No cause for Embarrassment

Got too enlarged breast? It is no big abnormality. You may just be suffering from gynecomastia, enlargement of breast in men which is just a hormonal imbalance
By Dr Rakesh Kumar Sandhir

Gynecomastia (woman’s breast) is a condition of enlargement of breast in males. It may affect both or one side only. It is a common problem for which males ask for cosmetic relief. The flat chest is considered a male character by lay public. The levels of both testosterone (male hormone) and estrogen (female hormone) may be normal in an individual. The ratio however may be altered.
The gynecomastia occurs physiologically in infants, at puberty and above the age of 50 years. It is present in newborns and disappears in 2 weeks’ time. Nobody is usually concerned about it. The old ladies of the house explain it by the common knowledge that mother’s blood (medically hormones) passes into the foetus.
The young adults between the age group of 13-30 years seek the advice most commonly. They complain of enlargement, pain and tenderness. The boys at puberty have some enlargement of breasts due to hormonal changes. It disappears in about 2 years. It may however persist in some boys. The treatment is requested for emotional reasons and the embarrassment which occurs at the hands of peer groups and at public places. The problem can be gauged from the following cases.

1:    A 17 years old boy agreed to fill the forms for admission in a college only when his parents got his surgery done for gynecomastia. He felt that with chest like girls, it will not be possible for him to adjust in college.
2:    A man of 24 years joined a company as a salesman. His assumption was that to look smart for the job he should wear tight shirts.  This he could not do with his chest condition. He underwent surgery with desired result and faced his clients with more confidence.
3:    A 26-year-old man was to get married. He requested surgery so that he could look manlier to his wife.
These boys usually have no other abnormality of endocrine, liver or kidney organs. The patients ask for medical treatment. It may be effective in some cases. It, however, is not effective if the condition is present for more than one year.
The mainstay of treatment is surgical. The surgery is subcutaneous mastectomy. It is done either alone or liposuction assisted.  The liposuction assisted means that the fat portion is removed by liposuction. The glandular breast has to be removed by excision surgery. There are various incisions to perform it. The periareolar is a commonly used incision. The operation is safe with low incidence of complications which include skin necrosis and hematoma formation. The recovery occurs in 5-7 days. The patients feel happy to see their flat chest. It along with psychological relief is reflected on their face.
The patient usually does not undergo surgery if it occurs after the age of 50 years in our scenario. The investigations are done to exclude carcinoma breast, kidney or liver failure. These investigations are indicated because gynecomastia may occur pathologically at any age.  The history of alcohol abuse, antihypertensive or chemotherapy is taken. The drugs like amphetamines and marijuana may also cause gynecomastia at any age.

(The author is Consultant Plastic Surgeon, Kailash Hospital and Heart Institute, Noida)