gynecomastia; It can occur in the case of both mammary gland and adipose tissue excess due to excess adipose tissue.

What is gynecomastia?
Gynecomastia, which means breast enlargement in men, is defined as the growth of glandular breast tissue caused by the imbalance of estrogen and testosterone hormones. The condition, which can be observed in about half of adult men, can cause psychological problems that reduce the quality of life of the person as well as aesthetic problems. When a boy enters puberty or an older man's body produces less testosterone, the balance of the two hormones shifts. In this case, a higher percentage of estrogen causes swelling of the male breast tissue. About half of adolescent boys and two-thirds of men over 50 years of age observe this growth in their bodies up to a certain size.

Causes of Breast Growth in Men
Breast tissue growth in the male body can be linked to many different causes of hormone changes. Hormone treatments, worn athletes, some external methods, doing more sports, weight loss methods do not prevent breast growth in men.

Some diseases and medical conditions that cause gynecomastia include:

Weight gain, obesity, which leads to an increase in adipose tissue in the breasts
Hormone disorders
Heart drugs, cancer drugs, hormone-containing drugs, antidepressants, amphetamine and cortisone
Alcohol and drug use
Some types of cancer, especially lung and liver cancer,
Testicular (ovarian) and kidney diseases,
Thyroid gland diseases (goiter)
congenital disorders
Tumors of the adrenal gland or pituitary gland
injury or trauma
What are the Symptoms of Gynecomastia?
The main symptom of gynecomastia is enlargement of one or both breasts. Enlarged glandular tissue is usually seen in both breasts but may be unilateral in some cases. Breast growth may be uniform or irregular relative to the nipple. Growth can be seen just behind the nipple in a rubbery or hard structure. In this case, pain or tenderness may be felt when the breast or nipple is touched. It is important to differentiate it from male breast cancer. When cancer is present, usually only one breast is affected, and the tissue does not necessarily have to be firm or firm. Cancer may also be associated with dimpling of the skin, nipple discharge, nipple retraction, and enlarged lymph nodes under the arms.

Another problem that can cause breast swelling in men is a rare breast abscess in men. Affected individuals may develop fever or chills. The swelling may be very painful and warm to the touch, and the skin opposite the swelling may appear reddish in color.

Before Surgery
Care should be taken to avoid sunburn or permanent scarring as a result of prolonged sun exposure up to two weeks before the operation. If any discomfort has been experienced one week before the operation date, the doctor should be informed. Smoking should be stopped at least 3 weeks before the operation and alcohol use should be stopped up to 48 hours before the operation. Consumption of food and drink should be stopped at least 5 hours before the operation. It should be ensured that aspirin, aspirin derivatives and drugs that increase the risk of bleeding are not taken at least 10 days before the operation.

How is Gynecomastia Surgery Performed?
Breast reduction surgery, which aims to achieve healthy, dynamic, fit and athletic breasts; It is a body shaping operation applied to eliminate the lubrication, growth, cambering, sagging and cracking that occurs in this area. How to treat your breast enlargement complaint depends on age, health status, how long you have been struggling with this condition, and how you react to the treatments applied.

If gynecomastia occurs during puberty, it usually goes away on its own. This can take from 6 months to 3 years. If it turns out that your hormones are out of balance due to another health problem, surgery may be necessary in some cases. Your doctor may recommend techniques such as:

Liposuction (removal of extra breast fat)
Excision (removal of mammary gland tissue)
Liposuction Technique
In cases where it is mainly the result of excess adipose tissue, one of the liposuction techniques alone can be used. This occurs by inserting a cannula, a thin hollow tube, through several small incisions. By moving the cannula back and forth with a controlled movement, excess fat is loosened and this fat is then removed from the body by vacuum suction. Vaser liposuction and laser lipolysis plus methods are determined by the doctor according to the needs of the person.

Excision Technique
Excision techniques are recommended in cases where glandular breast tissue or excess skin needs to be removed to correct gynecomastia. Excision is also necessary if the areola is to be reduced or the nipple is to be repositioned to a more natural male contour. Incision patterns, specific conditions and 

varies depending on preference. In some cases, gynecomastia is treated with both liposuction and excision. Breast reduction surgery is usually performed under general anesthesia. The operation takes about 1.5 hours. You usually need to stay in the hospital overnight.

Recovery after breast reduction surgery may take several weeks. You may experience pain, swelling, and bruising in your breasts for several weeks. After the operation, care should be taken to lie flat for 3 days and not take a shower. You will need to wear an elastic compression garment day and night for 3 weeks after surgery. This corset helps reduce edema and swelling in your chest while you heal. How long you need to keep your dressings will depend on how quickly your wounds heal. After 1-2 weeks, your stitches will either dissolve or be removed. Avoid stretching, strenuous exercise and heavy lifting for about 3 weeks after surgery. It will take approximately 6 weeks for you to fully return to your normal activities. A few weeks after surgery, you can drive again when wearing a seat belt is no longer painful. It may take up to 6 months for you to see the full results of your surgery.

It is not possible for this problem to recur after gynecomastia surgery. However, if there are conditions such as cirrhosis, liver disease, hormone disorders, drug and alcohol use, the breast tissue may grow a little more. Because in the surgery, some breast tissue is left under the nipple. When it comes to excess weight gain, there may be some growth, as there will be an increase in adipose tissue. Theoretically, it is not possible to re-occur unless these situations do not occur.

Op. Dr. Orhan AYDIN

Plastic and Aesthetic Surgery Specialist

Who is Orhan AYDIN?

Kiss. Dr. Orhan Aydın was born in 1984 in Kırcaali. He completed his primary and secondary education in İzmir. He graduated from Manisa Celal Bayar University Faculty of Medicine in 2008. He completed his specialization training in Pamukkale University Plastic, Reconstructive and Aesthetic Surgery Department between 2009-2014. Between 2014-2015, he completed his compulsory service at Şanlıurfa Mehmet Akif İnan Training and Research Hospital.

Health Sciences University, where he started working in 2015, Dr. Abduraahman Yurtaslan left his duty at Ankara Oncology Training and Research Hospital in November 2018...