Gynecomastia is a benign cosmetic problem found most commonly in young men and adults . It is a combination of fat as well as the glandular component below the nipple areolar complex. The most definitive treatment for gynecomastia is surgery and it is usually combination of liposuction and the gland excision. The gland excision depends upon the consistency of the glands. The glandular tissue is easily distinguished from the adipose tissue by its white glistening color versus the yellowish hue of the surrounding adipose tissue. According to the consistency, the glandular tissue is of the following types:
- Friable fatty glandular component – This type of glandular tissue below the nipple areolar complex is soft in consistency. Clinically we can palpate soft diffuse fat collection below the nipples which after infiltration and liposuction, breaks and melts and no resistance is felt to the cannula. There is no glandular component after the liposuction and we can appreciate a flat and thinned out nipple areolar complex .
- Fibrous glandular component – After doing the infiltration and liposuction, there is a remnant of tissue left behind under the nipples . Due to this tissue, one can appreciate a small bulge below the nipples which is a hindrance to the flat contour. Vaser energy is also not beneficial to melt this fibrous tissue. This fibrous glandular component can be removed through a small periareolar approach and gland excision.
- Nodular Cystic Glandular component – nodular cystic glandular gynecomastia is usually found amongst the body builders with history of steroid abuse. The orally or injected anabolic steroid signals the endocrine system that there is enough testosterone in the body, thereby decreasing the testosterone production by the body. Meanwhile the level of female hormone, estrogen becomes high relative to the testosterone level which leads to development of male breast. With continued use of anabolic steroid, glandular breast tissue slowly accumulates and becomes hard and nodular. Unfortunately, once this tissue forms, the breast will not return to normal proportions. While the testosterone and the estrogen level gradually normalize, the formed nodular glandular tissue seldom shrinks.