What is Gynecomastia?
Gynecomastia literally means female breasts in a man. Gynecomastia can be physiologic, i.e. a normal part of body development and aging or pathological, i.e. due to
hormonal imbalances associated with generalized endocrine disorders, medications, anabolic steroids etc. Physiologic gynecomastia
is frequently seen in neonatal male babies, adolescent teeangers, and elderly men. In all cases,
physiologic gynecomastia is a result of an imbalance between the male and female hormones in the body causing breasts to enlarge. In
adolescent teenage boys, gynecomastia results from the significant hormonal changes that occur during puberty. Some studies show that up to 60% of teenage boys will suffer from gynecomastia
of varying levels of severity. In minor cases, the breasts will be only minimally enlarged, usually with a firm lump of breast tissue being evident
directly behind the nipple/areola. In more severe cases, the enlarged breast tissue is more widely distributed in the breast and in extreme cases, can mimic the look of
a large female breast.
Gynecomastia can be both physically and psychologically painful for adolescent boys. The enlarged breasts are often tender, but more problematic are the psychosocial implications of the condition which can lead to extreme social withdrawal and embarassment. Boys with the condition will often shy away from social situations in which the chest is exposed such as swimming and other sports and may feel a constant sense of self-consciousness. It is this very real psychosocial impact of gynecomastia that can lead individuals with the condition to seek medical treatment.
Is Gynecomastia covered by OHIP?
The Ministry of Health of Ontario does offer coverage for removal of gynecomastia breast tissue through OHIP. The procedure to excise what is the excessive breast tissue, usually found behind the nipple/areola but sometimes more extensively spread out through the chest is insured by OHIP. In some cases, patients will require more surgery to optimize the aesthetic results. For instance, in some cases of gynecomatsia, the patient will also show substantial pseudogynecomastia which is essentially fatty tissue of the chest region. Removal of this fatty tissue is typically done by means of liposuction which and is not covered by OHIP. In these cases, doing additional liposuction is not absolutely necessary but leaving this step out and only removing the lumps of breast tissues could lead to a sub-optimal cosmetic result. In very severe cases of gynecomastia in which the breast is enlarged and hanging similar to a female breast, skin-tightening procedures such as a breast lift may be required in addition to simple removal of the breast lumps. In these cases, the additional skin procedures are not covered by the Ministry of Health (OHIP).
Types of Gynecomastia
Gynecomastia can be classified as Primary or Secondary. Primary gynecomastia (aka Physiologic Gynecomastia) is a result of the body's normal
response to hormonal changes that occur as a normal part of development and aging. Primary gynecomastia is seen in neonatal males (resulting from the residual effects
of maternal female hormones in the baby's system), teenagers (as a result of the hormonal fluctuations associated with puberty) and elderly men (resulting from a
drop in testosterone with age).
Secondary gynecomastia results from hormonal imbalances due to causes other than normal developmental fluctuations. This can be a result of other medical conditions (eg. liver disease, testicular disease), medications (antibiotics, stomach ulcer medications, asthma medications), marijuhana, anabolic steroids, etc.
A condition called pseudogynecomastia must be distinguished from true gynecomastia and is simply enlargement of the male breasts as a result of fatty tissue in overweight individuals.
Preparation for Gynecomastia Surgery (Male Breast Surgery) Surgery
Preparing for male breast surgery involves mental preparation, a review of your current medications and vitamins, and following standard pre-operative instructions. Mental preparation for male breast surgery is key to a pleasant post-operative recovery. It is important to understand that you are undertaking a very commonly performed procedure and that Dr. Backstein will have screened you pre-operatively to ensure you are a safe candidate for the procedure. Furthermore, male breast surgery by its nature is a safe procedure since the surgical work is carried out in a superficial plane of the body well away from large blood vessels or major organs. The chest cavity is never entered and bleeding is minimal and easy to control. It is equally important to understand that immediately post-operatively your breasts will look somewhat larger and less natural than they will several weeks post-op. Make sure you review any medications and vitamins at least two weeks prior to your surgical date. Medications such as anti-inflammatory drugs, blood thinners/anticoagulants and vitamin E products should be discontinued completely for at least two weeks prior to male breast surgery in order to minimize the risk of extra bleeding during or after surgery. Multi-vitamins may contain vitamin E and should be stopped if vitamin E is present. Finally, be sure not to eat or drink anything at all from midnight of the day before your male breast surgery so as to enter the operating room with an empty stomach.
Surgical Techniques of Gynecomastia Surgery (Male Breast Surgery)
The particular surgical technique used for gynecomastia surgery depends mostly on the extent of the gynecomastia. In very minor cases, in which the gynecomastia
is limited to an isolated lump behind the areola, surgery can be done through a well hidden incision placed within the pigmented skin of the areola and involves simple
removal of the breast tissue.
More extensive cases of gynecomastia will require procedures that involve more incisions and therefore more scarring. Breasts that have enlarged substantially may require surgery that has similarities to the breast reduction procedure performed in females. This is quite rare and Dr. Backstein, Toronto gynecomastia specialist, makes leaving as minimal scarring as possible a top priority in all cases of male breast surgery.
In cases of pseudogynecomastia (breast enlargement caused by being generally over weight), liposuction alone can be used to completely treat the problem with only very minor scarring being left.
Gynecomastia Post-Op Care
1. Leave your dressings on and dry until your first follow up appointment.
2. DO NOT SMOKE AT ALL.
3. Contact Dr. Backstein at email@example.com if you have significant concerns