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The term gynecomastia originates from the Greek words gynec (feminine, woman-like) and mastos (breast); it refers to the excessive enlargement of male breast tissue for any reason.
Male breast tissue, like female breasts, consists of milk-producing glands and ducts (glandular tissue) as well as fatty tissue. In cases of gynecomastia, the glandular tissue, fatty tissue, and breast skin enlarge and expand in varying proportions. This growth can be visible to the eye, and on physical examination, firm breast tissue can be felt. Surgical treatment varies depending on the condition of the components that cause gynecomastia.
Gynecomastia can occur at any age. In newborns, it develops due to estrogen hormones passed from the mother and usually resolves within a few weeks. At the beginning of puberty (ages 13–15), approximately 60% of boys develop gynecomastia to varying degrees, which typically regresses over a few years; by age 17, the prevalence drops to 7.7%. In older age, the prevalence increases again due to decreased testosterone levels.
In 25–75% of cases, gynecomastia is observed in both breasts. In one-third of patients, the size of each breast differs. Pain and tenderness may also be present.
In 25% of all gynecomastia cases and approximately 85% of surgically treated cases, no specific cause is found (idiopathic gynecomastia). Gynecomastia can also result from various conditions that increase estrogen levels or decrease testosterone levels, including cancers (adrenal tumors, testicular tumors, lung cancer, liver cancer, etc.), endocrine disorders, metabolic diseases, trauma, psychological stress, obesity, hereditary factors, viral infections, and especially medications.
Before surgical correction, it is essential to consult an endocrinologist to investigate the cause of gynecomastia. In adults, breast enlargement may signal a more serious underlying disease that can be easily overlooked. Ultrasound examination of the breast is important to evaluate both the structural condition of the breast and to rule out cancer.
The prevalence of breast cancer in men with gynecomastia is similar to that of the general male population. However, in patients with Klinefelter syndrome who develop unilateral gynecomastia, breast cancer should be particularly suspected, and a biopsy should be performed.
Studies show that men who underwent surgery for gynecomastia have a higher prevalence of testicular tumors. Therefore, men with gynecomastia should be evaluated for testicular tumors.
For newborns and adolescents, observation is usually appropriate. During puberty, gynecomastia is expected to regress within 1–2 years. If gynecomastia that began at ages 13–15 persists around age 17 and causes significant psychological distress, surgery should be considered.
If an underlying cause is identified, treating that cause may reduce gynecomastia. For drug-induced gynecomastia, it is appropriate to wait one year after discontinuing the medication.
During the waiting period, chest exercises can be performed to develop chest muscles; however, increasing muscle mass may make gynecomastia more noticeable.
Gynecomastia can be classified into three types based on breast tissue composition:
Simon (1973) classified gynecomastia based on breast size and excess skin:
Planning surgery considers:
If excess skin is minimal, glandular tissue is removed through small incisions around the areola. If fatty tissue dominates, liposuction is performed. Often, both surgical excision and liposuction are combined for optimal contour.
Incisions may be adjusted to equalize nipple diameter if asymmetry exists. Nipple repositioning may require different incisions if sagging is present.
In cases with excess skin, elasticity and contraction ability are important. In young patients, after liposuction, a compressive bandage is applied for 4–6 weeks to allow skin retraction, avoiding additional incisions. In severe cases, extra skin is excised, leaving circular, lollipop, or inverted-T scars. Sometimes a staged approach is used: liposuction and small incision first, followed by 6–9 months of skin retraction before further skin removal.
There is no single standard treatment; the surgeon determines the most suitable method in consultation with the patient.
Small, limited cases may be treated under intravenous sedation and local anesthesia. Larger or bilateral cases are more comfortably performed under general anesthesia.
Drains may be used for a few days to prevent fluid or blood accumulation. Sutures are usually hidden under the skin and removed after 5–7 days if necessary. A tubular bandage is applied for 4–6 weeks to ensure proper skin adhesion and contour. Active sports are restricted for 6 weeks to prevent hematoma, seroma, or wound disruption.
The most common aesthetic complications arise from surgeries performed by non-specialists, including nipple retraction (crater deformity) or irregular shapes.
Early postoperative complications include hematoma, seroma, infection, and partial or complete nipple circulation problems.
Late complications include overcorrection or undercorrection of breast tissue, asymmetry between breasts, mispositioned nipples, nipple numbness, color changes in the areola, and poor scar healing.
Specialist in Aesthetic, Plastic, and Reconstructive Surgery
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Assoc. Prof. Dr. Beşir Öztürk, Specialist in Aesthetic, Plastic, and Reconstructive Surgery, combines the latest surgical techniques with years of experience to achieve natural, balanced, and aesthetic results.
Each procedure is carefully planned to reflect the best version of you and help you rediscover yourself.