Gynecomastia is the abnormal growth of the mammary gland in man The causes can be of type:hormonal which appear at puberty and often resolve spontaneously. Also of aging.These do not resolve spontaneously. By ingestion of drugs or medications being the most common anabolic steroids in bodybuilding and practicing various drugs marijuana may be the cause of gynecomastia from certain antihypertensive drugs, and especially spironolactone, drugs to control gastric acidity (cimetidine), for the heart (digoxin) for vomiting, certain antibiotics (ketoconazole) or antidepressants ... Sometimes the cause is the regular use of creams containing estrogen, for example, for baldness, as these are absorbed very well through the skin. In rare cases (10%), the cause radiation in an insufficient production of male hormones due to alterations or testicular tumors, pituitary gland problems, thyroid disorders, malnutrition, cirrhosis, liver tumors, or alcohol abuse. On these occasions is often also associated with impotence. Regular use of drugs such as heroin, marijuana, or methadone, often favors the growth of breast tissue. Only a very small percentage, the cause of gynecomastia is a breast tumor. Unknown cause .. in alrederor 25% of cases it is possible to find any cause. CLASSIFICATION
True gynecomastia Pseudogynecomastia Glandular hypertrophy + fat Only fat in obese patients who have lost weight TREATMENT:
Most of the time the gynecomastia returns spontaneously. In newborns can take up to four months. During that time it is important not to handle the babies chest. Pubertal gynecomastia usually resolves in about six months but can sometimes persist for two or three years. In adolescents, the presence of breast tissue may cause insecurity and psychological problems, especially in summer, when usually most evident, since they are so bare-chested. It should reassure them by explaining that is a fairly common one time or another in adolescence, and also is likely to disappear spontaneously.
SURGICAL TREATMENT
The valid therapeutic option in cases of gynecomastia is not reversible surgical treatment and the indication is more responsive to the aesthetic impact that the disease involves a possible functional disorder. We must defer treatment of the disease if the affected patient is an adolescent male with an evolution of less than two years gynecomastia.
Taking into account age, smoking and extent of gynecomastia morphology of the patient, apply one or another type of surgical technique:
Simple surgical excision, young adolescents indicated in patients with breast augmentation mainly due to glandular hypertrophy. Surgical excision + liposuction indicated in obese adolescents with peri-and subareolar glandular component and excess fatty tissue. Liposuction alone: indicated in obese adults (habit picnic) with predominantly fatty breasts consistency. Excised skin tissue fatty-glandular-free CAP + autograft (the nipple-areola complex) indicated in individuals with significant weight loss excess skin show but also a certain amount of glandular tissue. The surgery can be performed under both local and general anesthesia, depending mainly on the amount of tissue need to be dry as well as characteristics of the patient.
We usually do it with sedation and local anesthesia on an outpatient basis. This means that once intervened and recovered from anesthesia may go home.
Simple surgical excision
In most cases, proceeds to skin incision at the top half periareolar unlike women make lower incisions. Here is dissected nipple-areola complex (CAP) of the underlying glandular tissue, leaving a thickness of about 6-10 mm. breast tissue attached to the deep surface of the CAP in order to obtain a correct projection and prevent depression thereof. Once CAP raised the flap is released skin and subcutaneous fat underlying glandular tissue severing the fibrous attachments to the subcutaneous space overlying glandular. The correct dissection and hemostasis. After freeing the gland from the subcutaneous tissue is dissected in its deep surface of the fascia separating the underlying pectoralis major muscle. Below is cut and removed fatty glandular tissue. In order to achieve a smooth contour and harmonic and avoid a palpable edge periphery thins as a bevel resection in small amounts and gradually to avoid excessive resection would cause an abnormal chest flattened. Finally, inserts a suction drain if necessary and periareolar incision is closed, ensuring that there are no irregularities and contour is achieved aesthetically correct.
Surgical excision + liposuction
We first performed the liposuction so that the gland is completely isolated and then resected following the directions above.
Liposuction alone
The incision for the introduction of the cannula can be drawn at the line periareolar, axillary or in regions close to the breast. After entering the liposuction cannula tracing routes will go to get a correct contour. In order to avoid excess tissue resected sized cannulas are used increasingly less as one moves resection.
Excision glandular skin-fat-free graft CAP +
Only in very special cases this procedure is done .
Source: clinicachong.weblogicnet.com