Gynecomastia is the abnormal non-cancerous enlargement of one or both breasts in males due to the growth of adipose (fatty) and glandular breast tissues as a result of a hormone imbalance between estrogen and androgen. Not all breast growth in men is considered abnormal, just pathological and abnormal growth.
Gynecomastia can cause significant psychological distress or unease. Patients with gynecomastia usually complain about lumps in their breasts with or without excess fat in the breasts.
Surgery to remove the breast tissues usually involves liposuction of the excess fat, surgical removal of the excess glandular breast tissue through an incision in the margin of the nipple-areolar complex, and/or skin excision (in large male breasts). It is important that the plastic surgeon perform a proper physical exam of the breasts to confirm gynecomastia and rule out the suspicion of any potential male breast cancer.
The goal of breast reconstruction is to restore one or both breasts to near normal shape, appearance, symmetry and size following mastectomy, lumpectomy or congenital deformities.
The plastic surgeon usually performs the breast reconstruction in conjunction with the breast surgeon’s operation, as there area number of factors that should be taken into consideration when choosing which option is best: type of mastectomy, cancer treatments, and patient’s body type.
Breast reconstruction generally falls into two categories:implant-based reconstruction and flap reconstruction. Implant-based reconstruction relies on breast implants to help form a new breast mound. Flap(or autologous) reconstruction uses the patient's own tissue, including fat tissues, from another part of the body to form a new breast.
In more than 80% of cases, an additional plastic surgery procedure is proposed to improve the symmetry of the size, shape and position of both breasts. For example, if only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast.
Breast reduction, also known as reduction mammoplasty, is a procedure to remove excess breast fat, glandular tissue, and skin to achieve abreast size more in proportion with the rest of the body and to alleviate the discomfort associated with excessively large breasts (macromastia). Macromastia can also lead to breast ptosis (drooping breast) or in some cases, breast asymmetry.
Disproportionately large breasts can indeed cause both physical and emotional distress for patients. Patients with macromastia may experience physical discomfort resulting from the weight of their breasts.Along with the physical ailments due to macromastia (neck ache, shoulder ache, backache), some patients may suffer from emotional distress or more significant mental health problems as a result of their large breasts.
Breast reduction surgery is usually performed through incisions on the breasts with surgical removal of the excess fat, glandular tissue, and skin. If breast size is largely due to fatty tissue and excess skin is not a factor, liposuction alone may be used in the procedure for breast reduction.
The technique used to reduce the size of the breasts will be determined by the patient’s individual condition, breast composition, amount of reduction desired, and the patient’s personal preferences (after thorough discussion with the plastic surgeon).
After the incision is made, the nipple (which remains tethered to its original blood and nerve supply) is then repositioned. The areola is reduced by excising skin at the perimeter, if necessary.
Underlying breast tissue is reduced, lifted and shaped. Occasionally, for extremely large pendulous breasts, the nipple and areola may need to be removed and transplanted to a higher position on the breast (free nipple graft).
A woman's breasts often change over time, losing their youthful shape and firmness. For example, women may experience breast pstosis (drooping breast and low areola). These changes and loss of skin elasticity can result from pregnancy, breastfeeding, weight fluctuations, aging, and heredity.
A breast lift, also known as mastopexy, raises the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour. Sometimes the areola becomes enlarged overtime, and a breast lift will reduce this as well.
A breast lift can rejuvenate the patient’s figure with abreast profile that is more youthful and uplifted. It should be noted that breast lifting does not significantly change the size of the breasts or round out the upper part of the breast. If the patient wants her breasts to look fuller, the combination of breast lifting with one of the breast augmentation options described above should be considered.
This combined technique allows the most natural-looking result for breast augmentation, even with very thin patients. For patients who are not so thin, they will also benefit from the liposuction of the desired body areas to get rid of excess fat tissue.
A breast lipofilling is an aesthetic surgery procedure that transfers fat cells from the patient's own body to fill or increase a lack of volume in the breasts.
The surgeon begins the procedure by identifying the areas where the fat will be collected, essentially from a discrete area of the body where there is a reserve, or even an excess of fat cells (generally the abdomen, hips, knees, inner thighs, or buttocks).
Then, the fat tissue collection is performed by micro-incision using a fine suction cannula or during a conventional liposuction. The collected fat cells are then subjected to a sterile centrifugation for several minutes to separate the cells that will be injected(intact fat cells) from the elements that must not be injected (fat cells destroyed by the sample, non-fat cells such as blood cells).
The reinjection of fat (lipofilling) is performed using micro-cannulas allowing incisions approximately 1-2 mm in length. The injections are performed at different angles and in multiple directions so as to increase the contact area between the grafted cells and the recipient tissues (feeders),allowing a "good grip" of the injection and ensuring a harmonious shape.
Breast lipofilling is in principle not recommended for some specific cases; for example, patients who underwent surgical treatment for breast cancer, breast carcinoma, or have cancer occurring in the medical history of family members and other close relatives. However, after a certain period of time following the breast cancer surgery, it will eventually be possible to perform breast lipofilling but it will require a recent radiological assessment consisting of mammography and/or mammary ultrasound.
Breast implants are made up of a silicone shell filled with silicone gel. The two basic breast implant shapes are round and teardrop (also known as anatomical or contoured). Both come in many different sizes and profiles. The reasons for choosing one breast implant shape over another include a woman’s unique aesthetic goals, preferred incision location, and implant placement. Her individual anatomy — including body type, sternum width, chest-wall contour, and existing breast tissue — also influences the decision.
Most breast implant patients have two common incision options: 1) under the breast or 2) under the areola (the pigmented circle surrounding the nipple).
An incision under the breast, or the inframammary fold (IMF), is typically an excellent choice for patients who do not also require a breast lift. Incisions under the areola (peri-areolar approach) work well for any patient undergoing abreast lift, or who has moderate to large areolas. For this option, the surgeon places the incision along the lower curve of the areola, easily concealing it in the areolar border.
There are two options for breast implant placement: above or below the chest (pectoralis) muscle. In general, implants are placed above the pectoralis muscle if the patients are athletic, have additional pre-existing breast tissue above the nipple to help camouflage the implant, or intentionally wish to have a , implanted look in the upper chest.
During the pre-operative consultation, Dr Tadler will explain in detail and discuss with the patient the above-mentioned options in order to finalize the choice of breast implants, their placement and related incision technique.