surgical procedures are required to correct the appearance.

What is Mixed Type Gynecomastia?

In mixed type of gynecomastia, generally, there is excess in both the hard tissue of the breast and the adipose tissue of the breast. In fact, it is a very disturbing type; because it causes a swelled appearance in the breast area of males.

A surgery will be needed to readjust the appearance, i.e. returning to the normal male breast appearance. In these types of surgeries, excess tissue removal procedures are performed.

What is Lipomatous Gynecomastia?

In lipomatous gynecomastia, there is an increase in the adipose tissue inside the breast. Unlike other types, it is possible to treat this type of problem with the liposuction method.

In fact, an excess amount of fat in the breast tissue is taken out by the liposuction method and a normal breast tissue is formed. In lipomateous gynecomastia, generally, the liposuction method is applied as the treatment method.

However, if appropriate, surgical procedures can also be performed.

In these cases, the doctor recommends a medication to the patient. In cases where breasts are larger than 6 centimetres, and the medical treatment does not show any results, a surgical intervention should be performed before it is too late. Surgical methods are operational and one of the different types is preferred depending on the suitability of the patient. The diversity of the surgeries performed in the gynecomastia field can provide more convenience to patients. Laser gynecomastia surgery is one of the most preferred methods. Gynecomastia problem is completely eliminated with the surgery.

Can Gynecomastia be treated by medical treatment?

Various treatment techniques are applied in cases in which gynecomastia is permanent. However, patients ask some questions very often. Can gynecomastia be treated by medical treatment?

Gynecomastia is a treatable disorder. However, the definite treatment is carried out by surgical procedures. Nevertheless, in some cases, people are afraid of surgeries. In such cases, generally, it is possible to apply medical treatment.

For males who do not want to have a surgical intervention, medications that act as oestrogen antidotes, such as clomiphene and tamoxifen are used. These medications help to reduce the oestrogen secretion.

Treatment with these types of methods is slower compared to surgical methods. At the same time, the possibility of showing side effects is much higher. In fact, medication treatments provide only a little efficacy for breast reduction.

Certainly, it will not be possible to produce definite results as in surgical treatments. So, in general, in the medical treatment method, there are no significant changes in the patients’ aesthetic appearance.

Can Gynecomastia be eliminated by Natural Treatment Methods?

In recent years, many treatment methods are developed for the gynecomastia problem. Some of the treatment methods are homemade, natural origin treatment methods. The disease can be treated at home by natural treatment methods such as; consuming fish oil, passionflower tea, turmeric, linseed added food, foods that contain zinc, adopting a healthy diet in case of overweight, exercising, applying a cold compress and creating at-home spas with Epsom salt.

In addition to these, it is compulsory to pay attention to not using medications with unknown ingredients and side effects that cause big problems, and reducing smoking and stopping consumption of harmful substances such as alcohol and drugs. Gynecomastia development can be controlled or stopped by applying the abovementioned procedures, however, natural methods do not guarantee anything.

For this reason, in order to reach a definite solution and have knowledge about the stage of the disease, patients have to consult a doctor. With natural methods applied in addition to treatment methods seen appropriate by doctors, patients can get more effective results. Natural methods should not be applied alone; a doctor should be consulted and they should be applied that way. Because; the natural method applied can create adverse effects and cause the disease to progress. The most effective solution is shaped by a doctor consultation. For this reason, patients encountering with gynecomastia should consult a doctor before it is too late.

How is gynecomastia surgery performed?

There are two types of gynecomastia as true gynecomastia and pseudogynecomastia. In fact, pseudogynecomastia is generally observed in children in the adolescence period and disappears spontaneously after a certain time.

In a true gynecomastia disorder, breast enlargement happens again during adolescence but it is permanent this time. Especially the breast enlargement problem encountered by males above 18 years of age is named as true gynecomastia. Then what is gynecomastia surgery and how is it done?

The duration of the surgery and procedures followed during the surgery vary according to the type of the surgery performed. For example; in cases when the gynecomastia problem is overcome by the liposuction method, local anaesthesia is applied, since the chest is not opened in this surgery. If the correction of the skin is requested additionally, then the surgery is performed under general anaesthesia and this lengthens the duration of the surgery to one to one and a half hour. Gynecomastia surgeries are surgeries that should be performed according to stages.

In the first stage, the problem encountered by the patient is easily eliminated by the liposuction method, whereas in the second stage depending on unrecovered mammary glands, the nipple can be made-up with an additional surgery apart from the liposuction method. However, in gynecomastia surgeries performed with liposuction, the condition of additional opening and making up of the mammary gland by the surgical method is needed in the third stage.

In the second stage, mammary glands can show signs of recovery after the surgery with the help of exercise and supporting materials like the corset recommended by the doctor.

In the third stage, it becomes compulsory to open and make-up mammary glands of the operated patient in addition to the liposuction method. Because; the condition of enlargement in mammary glands is more severe and it is hard to make it up. In some cases, depending on the age of the patient, it gets even harder to open and make up the mammary glands by surgical methods.

In gynecomastia surgeries, the fourth stage is treated in the same way the third stage is treated; however, it gets even harder to make up the mammary glands in the fourth stage. In some cases, since making up of mammary glands becomes extremely difficult, the procedure followed on female breast reduction is applied. Especially surgeries realized in the third and fourth stages, in which mammary glands are reduced surgically, a drain is placed in the area. The drain placed in the body is pulled out within one to two days.

What should be done prior to Gynecomastia Surgery?

The success of a surgery is highly dependent on the sensitive scanning prior to the surgery. A certain examination is performed for the patients who have applied to the hospital with a gynecomastia disorder, and bloodletting and some other medical examinations are to be held to find out results helping the surgery.

The patient sharing information about his previous diseases and medications he must take with his doctor helps the surgery to run successfully and to eliminate problems which may endanger his health. The patient’s one-week period prior to gynecomastia surgery is extremely important. The patient should let his doctor know about even the tiniest health problems encountered.

Health problems that may be encountered within this period or an extra medication usage should not be hidden and should be notified to the doctor. These notifications both influence the result of the surgery in a positive way and prevent problems that the doctor and the patient may encounter during the surgery. The patient should stop taking blood thinners prior to the surgery. Use of such medications causes the patient to encounter problems during the surgery.

Consumption of harmful substances such as alcohol and cigarettes should be discontinued prior to the surgery; beginning from the moment that the doctor determines to the time the surgery takes place. A specific diet may be determined by the doctor within this period and the patient should abide by this diet.

A test for anaesthesia is performed among the examinations performed prior to the surgery in order to determine the level of anaesthesia that is needed for the patient not to feel pain during the surgery and this prevents the patient to feel pain during the surgery or problems like waking up in the middle of the surgery performed under general anaesthesia. By the perfect examination performed prior to the surgery and the analysis carried out for the disease of the patient, the problems that may be encountered during the surgery are eliminated and the health of the patient is secured thanks to these examinations.

Examinations performed within the period determined by the doctor prior to the surgery and the appropriate actions of the patient according to the factors to be paid attention are not the requirements in gynecomastia surgeries but are the requirements that increase the rate of success in all surgeries.

An unelaborated preparation for the surgery would endanger the patient’s life and the patient may risk his life in case he practices things which the doctor recommends to stay away from.

Although gynecomastia surgery is ranked among the surgeries which have a high success rate, each surgery may lead the patient and the doctor to encounter problems if the procedures needed are not followed appropriately.

Is it compulsory to quit smoking and consuming alcohol prior to gynecomastia surgery?

This question is often asked doctors by addicted patients. Factors like smoking and alcohol consumption may create problems for the patient and the doctor during the surgery due to their effects on the blood.

Especially, smoking and alcohol consumption should be discontinued after the surgery since it helps to eliminate the factors that prevent the healing of wounds. Quitting these bad habits which may cause difficulties to the patient and the doctor before and after the surgery is a prerequisite for a successful surgery and recovery.

Points to take into consideration after Gynecomastia Surgery

Liposuction technique is applied for gynecomastia surgeries. This technique may be also named as a closed surgery. Since it is not an extremely difficult surgery, patients can be discharged from the hospital the next day and can return to their normal routines.

Depending on the anaesthesia application preferred during the surgery, the patient may return home on the same day or the next day of the surgery. There are some conditions, which need attention and affect the recovery period after the treatment of this disease, do not require a long hospitalization:

  • Taking a shower is not permitted for a short period of time such as one day after the surgery. Next day, it is possible to take a shower provided that the water is not very hot or cold.
  • The doctor will advise the patient about the period of his predisposition in high-pressure environments, such as travelling by air.
  • It is possible for the patient to drive a car within a short period of time such as one week. Attention must be paid to the sitting position while driving.
  • Regular use of certain medications prescribed by the doctor accelerates and positively affects the recovery period after gynecomastia surgeries.
  • Sexual intercourse needs to be paused for a period of one week since sudden post-operative movements can trigger pain and adversely affect the operated area.

What is a gynecomastia undershirt?

A gynecomastia undershirt is known as another treatment method for the gynecomastia disease. In fact, such products sold in various channels in the market are said to have properties of flatting the breast.

However, the most definite solution for gynecomastia is known as a surgical treatment. Other than surgical procedures, application of the liposuction method, especially for lipomatous gynecomastia, makes it possible to get definite results.

The results created by undershirts are not certain. At the same time, it is possible to mention that it is not a preferred option; because even if a certain level of recovery is observed, the results emerge in a very long time.

Surgical procedures always give more definitive and lasting results. For this reason, it is recommended that such surgeries need to be preferred in order to get rid of the breast enlargement problem completely.

How is the postoperative recovery period after Gynecomastia Surgery?

The recovery period after the surgery is quite fast. Gynecomastia surgery does not require a long-term hospitalization. Corsets and similar materials recommended by the doctor should be used during the period specified by the doctor in order to accelerate the postoperative recovery. In order to achieve visible results and complete recovery, 6 months are required for the postoperative recovery period.

Is There a Risk of Re-Enlargement of the Breast After Gynecomastia Surgery?

If an adipose tissue is present, and the patient is overweight or gains weight (15-20kg), there may be an increase in fat in the breast. Otherwise, it will never return back to its preoperative condition.

Is there an age limit for Gynecomastia Surgery?

Although there is no certain age limit, the surgery can be performed after adolescence, in other words approximately after 17 years of age (varies from person to person). Because breast enlargement caused by gynecomastia during adolescence may recover spontaneously after adolescence. If the person noticing breast enlargement has his examinations performed immediately and the intervention is carried out as soon as possible, psychological problems would also be prevented.

Which type of anaesthesia is applied in Gynecomastia Surgery and how long does it take?

Before the surgery takes place, sometimes local and sometimes general anaesthesia is applied. The patient does not need to stay in the hospital after the surgery and can go home. The surgery takes 45-90 minutes on average.

Are there any scars left after Gynecomastia Surgery?

If the reason behind breasts’ enlargement is the increase in the adipose tissue, breasts are reduced when the excess fat is removed by liposuction. There are no scars when the process is completed by liposuction since it is done through small holes. However, if basically, glandular tissue enlargement is of concern, the excess tissue is removed out through a semilunar incision placed below the nipple. All incisions leave a scar, nevertheless, since there is a transition line of two colours in this area, scars do not draw much attention. If there is excess skin that has a tendency of sagging, it is removed and scarring occurs.

Which Complications Occur After the Surgery?

Infection, regarding its risk, is on the top of the list of complications that may occur after every surgery. Therefore, the patient should abide by the doctor’s advice and be careful. The occurrence of oedema is rare in the area. Although allergic reactions are tried to be controlled by preoperative examinations, some risks are still present. It is possible to overcome problems by consulting a doctor if any complications are encountered.

Is Gynecomastia Surgery risky?

There may be asymmetry (the difference between the two sides), hematoma (subcutaneous blood accumulation), seroma (subcutaneous fluid accumulation), nipple necrosis and infection. However, the possibility of tissue loss and infection is fairly low. Antibiotics are used as protective agents after the surgery. Gynecomastia undershirts are used in order to reduce the adherence of the chest skin and accumulation of fluid.

Prices of Gynecomastia Surgeries

One of the subjects that most patients, who wish to undergo breast enlargement surgery, are curious about is the price of gynecomastia surgeries.

In fact, it is possible that prices vary depending on the type of procedures to be followed, the size of breast tissue enlargement of the patient, weight, type of anaesthesia and the requests and requirements of surgeons.
In order to have knowledge about gynecomastia prices of 2018, surgeons should be consulted and a pre-examination should be performed. Since these surgeries are considered as aesthetic interventions, both private and state health insurances, SSK or Bağkur does not cover the fee.

It is mandatory for patients to use a corset after the surgery. In fact, the medical institution which is going to perform the surgery has to be asked whether the price of the corset is included in the fee.

Price policy in gynecomastia surgeries would also differ depending on the type and size of existing gynecomastia.

A certain amount of change on the price is of concern if there are other aesthetic problems besides breast enlargement in patients.

Therefore, it will be more reasonable for patients to have a detailed examination prior to obtaining information about the price.

In general, prices are not high compared to any other surgery. Usually, it is possible to say that average prices are observed.

Author: Doç. Dr. Erdem Güven
We're writing about our patients.

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