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Gynaecomastia is the non-tumoral mono or bilateral increase in volume of male mammary glands.

There are several possible causes for gynaecomastia; there are idiopathic forms, related to hormone (oestrogen) hyperproduction or caused by drugs, some tumours (testicular, liver, pituitary gland, kidney) may cause gynaecomastia, therefore in cases of true gynaecomastia, instrumental examinations and an endocrinologic evaluation must always be performed before surgery is considered.

Gynaecomastia may occur before puberty, as transient gynaecomastia, or as a symptom of hormonal metabolic syndromes or alterations with various causes. There are various degrees of gynaecomastia and different classifications (Grasser, Simon, Wiesman) depending on the gravity.

Pseudogynecomastia (or adipomastia), where the volume of the mammary area increases, is due to the abnormal depositing of fatty tissue rather than glandular tissue, as in cases of obesity, for example.

The surgical treatment of gynaecomastia depends of the individual case and the gravity:

Fatty gynaecomastia with moderate-small enlargement (Grade I-IIa of Simon) can be treated with lipoextraction; more serious cases (Grade IIb-III) may require the removal of a little periareolar skin. Very severe cases, with a great excess of skin may even require a mastectomy, with a diamond-shaped skin incision and somewhat evident residual scars.

True gynaecomastia, with ascertained presence of obvious glandular tissue is treated with an actual subcutaneous adenectomy, i.e. the surgical removal of the whole gland via a small incision around the areolæ.

The operation is preferably performed under general anaesthetic in the day hospital or as an inpatient for a maximum of one night's stay. Suction drains are used for 12-24 hours.

The patient must wear an elasticated Velcro bandage around the chest for at least two weeks.

Possible complications of the operation are: bleeding, seromas, cosmetic irregularities, hypertrophic scars.





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