Breast Aesthetics in Men

Breast Aesthetics in Men

The growth of the breast tissue in men, which occurs due to the increase in the volume of the mammary gland or fat, is called gynecomastia. While gynecomastia creates an aesthetically feminine appearance in the breast, it can also be a sign of a hormonal disorder.

Breast aesthetics in men aims to give the breast a sporty appearance, similar to the volumetric problems it causes in women. Breast is an organ that can cause important problems in terms of both aesthetics and health in men.

Male breasts begin to develop with puberty. Normally, it is not expected to form real breast tissue.

Breast aesthetics in men becomes noticeable with the onset of puberty. With the recognition of structures such as body hair and breasts, which are called secondary gender characteristics in both sexes, patients often first apply to us at the age of 13-14, feeling a coin-sized hardness under the brown areola tissue, sometimes unilaterally. This hardness, which is part of a normal process, disappears over time. Rarely, patients with stiffness remaining after the age of 20 may apply. In these patients, surgical removal of the tissue under the skin may be recommended. In addition, rarely, real breast tissue manifests itself as gynecomastia .

The growth of the breast tissue in men, which occurs due to the increase in the volume of the mammary gland or fat, is called gynecomastia. While gynecomastia creates an aesthetically feminine appearance in the breast, it can also be a sign of a hormonal disorder.

The main problems affecting breast aesthetics and breast health in men are gynecomastia, congenital absence of breast and rib cage structures (Poland sequence), inflammatory problems of the breast (mastitis) and breast cancer.

In gynecomastia, the male breast, whose roughly palpable or visible size covers an area of ​​at least 10 cm, falls into this class. Physiological gynecomastia can be observed due to the effect of estrogens in the neonatal period, and in adolescence and over the age of 65, when the male hormone called testosterone decreases and estrogens originating from the adrenal gland begin to gain weight .

There is often no underlying cause for gynecomastia (idiopathic gynecomastia). However, it may also be due to obesity, hormone disorders, benign or malignant tumors (adrenal gland, testicle, pituitary and bronchus, etc.), systemic diseases (kidney failure, cirrhosis, nutritional disorders), drug use and physiological reasons.

Our patients with gynecomastia, which is the most common problem in male breast aesthetics, should not decide on surgery without undergoing screening tests and examination by an endocrinologist directed by a plastic surgeon. Often, no significant cause is found, but gynecomastia, especially one-sided gynecomastia that begins to develop after the age of 30, should be investigated.

While medical treatment methods for gynecomastia are determined by the endocrinologist, the only address for surgical solution is aesthetic plastic surgery. In surgery-based solutions, preferences are shaped according to the patient's condition.

When the underlying factor of gynecomastia is treated, some patients may experience spontaneous improvement. For example, in individuals with insufficient male hormone (testosterone) secretion from the testicles, with hormone supplementation, hair follicles that have not appeared until then slowly appear, while breast shrinkage may also be noted. However, if there is tissue left behind that bothers the patient, surgery may be considered.

Various classifications have been put forward for the size of male breasts. In fact, when we look at the situation of male breast aesthetics in ancient times, it is seen that many artists today make depictions that reach the extent of gynecomastia.

Image Note: Rubens' painting of a man with gynecomastia

Various classifications have been made for gynecomastia. Depending on the density of the tissue it contains, there are subtypes such as fluoride (dense breast tissue), intermediate form (fat-breast tissue mixture), fibrous (hard gynecomastia that has generally been present for more than 1 year), but it is more important to decide on surgical treatment. The extent of gynecomastia is evaluated first.

One of the most frequently used classifications for this purpose is the Simon classification.

Image Note: Types of gynecomastia

Accordingly;

• Type I: Minor tissue expansion – no excess skin
• Type II: Moderate tissue expansion
  • IIa: No excess skin
  • IIb: There is a small amount of excess skin
• Type III: There is severe breast enlargement and excess skin leading to sagging breasts.

Surgeries performed for male breast aesthetics are directly related to the typing of the breast.

Surgeries used in the treatment of gynecomastia can be classified as open, endoscopic (semi-open) and closed techniques. Liposuction is a closed technique class that is frequently used today.

While Type I, Type IIa and even Type IIb can be treated using a closed technique (liposuction, liposuction) , Type III patients may often need to perform one of the standard breast reduction surgeries. Liposuction surgery, in Type III, usually results in excess skin that will need to be removed.

However, in Type III patients, ultrasonic fat removal or laser-mediated fat removal (laserlipo) technologies can be effective in tightening the skin. These technologies reduce the possibility of leaving residual tissue behind, especially in fibrotic type gynecomastia.

Open surgery techniques are preferred in Type III gynecomastia, in fibrous gynecomastia that cannot be removed sufficiently with the traditional fat removal technique, and in patients with suspicious findings that may be a precursor to cancer during examination and breast ultrasound. It leaves a half-moon-shaped scar around the brown areola tissue of the breast. When breast reduction techniques are used in Type III gynecomastia, this scar may also be shaped like an inverted T letter.

Image Note: Dr. Figure drawn by Yeşiloğlu for a study showing gynecomastia incision scars. [Sevim KZ, Karasoy YA, Irmak F, Türkoglu KL, Yesiloglu N (2012). Our approach to gynecomastia cases and comparison of surgical techniques. Sisli Etfal Hospital Medical Bulletin, 46(2), 72-78.]

The endoscopic technique is made through two or three small incisions made on the edge of the areola of the breast, and allows the breast tissue, especially the nipple, to be seen and removed with the help of a camera. Today, it is mostly used in liposuction to clean the remaining tissues under the nipple that cannot be removed.

After male breast aesthetic surgery, you should stay away from heavy work for about 10 days. Otherwise, bleeding, edema and swelling may occur around the breast.

Just like after breast surgery in women, such surgeries in men also require rest. Do not rely on comments such as "You can do anything the day after surgery". Being aware that you are having surgery, you should wear the rib cage corset recommended for approximately 1 month. This corset allows your swelling to go away faster and the skin to contract more quickly within itself towards the chest wall. Whether open or closed techniques, this process will pass in this way. I recommend palm massage to my patients with some gels that can reduce edema. These will relieve any pain that may occur in the post-operative period more quickly.

You will notice swelling in both breasts the day after the surgery. Edema and swelling will increase on the second day. This usually occurs asymmetrically in both breasts, and the full regression we notice takes 6-8 months. Again, depending on the technique used during this period, extensive bruising may occur in the breast, reaching the armpit, especially in traditional liposuction. This bruise usually heals in up to 15 days.

There are two important conditions that affect male breast aesthetics as well as breast health and therefore general health. These include mastitis, which means microbial inflammation of the breast tissue, and of course breast cancer, which can be seen at a rate as high as 1% in men as well as in women. In both cases, treatment should be applied quickly.

In male breasts, mastitis , that is, inflammation of the mammary gland, is also among the reasons for application. It is manifested by swelling, increased temperature, redness and pain in the breast, sometimes with dull colored discharge. Our patients with such complaints should definitely consult a plastic surgeon . Sometimes such inflammations can be similar to breast cancer.

Breast cancer is a cancer that can cause serious health problems in men. Breast biopsy and whole body scans should be performed and the patient should be immediately taken to surgical treatment. Breast cancer may present with a hard, painless swelling or may present with signs of mastitis.