Inverted nipple

Important things to know about the initial medical examination for gynecomastia

The most important tool the doctor has in gynecomastia is the doctor-patient consultation (patient history assessment). Often, gynecomastia is caused by medication or drug use, or it is part of a natural growth process during puberty, the so-called pubertal gynecomastia. It is for this reason that no further diagnostics are required for boys under the age of 15 years.

The form and size of the nipple allow for the differentiation of breast growth stages which can be observed over a longer period of time. Regarding gynecomastia, the main task for a physician is to differentiate pseudo-gynecomastia (lipomastia) from genuine gynecomastia. This is why palpation is a very important diagnostic step, as it allows the physician to quickly differentiate glandular tissue from simple fatty tissue and, thus, to assess whether this is a case of abnormal growth of mammary gland tissue. Some doctors prefer to use an ultrasound device to determine this tissue difference.

The doctor will also take blood samples to assess liver and kidney values and the levels of the hormones oestrogen and testosterone and of their catabolites. The ultrasound examination of testes and abdomen is important to assess the sites where the hormones are produced. In this examination, the testes are palpated to check for structural changes or lumps. In youths, the development of the penis and the body structure are assessed at the same time. This allows to draw conclusions on the physical development and on the stage of puberty. A chest x-ray or CT (computer tomography) can be of importance for some specific types of gynecomastia or in case of suspected tumours.

A unilateral gynecomastia with hard tissue components (lumps) might indicate a suspected breast cancer. In this case, a mammography to exclude breast cancer is performed in men. If no cause of gynecomastia can be found or if it has existed since birth or puberty, a chromosome analysis might indicate a possible genetic defect. For cost reasons, this examination is only done if there are further indications for a genetic disorder.

Can gynecomastia be treated without doing surgery?

In gynecomastia, the treatment is determined by the cause of the disease. Often, this disorder is only of transient nature, as it is the case of pubertal gynecomastia, and no treatment is required.

If causes are known and can be treated, treatment approaches aim at correcting the hormone balance. If this cannot be achieved through simple means such as change of diet or avoidance of hidden external sources of oestrogen, medication can be used that will directly impact the hormonal balance: Either through direct administration of testosterone or by blocking the transformation, production and effect of the female hormone oestrogen. However, such medicinal treatment is controversial and one has to expect that it will only show effect within the first months after the beginning of breast growth.

How long does surgery take?

At Park-Klinik Birkenwerder/Berlin such an intervention usually takes one to one and a half hours and the patient is admitted at our centre on the day of the surgery.

Important things to know – before gynecomastia surgery?

A patient has to come on an empty stomach, though he will only get regional anaesthesia. Furthermore, any medication that is taken within the last two weeks before surgery should be agreed upon with our doctors (surgeons and anaesthetists), as some substances, – especially pain killers such as acetylsalicylic acid, ibuprofen or diclofenac –reduce the blood’s coagulation properties.

How is the surgery done?

At Park-Klinik Birkenwerder/Berlin, gynecomastia surgery is performed by a specialist for plastic and aesthetic surgery. For this, usually a small incision is made in the areola of the nipple. Thanks to new operation techniques, large scars can be prevented in many cases. During surgery, glandular and fatty tissues are removed so that the breast should no longer grow in future.

What are the complications that can occur during or after the surgical treatment of gynecomastia?

The risks of this type of surgery are low. However, there might be renewed breast growth, i.e. a relapse. Furthermore, sensory disorders might develop in the area of the breast or parts of the nipple may die or collapse. A further risk of this operation is a possible later asymmetry of the breasts. Inflammations or extensive scarring are also possible consequences of the operation. This is why a surgical intervention has to always be well contemplated.

Do I need general anaesthesia for a gynecomastia surgery?

Gynecomastia operation at Park-Klinik Birkenwerder/Berlin can be performed under regional or general anaesthesia. This is a decision that the patient and the anaesthetist take jointly. Here, the extent and the expected duration of the intervention play a role. As part of the information process, the surgeon who will perform the intervention will explain the surgical procedure and the risks associated with it in all detail and answer any questions that might come up.

Important things to know – after gynecomastia surgery

After the intervention, the healing process of the surgical scar needs to be monitored closely. Wound control is important to quickly detect and treat inflammations and excessive scarring.

The improvement of the external appearance is one important goal of the gynecomastia treatment. Before and after pictures can very well document the success of a surgical intervention and show the achieved improvement to the patient. This is also a means to detect renewed breast growth.