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Male breast reduction, endoscopic correction of gynecomastia


  The enlarged, feminine form of the male breast (gynecomastia) develops usually during puberty due to constitutional, sometimes hormonal factors, in later years it can be the consequence of taking steroid hormones or roborating food supplements. Most of the patients have no idea that some dietary/nutritional supplements considered to be healthy contain numerous hormonal substances which are unnamed or have misleading names. This malformation disturbs the male patients a lot, even wearing a shirt or T-shirt might be uncomfortable for them, not mentioning the beach or swimming. By careful physical and/or radiological (e.g. ultrasound) examinations it must be dissociated from the rare, but potentially found benign and malignant tumors.

 
 
Typical gynecomastia (enlarged, feminine male breast) after unsuccessful correction attempt with unfavorable submammary scars by another surgeon


The glandular tissue of the male breast contains strong, hard septa (columns) of connective tissue, which go borderless and gradually into the surrounding, thickening fatty tissue on the entire frontal chest wall. With the traditional, old fashioned, but unfortunately even nowadays used surgical technique the glandular tissue is removed through an incision under the areola on the chest wall, which has two major disadvantages: the scar is always very disturbing on a men’s chest causing a similar aesthetic problem as the malformation itself before the operation, and the other one is the dent or deficiency at the edge of the glandular tissue, since the fatty tissue remains there. From the plastic surgeon’s point of view we consider such a method unacceptable.

 
 
Other plastic surgeons tried to correct the submammary scars of a traditional male breast reduction – without any success, and the reason for this wasn’t their technique, but the least favorable place where a scar could be. These scars disturb the patient more than the gynecomastia before. Unfortunately, this scar can’ be corrected.


We cannot agree with those, who in favor of a smaller scar want to remove the glandular tissue and some fat with liposuction only, because this leads to laceration of the gland and to its incomplete, partial removal. The malignant tumor incidentally originating of the glandular tissue of the male breast is one of the worst ones, therefore we either remove the entire gland completely, or do not damage it, namely we “do not rouse the sleeping lion”.


In our operation
which is similarly performed nearest in Israel, since 1996 we remove the entire gland without leaving disturbing scars and we achieve a smooth result on the surface of the chest. After detailed laboratory check-up, ECG, chest X-ray (if needed) and anesthetist consultation, under the conditions of a private hospital-clinic, in narcosis, we make only a few centimeter incisions in the armpit and inside the areola, and with the help of the endoscope we remove the entire gland and the surrounding fatty tissue in one piece, then we make the result smooth and even with additional power assisted liposuction around. The sensitivity of the nipple usually becomes weaker temporarily, rarely permanently, but the scars hardly visible even with a magnifier compensate for the patient. To achieve a good result, it is necessary to wear a special taping for 1 week and a special compression waistcoat for 4-6 weeks after the surgery. For safety we send the removed gland for a detailed histology analysis.

 

Sketch of the operation area differentiating certain tissues at gynecomastia


We have numerous satisfied patients, who never went to the beach in the summertime along the years, and after the operation they could hardly wait for it taking of the waistcoat without inhibitions or feeling ashamed because of their prior problem.


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