Gynecomastia typically develops in young males around the time of puberty and generally only persists in a relatively small percentage of individuals. It is an over-growth of breast tissue causing an enlargement of the breasts. Men have glandular breast tissue just like women, but to a much smaller extent. It is the excessive growth of this tissue that results in enough of an increase in size of the breasts to give a patient the diagnosis of gynecomastia. The condition usually includes a combination of both excess glandular tissue and excess fatty tissue. The relative proportion of these tissues may determine the type of treatment that is necessary to resolve the condition.
The incidence of gynecomastia is higher in men with obesity. In most of these patients, the predominant tissue is fat. This type of gynecomastia generally responds better to liposuction than those where the tissue is mostly glandular which is harder to remove with standard liposuction. The majority of gynecomastia cases have an over-growth of both fat and glandular tissue. In these cases, a specialized form of liposuction called ultrasonic liposuction is more effective than standard liposuction. A specialized machine is used with a unique hand piece that causes a titanium cannula to vibrate at 10,000 cycles per second. The tip of the cannula ruptures the fat cells as it vibrates so that it is removed as liquefied fat rather than clumps of intact fat cells as is done with standard liposuction. This allows the wand to vibrate through the tough fibrous breast tissue to remove the excess tissue. Standard liposuction is performed at the end of the procedure to remove any residual liquefied fat in the tissues.
Only patients where the condition persists or becomes severe tend to seek professional help to reduce the size and improve the appearance of their breasts. Depending on the severity of the condition and the length of time that it has existed, excess skin may also contribute to the deformity of the breasts. Mild cases where there is no sagging of the breasts can be treated with liposuction or ultrasonic liposuction alone leaving minimal scarring. When the condition is severe, with considerable excess skin, the skin must be removed along with the excess breast tissue resulting in more scarring.
In some cases, more common in young men, only a small nodule of tissue may be present under the areola causing a small bulge in that area. This condition responds poorly to liposuction and is generally treated by direct excision through a curved incision along the lower half of the edge of the areola. This can often be done under just local anesthesia in an office operating room and tends to leave minimal scars.
In addition to obesity, smoking pot, taking steroids, drinking alcohol, taking hormones and several other medications such as ulcer preparations, heart drugs, anti-depressants and others can contribute to the development of gynecomastia.
Also see 'Daddy Make-Over'