Gynecomastia is a benign enlargement of the male breast due to proliferation of the glandular tissue and hence the common term “Man boobs”. The term Gynecomastia is derived from the Greek words ‘gyne’ and ‘mastos’ meaning female breasts, as the male chest resembles female breasts.

Gynecomastia is far more common condition than one thinks. It is commonly seen in three age groups: Neonatal period, At puberty and at old age (>50-60 years). Gynecomastia can affect one or both breasts, sometimes unevenly.

Pseudogynecomastia is another condition similar to gynecomastia. This condition is due to an increase in fat rather than glandular tissue. The main cause of this condition is hormonal imbalance : Decreased Testosterone(Male hormone) and Increased Estrogen( Female hormone). The other causes can be due to renal disease, Liver disease, Certain drugs and illegal use of steroids/ Marijuana.

The common symptoms associated with gynecomastia are pain, puffiness of the nipple and areola, swelling below the nipple areola region in one or both the breasts, and feminine appearing breasts which can cause embarrassment.

There are four grades of gynecomastia

Grade- I

1. There is a small breast tissue growth that appears like puffy nipple and areola without excess skin.
2. There can be asymmetry of the gland enlargement.
3. Surgery gives a very successful outcomes in these grade of patients.

Grade-II

1. In this grade there is a moderate enlargement of the breast tissue without excess skin.
2. Breast tissue growth expands broadly across the chest width, going no further.
3. The best treatments for this grade is liposuction along with gland excision.

Grade -III

1. There is moderate breast growth along with some amount of excess skin.
2. The breast tissue expands beyond the width of the chest which is very noticeable even when clothed.
3. Treatment for this grade is liposuction along with gland excision.

Grade-IV

1. In this grade there is a significant breast enlargement with extra skin. These breasts tend to mimic female breasts.
2. Surgery with liposuction, gland excision with or without skin excision is the treatment for this grade.

For all the grades of true gynecomastia, Surgical treatment is the only option. Medical therapy does not work. Pseudo-gynecomastia responds to exercise and diet management.

Pre-operative evaluation:
Patient is evaluated preoperatively by anaesthetist for surgical fitness. If the patient is using blood thinners, we advise them to stop 1-2 weeks prior to surgery.

Surgery:
Surgery for gynecomastia is usually done under General anesthesia. During the procedure, excess fat is removed by liposuction and gland tissue is removed by excision. One can expect some amount of skin shrinkage after surgery over a period of 3 months. If there is an excess skin, like in higher grades-III & IV, Secondary surgery to remove the excess skin will be required.

Recovery:

1. Recovery period for gynecomastia varies depending on the grade. During this time, it is mandatory to wear a compression garment for 6 weeks. The compression garment helps in decreasing the swelling and improves the blood circulation for faster wound healing.
2. Daily activities can be done 1-2 days after the surgery. Mild physical activity like cardio can be done 2 weeks after surgery.
3. Moderate to Strenuous exercises like strength training should be done after 6 weeks period only.

During the recovery period bruising and swelling are commonly seen, which is normal after the surgery. These can be minimised by taking few measures like Adequate hydration, Sleeping in elevated position and taking a Healthy nutritious diet.

Risks of surgery:
Any surgery is associated with mild risk of complications, Although these are minimal in the hands of experienced board certified gynecomastia surgeon. The risks are hematoma, seroma, infection, bruising and breast asymmetry.

Gynecomastia surgery is well worthy, if you consider the boost of confidence you gain and to lead a better quality of life.