I obviously receive many women in my practice. Nevertheless, more and more men are now coming through my door for medical aesthetic treatments or aesthetic surgery procedures.
This is the case for patients with gynecomastia, an illness that causes the development of breasts in men and which, it goes without saying, can be very difficult to live with.
What is gynecomastia? What is the difference between « genuine » gynecomastia and just excess chest fat? How is it treated?
What is gynecomastia?
Gynecomastia is hypertrophy of the mammary gland in boys or men, in other words, the development of « breasts ». Caused mainly by an estrogen and testosterone imbalance, gynecomastia can affect one or both breasts, sometimes unevenly, and, unsurprisingly, results in considerable complexes and great psychological suffering.
Gynecomastia affects the mammary gland, whereas we talk of pseudogynecomastia – or adipomastia or lipomastia – when the appearance of breasts is only caused by an increase in fat tissue.
What are the causes of gynecomastia?
Gynecomastia often appears due to an imbalance between estrogen (female) and androgen (male) hormones produced by male subjects. Either the body contains too much estrogen, or inversely not enough testosterone, thus leading to the development of breasts in men.
Babies, pubescent boys, and older men (during the andropause) can develop gynecomastia following hormonal changes inherent to these different periods in life.
Whether it is gynecomastia or pseudogynecomastia, other factors can result in the development of breasts in men:
- Tumors, cancer
- Kidney disease or kidney failure
- Klinefelter syndrome (a hereditary disease)
- Liver disease
- Thyroid disease (notably hyperthyroidism)
- Hormone treatments
- Taking certain medicines
- Taking drugs, notably cannabis
- Severe denutrition
Generally speaking, the cause of gynecomastia can be physiological, pathological, or reactional after taking a medicine.
Although this disorder is not a serious problem in itself, men and boys with gynecomastia sometimes experience painful breasts and often considerable embarrassment, even suffering.
Gynecomastia can resolve over time but solutions exist to treat it: medication or a surgical procedure.
Gynecomastia: how is it diagnosed?
It is generally easy to detect by the patient himself.
Nevertheless, to make the right diagnosis (is it gynecomastia or pseudogynecomastia?), find the causes, and propose appropriate solutions, an appointment with your family physician is necessary.
- During this consultation, the physician will assess the symptoms, conduct a physical examination, and examine your medical and family history.
The following may be carried out:
- A blood and hormone test to determine levels of sex hormones, as well as other hormones such as cortisol, prolactin, pituitary and thyroid hormones;
- A mammogram and/or breast ultrasound may be recommended to ensure that it is not breast cancer (approximately 500 cases of breast cancer in men are diagnosed each year);
- A biopsy, particularly if the physician felt a lump during palpation.
Gynecomastia: what treatments?
Patient treatment depends on their age, the nature of the gynecomastia, and its causes.
Of course, if the gynecomastia is caused by an underlying problem, then the latter needs to be treated first.
If medication is the cause, then it will be recommended that you stop taking it and substitute it. In adolescents, gynecomastia often resolves itself in less than two years.
However, if it persists, several solutions can be considered:
- Androgen-based medicines to restore the hormone balance;
- Surgery to remove the mammary gland and/or excess fat tissue, if the aesthetic appearance is unacceptable and of course, if the breast is healthy following the mammogram.
Gynecomastia correction surgery to recover a masculine torso
During the consultation, I will ask you to bring all the examinations carried out.
We will go through everything together and depending on the nature of your gynecomastia, I will explain point by point the steps of this operation of which the aim is to definitively correct your chest and restore a masculine torso.
It may concern:
- The ablation of the mammary gland or gynecomastia correction surgery: the gland is totally removed and will not come back. This operation is carried out under general anesthesia and the scars depend on the complexity of the procedure and in particular the quantity of excess skin. We can make an incision along the lower edge of the areola or, if there is a considerable amount of excess skin with or without excess fat, a horizontal scar that will be as short as possible. The aim is, after healing, to have a torso as flat as possible.
- Carry out liposuction in the case of pseudogynecomastia. If the skin is good quality, liposuction can be enough and leaves no scar. If, however, there is sagging, excision – and therefore a scar – will be necessary.
- A hybrid procedure to remove both the mammary gland and the excess fat.
Gynecomastia: what about cryolipolysis?
This non-invasive technique aims to destroy part of the adipocytes – fat cells – by « freezing » them. This extreme cold (down to -12 degrees) crystallizes the fat cells resulting in apoptosis (self-destruction), definitively destroying approximately 20 to 30% of the fat deposits.
A specific applicator is applied to the area for approximately 1 hour, it is then removed and the area is massaged to stimulate circulation and lymph. The results can be seen after a few weeks.
However, everyone reacts differently to cryolipolysis. It is more effective for some than others and some areas are also known to be more responsive (tummy, hips, thighs…).
In the case of gynecomastia, surgery is however more effective than cryolipolysis.