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    Gynecomastia

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    Gynecomastia – What is it?

    Gynecomastia is the over-development or enlargement of the male breast that extends more than 0.5 cm in diameter, from the nipple (true gynecomastia).

    When there is deposition of fat tissue is called false gynecomastia or pseudo gynecomastia, but there may be a combination of both types.

    It often occurs when men reach puberty, from eleven to fourteen years, due to low testosterone and estrogen increase estrogen. This type of gynecomastia tends to regress after two years later.

    Those that do not regress spontaneously are treated with surgical correction.

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    Gynecomastia Pathological

    There are several causes of pathological gynecomastia, including: hormonal changes; Corticosteroids and anabolic (common in bodybuilders), liver disease, kidney failure, hyperthyroidism, testicular tumors and adrenal.

    The clinical history should inform how the growth of the glands was quick, what medications were frequently used, the patient’s habits and whether it carries any liver disease, kidney or endocrine.

    The physical examination should assess whether there is hypersensitivity of the breast, hard and uneven texture and if the lesions are larger than 5 cm in diameter.

    Mammogram or ultrasound may be useful in differentiating the false from the true gynecomastia.

    Laboratory tests include: test of liver and kidney function, and hormone levels.

    Surgical treatment is rapid (one to two hours), and the patient may be discharged at the same day of surgery.

    False gynecomastia constituted of fat are treated successfully with liposuction.

    True gynecomastia are treated with surgical incision encircling the lower diameter of the nipple and pulling out the increased mammary gland.

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    Anesthesia

    Most part of patients that undergoes gynecomastia is operated under local anesthesia.

    Only in cases of large breast volume, the epidural anesthesia or general anesthesia are chosen.

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    Candidates

    Teenagers who refuse to take off his shirt near friends or relatives, or those who are uncomfortable about their appearance, avoiding certain activities because they are afraid to show their chest. The surgery will bring great improvement in the patient’s social life.

    Patients who developed disease due to medications usage will also benefit from the surgery.

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    Pre-Surgical Recommendations:

    1. Communicate us before surgery in the case of flu, fever, malaise, etc;
    2. Avoid use medications containing acetylsalicylic acid (AAS®, Bufferin®, Aspirin, etc.), Vitamin E or any other containing Ginkgo biloba for up to 14 days before surgery.
    3. In the case of pain, can use dipyrone and Paracetamol;
    4. Discontinue any medication for weight loss you may be using, for a period of 10 days before the surgery. This also includes diuretics;
    5. Avoid smoking for at least 21 days before surgery;
    6. Avoid taking or using toxic substances or drugs during the two weeks before the surgery;
    7. Avoid alcohol or too heavy meals the day before surgery.
    8. To check-in the hospital, observing the hospital schedules and fasting for 8 hours and monitored;
    9. Come to surgery wearing comfortable and loose clothing, remembering to choose a button shirt instead of T-shirt;
    10. Bring a small bag with personal items.
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    Post-surgical Care

    1. Strictly obey the prescription;
    2. You will probably be feeling so good as to forget that was recently operated. Watch out!
    3. The euphoria may lead the patient to an untimely effort, which determine certain disorders;
    4. Make us any questions;
    5. Any change during the postoperative course, such as redness in the operated area, pain that does not improve or worsens, etc., must be reported immediately to the doctor;
    6. Do not move your arms excessively. Obey the instructions that will be given at the time of hospital discharge, concerning movement of the upper limbs;
    7. Take liquids constantly;
    8. Have a regular diet (except in special cases);
    9. Do not lie on the side or face down until being allowed by the surgeon;
    10. Do not change or handle the dressing, even if a small bleeding (which is normal and should not scare you).
    11. All the dressing changes should be performed by the surgery team or under their supervision;
    12. Do not drive for a period that may vary from 10 days, depending on the extent of each case;
    13. After a month light exercise will be allowed. Intense exercises could be performed after two months;
    14. Sex life, soberly, will be released after 7 days of surgery;
    15. Do not expose yourself to the sun for a minimum of 8 weeks;
    16. The patient should never use hot compresses on the operated area to improve the swelling.
    17. The clothing should be loose and comfortable;
    18. The elastic mesh should be used for a minimum period of 30 days, all day, including sleeping time. However, particularities of each case will be evaluated and this period may even be extended. Your doctor will give you all complete guidelines;
    19. The drop in blood pressure symptoms are cold sweat, nausea, vomiting, blurred vision and fainting. If any of these symptoms occurs, lie down immediately and elevate your legs as long cerebral circulation is restored and the symptoms disappear;
    20. The soreness is usually small, but treated with painkillers, if required sometimes it is necessary to apply drains, which are removed after 48 or 72 hours.
    21. The patient should keep moderate rest, use elastic mesh, avoid high temperatures and agglomerations.
    22. To be back to regular activities is possible about a week after surgery and sports will be released after 30-40 days.
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    Dr. Mariangela Santiago. – CRM 45138 states that this is a spontaneous and illustrative deposition procedure performed after medical consultation and indication of surgery and all medical and laboratory exams required as CFM’s recommendation.

    Even though this one was a successful case, no conclusion can be drawn based on this evidence, moreover, as in any case of plastic surgery, medical consultation with a Plastic Surgeon Specialist is required for making any decisions

    Following the rules of the Brazilian Federal Medical Council, to illustrate the results with photos made before and after procedures is not allowed.

    Dr. Mariângela Freitas Lima Santiago
    CRM-SP 45.138 (São Paulo Regional Medical Council)
    Plastic Surgery - RQE nº 11476 | General Surgery - RQE nº 7678

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