Gynecomastia

WHAT YOU SHOULD KNOW

Gynecomastia---an enlargement of the breasts in males---typically occurs either during puberty or late in the senior years. Cases that develop during puberty are usually temporary and subside on their own. For a persistent problem, surgery is the only sure cure.

Causes

The type of gynecomastia that strikes young males (usually around ages 14 or 15) is the result of a temporary imbalance in the sexual hormones estrogen and testosterone. The same imbalance may develop in older men. When gynecomastia occurs outside of puberty or old age, the culprit is often liver disease or a tumor. The problem can also be triggered by a variety of prescription drugs, as well as marijuana.

Signs/Symptoms

One or both breasts may become enlarged. Some degree of tenderness is also possible.

Care

Treatment is rarely required; the condition usually disappears as soon as the underlying cause is eliminated (or at the end of puberty in the case of teenage boys). In stubborn cases, surgery is an option.

Risks

Gynecomastia may be embarrassing, but in itself, it is usually harmless.

WHAT YOU SHOULD DO

• Because gynecomastia occasionally signals a serious underlying disorder, you should see your doctor for a check-up when the enlargement first appears.
• If an underlying disease is at fault, it should be treated immediately. If a drug is the source of the problem, your doctor may be able to prescribe a less bothersome alternative.

Call Your Doctor If...

• The breasts become tender or painful.
• You detect a lump in the breasts.

IF YOU'RE HEADING FOR THE HOSPITAL

Before You Go

• A few days before the procedure to remove the excess tissue, your doctor will probably give you guidelines regarding eating, drinking, and taking certain vitamins and medications. You'll definitely need to stop taking aspirin-based medications prior to surgery, as they tend to prevent blood-clotting.
• You will need to stop eating and drinking several hours before the operation. Your doctor will give you an exact timetable.
• If you smoke, you will need to stop one to two weeks prior to the surgery and for several weeks afterwards, as smoking impedes healing.

What to Expect While You're There

You may encounter the following procedures and equipment:

• Taking Vital Signs: These include your temperature, blood pressure, pulse (counting your heartbeats), and respiration (counting your breaths). A stethoscope is used to listen to your heartbeat and lungs. Your blood pressure is taken by wrapping a cuff around your arm.
• IV: A tube placed in your vein for giving liquids or medications.
• Preparation: The surgeon may use a felt-tip pen to draw guidelines on the breasts to follow during the procedure. You may feel a tickling sensation.
• Medicines:
• • Before surgery , you may be given medicine to make you sleepy. This type of surgery is typically performed under general anesthesia.
  • Pain medicine is commonly given in your IV but it can also be administered by mouth or as a shot.
  • Antibiotics will also be given to you either through the IV, by mouth or in a shot to fight infection.
• During the operation:
• • The excess tissue is removed by either cutting it out with a scalpel or "vacuuming" it away with liposuction. In some cases, the surgeon may use a combination of both techniques.
  • If liposuction procedures are used, a small incision---less than half an inch---will be necessary either around the edge of the dark-colored tissue surrounding the nipple (the areola) or under the arm. A small, flexible hollow tube called a cannula will be inserted through the incision to suck out excess tissue.
  • A separate incision may be needed for insertion of a small drain to draw off excessive fluids during the procedure.

After You Leave

• You will be swollen and bruised and feel some discomfort for several days after surgery. Your doctor will probably prescribe a painkiller to get you through this period.
• Arrange to have someone drive you home after the surgery. You'll probably need someone to help you for the next few days.
• To reduce swelling, you may be instructed to wear an elastic pressure garment day and night for the first 1 to 2 weeks, and possibly at night for a few weeks longer.
• You will be able to return to work or school when you feel up to it. However, for at least 4 weeks you should stay away from any job or sport that presents the risk of a blow or injury to the chest area.
• Stitches will be removed one to two weeks following the surgery.
• Avoid sex for 1 to 2 weeks---and strenuous exercise for at least 3 weeks---following the surgery.
• Avoid exposing your surgical scars to the sun for at least six months; sunlight can permanently discolor the scars. If you must be in the sun shirtless, use sunblock. The small scars will eventually fade to tiny white lines.

Call Your Doctor If...

• You notice bleeding or feel increasing pain at the incision sites.
• You develop a fever or any other signs of infection, such as a headache or a generally ill feeling.