Gyne Info

Information About Gynecomastia Surgery in Kolkata, India

Introduction

Welcome to this informative website on Gynecomastia or Male Breasts where you will find most of the information pertaining to this condition. This website has been prepared by Prof. (Dr.) Souvik Adhikari, who is a Professor of Plastic Surgery and Consultant Plastic, Reconstructive and Aesthetic Surgeon based in Kolkata, India.

Prof. Adhikari feels that every patient should have a complete understanding of his or her condition before subjecting oneself to surgery. With this aim in mind, he has tried to incorporate all relevant information related to gynecomastia.

This website will help you decide whether you would like to go ahead with surgery for your male breast problem. Before/After pictures are also provided in the gallery so that you have an idea of what to expect. Videos are also provided of Gynecomastia Surgery in Kolkata both under local and general anesthesia.

We hope that you would find the information in this website useful. If you have further queries even after going through the website, you are welcome to get in touch with Prof. Adhikari if you are considering gynecomastia operation in Kolkata.

Gynecomastia – Overview

Introduction

Gynecomastia (MOOBS in slang) is a medical term which is used to signify the presence of abnormal breast tissue in males. Normally, males should have a well sculpted skin with the underlying pectoral muscles showing through which is lost when male boobs are present. The presence of male boobs confers a feminine appearance to the chest, therefore, gynecomastia means the presence of breasts like a female.

Although this condition per se does not mandate any sort of intervention, it is the psychological stress this condition confers that upsets the patient. Peer ridicule, inability to wear a T-shirt, unable to use swimming pools and unable to be bare-chested in public creates extreme stress in affected individuals such that thoughts of suicide also come to the minds of these patients!

Affected patients

Mostly teenagers are affected with this condition because this usually starts out at the time of puberty. This condition may also occur in adults and in elderly patients as a result of aging changes.

Etiology or Causes

Gynecomastia may be physiological or pathological. Physiological gynecomastia can occur during puberty or in elderly people and is primarily due to an imbalance of the hormonal milieu whereby the androgen/estrogen balance is altered.

Physiological pubertal gynecomastia occurs in teenagers during the adolescent period where there can be a gross abnormality in the estrogen levels. In fact, more than 6 out of 10 boys may have some form of breast tissue enlargement at this time. However, in many cases, the breast tissue disappears in a few years, therefore, no intervention is usually needed at this stage except in patients with huge breasts or with extreme psychological problems. Hormonal analysis usually does not reveal any problem.

Physiological elderly gynecomastia occurs in elderly people as the androgen levels start decreasing and estrogen takes upper hand along with an increase in body fat. This will not usually disappear by itself.
https://gynecomastias.com/physiologic-male-gynecomastia/

Pathological gynecomastia can occur because of many things with the underlying cause being an excess of estrogen, a deficiency of androgens or both. It can be seen in patients who intake steroids and other recreational drugs like bodybuilders, some diseases due to underlying hormonal problems, testicular and other tumors, chronic disease, genetic abnormalities, familial disorders and others.

Patient Groups

• Teenagers
• Young adults
• Bodybuilders
• Adults with weight gain
• Elderly people

Components of Gynecomastia

Nipple Abnormality – “Puffy nipples” is a complain that many youngsters have. The normal male nipple sits flat on the chest wall as you can see in well sculpted chest of bodybuilders. In “puffy nipples”, there is a mass of breast tissue behind the nipple and areola typically extending beyond the areola which takes a conical shape and pushes the nipple and areola as in the shape of a pencil. This causes extreme psychological problems as the affected individual is unable to wear a T-shirt as the nipple projects through causing embarrassment. Many bodybuilders tend to have this problem.

Areolar Abnormality – The average areolar diameter in males is around 2.66 cm or about 1 inch and the average nipple diameter is around 0.69 cm. There can be 2 types of abnormalities in the areola in patients having male breasts. The normal areola is usually flush with the skin but as mentioned above, in patients having puffy nipples, the areola projects outward which is exaggerated during summer times. The second abnormality concerns areolar size. In patients having a large amount of breast tissue behind the areola, because of the long-standing pressure on the areola, the size of the areola increases, sometimes assuming a large size.

Glandular Abnormality – In all patients with gynecomastia there is some enlargement of the glands sitting behind the areola and in front of the pectoralis major muscle. This is what is known as “Classic Gynecomastia” and the component of glandular tissue in the actual breast varies from person to person. The consistency of the glands also varies: in some individuals, the glands are soft, in others they are firm in palpation and in a few patients, these are extremely hard. Glands may either be tender or not.

Fat Abnormality – In most cases of gynecomastia as in Classical Gynecomastia, there is some component of fat that is present in the breasts. This percentage of fat varies. In healthy individuals, usually the fat component is more while in thin individuals, the proportion of fat is less and the breast tissue is mostly glandular. Very few individuals may have a breast tissue comprised of fat only, a condition known as “Pseudogynecomastia”. This can also happen in recurrent cases of gynecomastia if the individual gains excessive weight and fat deposits start occurring in the chest.

Skin Abnormality – As the proportion of breast tissue increases, it pushes on the overlying skin and therefore stretches it. There is an inherent property of the skin known as elasticity which is the accommodation the skin undergoes when it is stretched. This is because of the presence of a special protein in the skin known as elastin which along with collagen confers this property to the skin. When the underlying cause that causes skin stretching is removed, the skin promptly springs back to its original position. However, there is a limit to this. With long-standing stretching, the fibers that maintain this elasticity are overstretched and break and are finally replaced by fibrous tissue. Thereafter, even if the underlying cause is removed, the skin will not come back to its original position. In long standing cases of gynecomastia or male breasts, therefore, even after complete removal of the glands, there might be some skin redundancy because of the loss of elasticity. This is particularly evident in individuals who have a lot of stretch marks or “striae” over their chest.

Treatment

Proper examination can identify the underlying cause of gynecomastia although, in most cases, no cause is found. Patients can be cured of this problem through surgery which entails removal of the breast tissue and imparting a masculine look to the chest. Surgery is safe as performed by Prof. (Dr.) Souvik Adhikari as he performs most surgeries under local anesthesia and patients can go back home immediately after the surgery.

Complications of Gynecomastia Surgery

No surgery is without the possibility of complications and gynecomastia surgery is not an exception. Common complications include collection of blood in the position of the breast tissue after surgery (hematoma), unfavorable scarring, skin laxity after surgery, decreased sensation in nipples and so on. Partial or complete loss of the nipple-areolar complex is rare but still a possibility. All of these would be highlighted in the Surgery section.

It is important to note that complications might happen even in the best pair of hands but top gynecomastia surgeons like Prof. Adhikari with profound experience in gynecomastia surgery for more than a decade have fewer complications when compared to other cosmetic surgeons in Kolkata.

Cost of Gynecomastia Operation in Kolkata

The cost of gynecomastia surgery in Kolkata varies between clinics and hospitals and can be anywhere between Rs 25000 to Rs 1 lakh and more. Prof. (Dr.) Adhikari has one of the most reasonable rates for gynecomastia operation in Kolkata and has even concessional rates for individuals with hardships and students. Compared to other clinics, here the cost of gynecomastia surgery is less because most of the surgeries are performed under local tumescent anesthesia and Prof. Adhikari is a pioneer in this.

Frequently Asked Questions

Q: What is gynecomastia?

A: Gynecomastia is a condition in males where there is enlargement of male breasts in varying degrees.

Q: What is the incidence of gynecomastia in males?

A: Do not be depressed, this is an extremely common condition in males! Although the incidence varies among populations it is estimated that 3-6 boys out of 10 may harbour gynecomastia although all might not be large.

Q: When should gynecomastia be operated?

A: In patients having smaller degrees of gynecomastia, observation can be recommended till 18 years of age as many of these can resolve by themselves. Surgery after 18 years of age also has shown to have very little incidence of recurrence if done perfectly. However, in adolescents in whom there is advanced degree of gynecomastia, the surgery can be done in earlier years as it typically creates a social problem for individuals.

Q: What is the treatment for gynecomastia?

A: Only surgery can cure gynecomastia. Medicines have not been shown to have any effect on gynecomastia.

Q: What is pseudogynecomastia?

A: In obese individuals, with accumulation of body fat, fat also tends to accumulate in the chest. This condition is known as pseudogynecomastia where it resembles a gynecomastia but there is only fat, no glandular element.

Q: What are the components of male breasts?

A: Male breasts can comprise of a mixture of gland and fat like females although the proportions vary. In some patients, the swellings can be seen to be comprised exclusively of glandular tissue.

Q: My gynecomastia is hard, am I having breast cancer?

A: No! The consistency of gynecomastia varies. In some patients, the swellings can be soft while in others with exclusively glandular component, the swellings can be quite hard. This can be different from breast cancer.

Q: How do I distinguish breast cancer from gynecomastia?

A: Breast cancer in males is quite rare and usually affects one side. The growth can be quite rapid and the swelling is not uniform. If you have breast swellings it is best to check with a surgeon.

Q: Is there a risk of breast cancer if I leave my gynecomastia alone?

A: No. Surgery is done only for cosmetic reasons.

Q: If I go in for gynecomastia surgery will I have increased chances of breast cancer in future?

A: No. Surgery for gynecomastia does not increase chances of breast cancer.

Q: What are the components of gynecomastia surgery?

A: Liposuction can be done to address the fatty component in gynecomastia followed by open surgical removal of the underlying glandular component known as subcutaneous mastectomy.

Q: What is the type of anesthesia administered?

A: Unless the gynecomastia is very large, most of the cases can be performed under local anesthesia. In patients having advanced grades of gynecomastia general anesthesia may be required.

Q: Will it hurt if the surgery is done under local anesthesia?

A: You will feel the sting of injections but the surgical procedure is nearly painless.

Q: My skin over the chest is very loose. What can be done?

A: In many patients, the skin redundancy can be huge. In these cases, a different technique employing removal of skin is performed along with the above surgical procedures to address the same. Please note, a revision surgery may be required after 6 months to address any residual skin laxity.

Q: Will I be requiring any other surgical procedures in future?

A: Most cases do not require any further surgery. However, in a few cases, laxity of skin may need to be addressed 6 months after surgery.

Q: When will I expect to get final results?

A: 6 months after surgery although you will get an idea after 2-3 months only.

Q: Do I need any investigations prior to surgery?

A: Yes, blood tests are required prior to surgery if the surgery is done under local anesthesia. General anesthesia entails additional tests in the form of chest X-ray and ECG.

Q: Any other preoperative preparations I need to follow? A: You may be asked to clean your chest on the day of surgery. If the surgery is being considered under local anesthesia then you may have a light meal on the day of surgery.

Q: What do I expect in the surgery?

A: Pictures would be taken first, followed by markings. Next follows anesthesia of the chest and then surgery.

Q: What are the postoperative instructions?

A: Immediately after surgery the area would be dressed and a pressure garment applied. You would be asked to take antibiotics and pain killers after surgery. You can start working from the next day (light job).

Q: Can there be bleeding after surgery?

A: Since drains are there in place you may expect soakage of dressings with blood-stained fluid. This is normal and of no concern. If you have excessive bleeding (which is rare), contact your surgeon.

Q: When do drains come off?

A: 3-5 days or as determined by your surgeon.

Q: When are stitches removed?

A: 8-10 days or as determined by your surgeon.

Q: What happens if there is a collection of blood in my chest after surgery?

A: In very rare cases there can be accumulation of blood in your chest after surgery, In these cases, 1-2 stitches are removed in the nipple area and the blood evacuated and the cavity washed.

Q: I have a hard lump behind my nipples after gynecomastia surgery?

A: This is very common and does NOT imply that any glands were left behind. This usually happens because of clot formation. Just keep massaging on a daily basis and this will resolve by itself.

Q: How long do I need to wear the pressure garment? Do I need to wear it 24 hours?

A: Yes, in the initial postoperative phase you would need to wear the pressure garment 24 hours. The duration of pressure garment use varies between patients, your surgeon will guide you regarding this.

Q: When can I start exercises after surgery?

A: Usually 3-4 weeks after surgery.

Q: I am a smoker. Do I need to stop smoking?

A: Yes, smokers are advised to stop smoking 3 weeks prior to surgery and 3 weeks thereafter to reduce any risks associated with smoking. Same applies to alcohol consumption.

Q: Why are drains given?

A: After removal of the glands, there is a large cavity in the chest. Blood and fluids may collect in the cavity and may delay healing. Drains are put in so that any collected blood and fluids are promptly evacuated outside to aid in healing.

Q: Is gynecomastia surgery covered under medical insurance?

A: You would need to contact your insurance provider regarding this.

Q: How long do I have to stay after surgery?

A: If you are operated under local anesthesia then you will be discharged after surgery. General anesthesia usually entails a stay of 1 day.

Q: Where is the surgery performed?

A: The surgery can be performed in a nursing home (cheaper) or in a hospital (more expensive) setting as per your choice.

Q: Do I need anyone to accompany me at the time of surgery?

A: Yes, someone should accompany you at the time of surgery in case any emergency situation arises.

Q: Can I board a train or flight after the surgery?

A: Yes, you usually can if the surgery is done under local anesthesia, your surgeon would guide you regarding this.

Q: Are there any complications after surgery?

A: Your surgeon will provide you with a consent form which will highlight all possibilities. Usually, the surgery is extremely safe with minimal incidence of complications.

Q: Will I have a scar after surgery?

A: Yes, you will have scars over the areolar area and drain sites. The scars tend to lighten over months. In extremely rare cases hypertrophic scars and keloids may occur.

Q: I’m afraid of getting a depression in my chest after surgery?

A: A small amount of breast tissue is kept behind the nipple to prevent it from sinking. However, this will not grow back!

Q: My gynecomastia was operated but it seems it was not completely removed. Can a revision surgery be done now?

A: Yes, it can be done although a revision surgery may be difficult.

Q: Can I have a recurrence of gynecomastia?

A: No! If the glands are completely removed, then no recurrence is possible as glands can never grow back. However, if you continue to gain weight, then you may accumulate fat again the chest region which would be akin to pseudogynecomastia.

Q: Can you do a minimal incision technique in my case?

A: Depends! It is usually done in select cases with smaller swellings.