This video was made to provide you with the latest technique of gynecomastia surgery followed by Dr. Sreekar Harinatha, Plastic and Cosmetic Surgeon in Bangalore, India. This technique won an Award for the best new Technique at the IMCAS conference in Taipei, Taiwan.
Meet Dr. Sreekar Harinatha at Contura Clinic, Bangalore
Call 7022543542 or 08047094167 and clear your doubts.
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If there is one factor that determines the kind of surgery and the outcomes it the grade of gynecomastia. Though there are many different methods of grading gynecomastia, the most commonly followed is Simon’s grading described in 1973. He classified gynecomastia into three grades depending on the amount of breast tissue and loose skin on top of the breast.
Rohrich in 2003 proposed another classification into four grades.
Though these two are used worldwide, Simon’s grading is simple and used more widely. One addition I would like to suggest to these gradings is the addition of skin tone factor. To put it simply, while skin excess is the loose skin on top of the breast tissue, skin tone is the inherent capacity of the skin to shrink and contract after the surgery. While skin excess has a linear progression from grades 1 to 3, skin tone can be independent of it.
The revised grading by Dr. Sreekar Harinatha is as below:
The ‘L’ here would indicate laxity, meaning poor skin tone. This revised grading would also predict the eventual surgical results in terms of skin reshaping in a more accurate way. And once documented into history, it would serve as a reminder about the patient’s original skin tone before the surgery and during follow-up.
Dr. Sreekar Harinatha’s revised grading is now widely accepted and also published in the prestigious Brazilian Journal of Plastic Surgery. Read the article here…
This is very important and is very often understated for reasons I cannot fathom. When two patients with grade IIA come for surgery and get operated by the same technique under the same surgeon, the results may be different. The reason being the difference in skin tone between the two. This should not come as a surprise as such a difference in results follows other surgeries like liposuction too. The lack of skin tone makes a visible difference in the results after any procedure. And patient with loose skin even after seemingly lack of loose skin may need other non-non-surgical procedures or very rarely surgery to tighten the loose skin. This can happen even in Grade IIA gynecomastia.
Meet the experienced gynecomastia surgeon in Bengaluru, Dr Sreekar Harinatha to get your male breast sorted.
Traditionally it was viewed that one should undergo Gynecomastia surgery only after puberty and around 16-18 years. Unfortunately, many teenagers spend their entire teenage years waiting for the surgery and are subject to ridicule and embarrassment during this critical time in their lives. Many people even think that Gynecomastia resolves on its own after puberty which is a very rare occurrence. It’s important to notice the state of the breast gland for a period of two years. If it has increased or is the same, then it’s prudent to plan the procedure. The decision to operate is based not only on the diagnosis of gynecomastia but also on the physical and mental maturity of the person and his capability of understanding the surgery as well as the ability to cope with the post-op pain and to follow the post-op care regimen. Surgery has been successfully performed on hundreds of young men from ages 12 through 18. Obviously, this decision is made is on an individual basis.
One parent in 2014 met me with their son who was studying in 11th. They were worried about the sudden drop in his grades and his low self-esteem. They had taken him to a psychiatrist too. The boy was on medication as he did not fully disclose the issue to the psychiatrist. Only later did he reveal gynecomastia to his father who in turn got him to meet me. The boy had in the last four years been under severe psychological impact apparently as his friends poked fun at him for his breasts. He started wearing loose-fitting shirts on top of a male bra. Yes, you read that right; a male bra.
The male bra is actually a compression vest that is actually used post-surgical correction for a few weeks for the surgical swelling to reduce. Many misguided boys wear it under their shirts to compress the breasts hoping that it would not show up on top of clothes and also that wearing it long enough would make the gland disappear. Some others try bandaging, where they roll a tight length of a bandage or a cloth in order to compress the glands against their chest to hide it better. Some boys end up getting their skin damaged and even sustain rashes that have to be treated independently. They occur due to the tightness and the subsequent skin damage and irritation.
The extent to which some men go to for correction of the breast is quite baffling; especially in these days where a simple google search reveals that surgery is the straight forward option.
In August 2018, a very important and systematic meta-analysis was published on the psychological impact of gynecomastia and surgery. Meta-analysis is like an analysis of many research projects under one umbrella. In such studies, various other research patterns and results are analyzed to give us a better and clearer understanding of the issue being researched on. This study was published in the Gland Surgery journal by Martin Sollie from Denmark. They analyzed over 500 research papers on the topic. They too noted that gynecomastia impacts the general health, functional capacity, social aspects, vitality and mental health of the individuals. And all these were significantly and objectively improved once it was corrected by surgery. This is a seminal piece of information on the often neglected psychological aspects of the male breast. There are many more detailed and meticulous trials and studies that second this conclusion.
Men older than 45 years suffering from gynecomastia are also candidates for surgery but must understand that the skin may not totally tighten after the surgery is performed since they may have lost some elasticity in their skin through the natural process of aging. Such candidates also require more blood tests and other investigations before surgery.
On the day of surgery, you will need to come down by 9 am. You will also need to be on empty stomach from 12 midnight. Once you come to the clinic, your medical history will be taken and you need to read, understand and sign on the consent forms.
Then Dr. Sreekar Harinatha will mark the extent of breast tissue and the areas of fat that need to be treated. You can again clear all your doubts before the procedure is started. He may point out any asymmetries and the scar location during the markings. Then you will be started on a few injections through an intravenous cannula. Then your chest and armpit hair are shaved (if not already done). The anesthetist will also check on you and talk to you before you are shifted to the OR.
In the OR you will be anesthetized. It will feel like going to sleep. You will be given certain injections along with oxygen for inhalation through a mask. The male breast reduction procedure typically lasts for around 90 minutes. The procedure is performed under general anesthesia by our experienced anesthetist and surgeon. Dr. Sreekar Harinatha will create a well-hidden incision either around the areola. He will then remove the excess fat, skin and glandular tissue from the chest area depending on the requirement.
Once the procedure is completed, a compression dressing will be done on the chest. Then your anesthesia will be reversed and you will be shifted back to your room. Here, you will recover for a few hours during which the staff will monitor you and check on you frequently. Once you are feeling better, you will be given liquids to drink and then made to walk. Once you are walking comfortably and fit our discharge criteria, you will be sent home with a discharge summary and detailed instructions. Before you leave, Dr. Sreekar will check on you and let you know about the follow-up protocol. You will normally be advised to come for a check-up after two days.
Gynecomastia is fat and you can just workout and burn it
This is probably the most common misconception going around about gynecomastia. Gynecomastia, the word itself means ‘Male Breasts’, so there is no question of fat causing it. hence any treatments or remedies that focus on only reducing the fat will never work to treat gynecomastia as it is primarily breast tissue and NOT FAT!
Gynecomastia is caused by Hormone imbalance
While hormone imbalance is definitely one of the causes of gynecomastia, it is not the only one. There are over 50 factors that can contribute to gynecomastia including chromosomal anomalies, genetic disorders, excessive smoking, alcoholism, liver disorders, tumors etc. In most of the cases it is just idiopathic- Meaning there is no definite cause!
Gynecomastia can be operated by any surgeon
Gynecomastia surgery is one of those where the specialist’s skill is conbined with the science and art behind achieveing an aesthetic chest. This requires expereince, a keen understanding of the anatomy and the aesthetics. This is best achieved by a board certified, professionally trained and specialised plastic and cosmetic surgeon.
If you still have gynecomastia, it means you dont workout enough
The truth cant be farther from this statement. As obvious, gynecomastia is breast tissue and hence cant be expected to resolve with exercises. In fact excess chest exercises only make the gland stand out as the fat around it gets reduced. This is in fact called “bodybuilder’s gynecomastia”.
Hormone tablets can reduce gynecomastia
Once the breast tissue grows in puberty, any number of hormone pills cannot reverse the tissue growth. only way that can be sorted is by surgery. Morever unsolicited use of hormone pills can have various advers effects on the indivisual including loss of bone density, hair loss, sterility etc.
Gynecomastia is a cause of considerable psychosocial discomfort, stress, and worsening of self-image in adolescent boys. It is important to understand these concerns in order to provide proper management. Many parents casually neglect the issues raised by the boys only to later realize the psychological effects of a poor body image.
Many parents attribute adolescent gynecomastia to fat. A rapid increase in obesity among children and adolescents results in a higher number of patients presenting with breast enlargement and disproportionate diagnoses of ‘pseudo gynecomastia’. Despite the fact that obesity causes pseudo gynecomastia, which is a proliferation of fat rather than breast glandular tissue, true gynecomastia is also associated with higher body weight. Many studies like ones by Rivera et al. indicated that there is a correlation between pubertal gynecomastia and higher BMI (Basal Metabolic Index) percentiles (Reference). Kulshreshtha et al also reported that most of the patients (64%) with breast enlargement were obese as per scientific Coles criteria (Reference).
It is common to notice higher BMI values than the general population according to the Centers for Disease Control (CDC) growth charts in gynecomastia patients. However, there is no relationship between BMI and breast size. Despite the fact that many overweight children (57.1%) succeed in losing some weight, breast size was not reduced in any of them and weight changes did not affect sex hormone levels (Reference). This observation, that weight loss alone will not correct true glandular breast enlargement is consistent with that reported by many other authors (Reference 1, Reference 2).
It should be also underlined that in the majority of our patients the breasts do not show a drastic increase in size with age. Adolescents with gynecomastia should be encouraged to lose weight, but it does not treat the underlying breast tissue.
Surgical management of pubertal gynecomastia may be considered in obese or non-obese male adolescents who present with persistent breast enlargement after a period of observation of at least 12 months, breast pain or tenderness, and/or significant psychosocial distress. Obesity is not a contraindication to the surgical approach. Liposuction techniques are helpful in those patients with considerable fat deposition in the breast during the removal of the glandular component. The aim of surgical treatment is to achieve a normal appearance of the masculine thorax with the smallest possible scar. The surgical treatment of gynecomastia requires an individualized approach.
In conclusion, teenage boys who have persistent gynecomastia after the end of pubertal development and adolescents who have concerns about the cosmetic correction can undergo gynecomastia surgery. Therefore, the decision to perform surgery depends on the degree to which this condition has affected the quality of life, psychology and on their desire for cosmetic correction
Though gynecomastia is very common, it is fairly obvious that not everyone is the right candidate for under gynecomastia surgery. There have been instances where we had to reject a few healthy patients when they did not meet a few criteria.
Here is a list of pointers that make one a good candidate to undergo gynecomastia surgery:
The first task when you decide to go ahead with Gynecomastia surgery is finding a competent cosmetic surgeon to successfully treat it. It may seem like a challenge at first, but its a lot straight forward than one may think.
Here are the 12 steps that will help you reach your decision.
To Schedule, a consultation with Dr. Sreekar Harinatha, call 7022543542 or 08047094167
In Bangalore, Bodybuilders with gynecomastia come with a special circumstance, since their gynecomastia is usually small (confined to the area just under the areola) and is a result of self-medicating with hormones and anabolic steroids to bulk up their muscles. They have very low percentages of body fat and are in good physical shape.
These bodybuilders get gynecomastia following usage of self-prescribed (or gym trainer prescribed) medications, which disrupt the delicate hormonal balance.
Some men do not specifically take anabolic steroids. But they may take “protein supplements,” prohormones and other seemingly harmless supplements, available at health food stores or through the internet. The problem is that many of the listed ingredients are not specific and these supplements may indeed have hormone-like qualities. The net effect is that gynecomastia may develop most unexpectedly and sometimes very quickly. And once it has developed, there are no treatments for it other than surgery.
There are other side effects as well. By taking extra hormones, the body senses that it has sufficient amounts of testosterone and therefore decreases its own natural production of testosterone. The testes then begin to under perform, since they are no longer “needed.” There are also other effects on various organs of the body. Tumors may develop.
A study conducted by Blau M and Hazani R. titled ‘Correction of gynecomastia in bodybuilders and patients with good physique’ and published in Plastic and reconstructive surgery in 2015 stress the importance of direct excision of the glandular tissue over any other surgical technique when correcting gynecomastia deformities in bodybuilders. They also advise that novice surgeon is advised to proceed with cases that are less challenging, and leave such cases to experienced surgeons. (Article Link)
Male breast reduction surgery for Bangalore (Bengaluru) bodybuilders is very similar to the standard procedure described elsewhere on this website. There are some significant differences, however.
The results of gynecomastia surgery are usually permanent provided that additional illicit drugs are not used in the future. There is always a small amount of breast tissue deliberately left under the areola to prevent a crater deformity. Should additional drugs be taken in the future, it is that residual breast tissue that can possibly re-grow again with hormonal supplements.
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