Types of Gynecomasia?
Pubertal or ‘adolescent’ gynecomastia – Also called (inaccurately, by the way) ‘congenital’ or ‘hereditary’ gynecomastia, this condition generally appears between ages 9 and 14 and may be seen transiently in as many as 30 to 50 percent of boys. In some cases pubertal gynecomastia recedes with age, but about a third of all patients will have breast tissue that persists into their young adulthood, and improvement can only be achieved through surgical excision. Because pubertal gynecomastia can spontaneously regress, it is our practice policy not to provide surgical treatment for this group of patients until they are at least 16 years of age.
‘Puffy nipples’ or ‘pure glandular’ gynecomastia – This is a very common form of gynecomastia, particularly in adolescents. The proliferation of breast tissue is limited primarily to the area immediately behind the nipple and areola, sometimes extending a short distance beyond. This creates a dome-like appearance of the nipple-areola complex. There is no associated proliferation of fatty tissue in the surrounding area. In most cases, this can be treated by simple excision of the retro-areolar breast tissue through a limited incision at the lower border of the areola.
Adult (mixed glandular/adipose) gynecomastia – Most cases of adult-onset gynecomastia, and some cases of adolescent gynecomastia, consist of a combination of enlarged breast tissue and an accumulation of fatty tissue. As the condition progresses, the male breast area becomes more and more feminized in appearance. The primary surgical treatment of this, the most common kind of gynecomastia, is ultrasonic liposuction. At my state-of-the-art, accredited surgical suite, I use the latest VASER device from Sound Surgical Technologies. Direct excision of breast tissue is performed, when necessary, at the completion of the surgical procedure. I make every effort to avoid skin excision procedures; in some cases this means staging the surgical approach (i.e., two surgical procedures several months apart).
Pseudogynecomastia (primarily adipose) – In this condition, seen in overweight or obese individuals, the breast enlargement is associated with a generalized increase in overall body mass and adipose tissue. While this may improve with weight loss, many men with weight gain–related breast enlargement gradually develop some element of true gynecomastia as well. The condition of being overweight or obese can increase the relative ratio of estrogens to androgens that circulate in the bloodstream, which can trigger the enlargement of actual breast tissue.
Severe gynecomastia – When the male breast becomes significantly enlarged, it is associated with skin excess and eventually a sagging, droopy appearance. In most cases, this condition requires skin removal in addition to the removal of breast tissue and excess fat. There are a number of surgical procedures designed to treat gynecomastia with major skin excess, including circumareolar mastopexy (for moderate skin excess) and simple mastectomy with free nipple-areola graft (for major skin excess); these are described in greater detail under ‘Surgical Treatment for Gynecomastia.’