Download GYNECOMASTIA - Dave Palumbo

GYNECOMASTIA
“Hey, look at Charlie. His breasts are so big you could milk him like a cow!”
How many teenage boys have been emotionally traumatized in gym class by a legion of
cruel and sadistic kids who take pleasure in seeking out the slightest imperfections among their
peers? How many men, young and old, are living with this embarrassing condition for
innumerable years not realizing that there is a very simple corrective procedure available? For
those of you who are a bit confused, what I’m referring to is a medical condition known
professionally as gynecomastia; colloquially as “bitch tits”.
Literally translated, gynecomastia means “woman-like breasts” and, believe it or not,
gynecomastia affects an estimated 40 to 60 percent of all men in either one or both breasts.
Just as woman don't enjoy being teased about having small breasts; men are extremely sensitive
when it comes to having a hint of breast tissue hanging from beneath their nipples. I mean, it’s
only reasonable to believe that if King Kong doesn't have "bitch tits"; why should I?
What causes the overgrowth of breast tissue in men?
Commonly, 30-40% of the time, gynecomastia appears in adolescent boys around the age
of 12 and lasts about 2-3 years. When boys enter puberty they start producing large quantities of
the masculinizing, muscle-building, hormone, testosterone. As testosterone levels rise in the
body, a certain percentage converts into the predominately female hormone, estrogen. Boys
whose mammary glands (found under the nipple) are particularly sensitive to estrogen seem to
exhibit an abnormal overgrowth of their breast tissue. In most, this condition disappears;
however, in about 10% of the male population it persists as a stigma throughout life.
Another type of gynecomastia that is commonly seen among athletes usually results from
the use of synthetic anabolic steroids. When large quantities of exogenous steroids are taken,
testosterone levels rise rapidly and the body responds by converting the excess testosterone, via
aromatase enzymes, into estrogen. This elevated testosterone level provides significant gains in
muscle mass and strength; however, the resulting estrogen often causes long-term changes in the
breasts. In some steroid users, gynecomastia may occur after the very first injection. In others it
may require many months of repeated use; while in some, they may never see as much as a
single lump. When evaluating steroid consumption, gynecomastia is more often than not a doserelated phenomenon.
Other causes of gynecomastia include obesity, aging (estrogen levels increase as men
age), estrogen-producing tumors, genetic and familial predispositions, chronic liver disease (e.g.
chronic alcoholism), and drugs (e.g. antacids, diuretics, cardiac medications, marijuana, and
Valium).
In rare cases, gynecomastia can transform into cancerous growths. When this occurs, a
painless nipple discharge and ulceration may be noted. In some areas of the Middle East and
around the Horn of Africa, such incidences of male breast cancers climb to more than 6% of all
gynecomastia cases.
Presentation
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The patient with true gynecomastia complains of hard lumps under the nipple that often
expand both toward the inside and the outside of the breast. Oftentimes this overgrowth of
glandular tissue will even manage to invade the armpit region. The enlarged glands may vary in
size and texture, can be painful or tender to the touch, and occasionally present with nipple
discharge. Excess fatty tissue sometimes accompanies true gynecomastia and adds to the bulk of
the growth.
Treatment Modalities
While we don’t think of breast reductions as a subject usually associated with men;
surgical excision of the overgrown glands remains the treatment of choice in true gynecomastia.
Planning Your Procedure
The initial consultation with your surgeon will require a complete medical history,
examination of the breast and nipple regions, and a full lab workup to ensure that you are
medically fit for surgery. If there are any impaired liver functions or other medical problems,
you will be referred to a specialist.
Breast reduction surgery can be performed on men of any age who are in good physical
and emotional health. The best candidates for surgery have firm skin with good elasticity.
All surgery, even elective procedures, has elements of risk and uncertainty. Using a board
certified plastic surgeon minimizes problems, but complications may still arise. They include
infection, skin injury, excessive bleeding, excessive fluid loss or retention, and adverse reaction
to the anesthesia. Another inconvenience may be numbness or temporary loss of nipple sensation
which may last for several months or more.
The Surgical Facility
Your gynecomastia surgery will most likely be performed as an outpatient procedure at
either your plastic surgeon's office or an ambulatory surgical facility. If there are medical
conditions of concern, an overnight hospital stay may be recommended. The procedure typically
takes an hour and a half to complete, although that time may increase or increase according to
the individual.
Pre-Operative Preparation
Gynecomastia surgery involves the removal of extremely vascular glandular tissues;
therefore, it is imperative that, two weeks prior to surgery, patients refrain from consuming
aspirin, NSAIDs (non-steroidal anti-inflammatory drugs), and nutritional supplements. These
products significantly increase bleeding times and thus can turn routine surgical procedures into
proverbial “blood baths”. While I advise my patients to discontinue all vitamins, meal
replacement shakes, and herbals, I’ve found the following products to be the most troubling:
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Bilberry (Vaccinium myrtillus) - Bilberry can affect blood cells called platelets and may
increase bleeding.
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Cayenne (Capsicum frutescens) - Also known as red pepper, cayenne may affect
platelets.
Dong Quai (Angelica sinensis) - An active constituent in Dong quai is a coumarin-like
compound, which may increase existing anticoagulant (blood-thinning) medications.
Echinacea (Echinacea augustfolia) - Used to boost the immune system and for infections
of the respiratory tract, Echinacea may negatively affect the liver when general
anesthetics or certain other medications are used.
Feverfew (Tanacetum parthenium) - Feverfew may increase bleeding, especially in
patients taking certain blood-thinning medications.
Fish Oil - The Omega-3 essential fatty acids found in fish oil have blood-thinning
properties which can be problematic during surgery.
Garlic (Allium sativum) - Garlic may augment the effects of blood-thinners like
Coumadin (warfarin) and non-steroidal anti-inflammatory drugs (NSAIDs) causing
abnormal bleeding time.
Ginger (Zingiber officinale) - Use of ginger may alter bleeding time and interfere with
cardiac and anticoagulant medications.
Ginkgo Biloba (Ginkgo biloba) - Ginkgo biloba improves blood circulation by
strengthening the vascular system and inhibiting platelet aggregation. Ginkgo has
significant blood-thinning activity which is three times stronger than Vitamin E.
Ginseng (Panax quinquefolium/Panax ginseng) - Ginseng acts as an anticoagulant and
may interact with cardiac, high-blood pressure medications and blood-glucose lowering
medications.
Red Clover (Trifolium pratense) - An active constituent in Red Clover includes
coumarin derivatives, which may potentiate existing anticoagulant medications.
Vitamin E - Vitamin E has strong anti-clotting activity can prolong bleeding time during
surgery.
Yohimbe (Corynanthe yohimbe) - Yohimbe can raise the heart rate and blood pressure,
and increase the potency of anesthetics.
Surgical Procedure
Your surgeon will choose either general anesthesia or local anesthesia (with sedation);
and he will explain the basis for the particular option that is recommended. In a typical
gynecomastia surgery, an incision is made in an inconspicuous location-- either on the edge of
the dark skin around the nipple, or in the underarm area. Through the incision, the surgeon cuts
away the excess glandular tissue, fat, and skin from around the areola and from the sides and
bottom of the breast. If your surgeon has determined that liposuction will be used in conjunction
with excision, the liposuction cannula can be inserted directly through the same incisions. In
breast reductions involving greater amounts of breast tissue, larger incisions may be necessary
and more noticeable scars can result.
If your surgeon has determined that your gynecomastia consists primarily of excessive
fatty tissue, liposuction would be an appropriate surgical technique for removal of this tissue. At
the edge of the areola, in the dark skin that surrounds the nipple, a very small incision (less than
a half inch in length) is made. Depending on patient-specific factors and preferences, the incision
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may be placed in the underarm area, as well. A cannula, (a slim, hollow, tube attached to a
vacuum pump) is inserted through the incision. Your surgeon uses the cannula to break up the fat
and suction it out. In cases where large amounts of tissue have been removed, it may be
necessary for excess skin to be trimmed so that the remaining skin will adjust to fit the new
breast contour.
Post-Operative Experience
It is normal to feel some discomfort for a few days after your procedure. This can be
controlled with pain medication prescribed by your surgeon. You should arrange to be driven
home after the surgery and you should have someone to help you manage for a day or two after
the surgery.
Bruising and swelling may cause it to appear that there has been little improvement in
your gynecomastia. Although extreme swelling usually resolves itself within the first few
weeks, it may take three months or longer before the true results are visible.
In over two thousand cases, I have rarely used drains or compression garments. Routine
follow-ups include a suture removal visit 5 to 7 days post surgery. Sexual activity should be
avoided for at least a week post surgery and heavy exercise for at least three weeks. All
activities that risk blows to the chest area should be avoided for at least a month. Avoid exposing
scars to the sun for at least six months. Sunlight can cause the scar to darken permanently. If sun
exposure is unavoidable, use a strong sun screen (SPF 15 or greater).
Most conventional surgeons use a textbook procedure that results in the need for
additional surgeries since they don’t remove all the underlying breast tissue. I have developed a
technique that safely and effectively removes all the glandular tissue and produces an athletically
contoured chest. I get it right the first time so that there is no need for additional surgeries.
DR MORDCAI BLAU, M.D., P.C.
Dr. Blau has operated on over 1000 top amateur and professional bodybuilders alone. He is,
without a doubt, the most experienced gynecomastia surgeon in the country. Located in White
Plains New York, Dr. Blau’s office can be reached at (914)-428-4700. His email is:
[email protected] and his website can be seen at http://www.cosmetic-md.com/. Feel free to
contact him.
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