Treatment For Gynecomastia
The treatment for gynecomastia starts with evaluating the following components:
- Skin laxity and the position of the nipple-areola complex.
- The amount of excess tissue present.
- The size of the nipple and areola.
- Estimation of the amount of fat versus the amount of male glandular tissue.
I differentiate between female gland tissue and male gland tissue because their compositions are not the same.
You can appreciate the glandular tissue in the female breast inside the circles and its absence in the male gynecomastia tissue, where there is duct tissue proliferation but no true gland.
1. Skin laxity and the position of the nipple-areola complex.
Unless there is an excessive amount of weight loss or significant skin stretching, I would not move the nipple to a new location. Instead, I allow the tissue to tighten around the nipple to position it in an acceptable location. It’s important to understand that there is a range of acceptable positions for the areola. When there is a scar all around the nipple, the blood supply needed for its survival depends on the glandular tissue below and limits the amount that can be excised. This is why I try to avoid a scar around the nipple, using it only if significant elevation is needed. Moreover, there will be a resultant vertical scar below and likely a horizontal component. It will take a long time for these scars to become acceptable in appearance.
2. The amount of excess tissue present.
Next, when evaluating the tissue, one needs to decide whether there is a large fatty component. If so, it will be treated with liposuction. If there is a significant component of male gland tissue, this will require an incision in the lower half of the areola at its junction with the skin. This approach allows for tissue excision. In the majority of situations, a combination of both liposuction and male glandular tissue removal will be performed.
3. The size of the nipple and areola.
There are different maneuvers available to reduce its size:
- By removing the tissue underneath, the nipple will contract as it is no longer under stretch.
- Placing a suture in the dermis to tighten the circumference of the areola and make it smaller.
- Removing two wedges of areola and then closing the incision, thereby diminishing the circumference and diameter of the areola by the amount removed.
To visualize this maneuver, imagine ordering a circular pizza, removing two slices, and then putting it back together.
- The amount of fat versus gynecomastia tissue is an estimate based on the history of the appearance of gynecomastia, the weight of the patient historically, and the feel of the tissue on examination. It is an estimate and that is why we plan on doing both liposuction and gland excision. We start with the suctioning, and if we obtain enough fat, we know that the gynecomastia tissue removed will be small.
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