Articles

A teenager's Curse - Gynaecomastia

A spark that is snuffed out before it can become a flame.

This is what the problem of Gynaecomastia can do to the self-confidence and life of a teenager, waiting to turn into a young man. Inability of others around to understand the problem adds the matter. A young active, talented adolescent, on the threshold of adulthood, bruised by the damage caused by this problem, gets turned into a reclusive introvert who loses interest in life.

What is this problem that can cause such seemingly catastrophic damage? Why is it that the problem is not seen or heard of much in the public domain?

Though derived from the Greek word Gynaec (meaning feminine) and Mastos (meaning breast), it refers to means any condition that results in excessive growth of breast tissue in males. It may consist of excess glandular tissue, fat or both.

Though considered as an abnormal growth, this increase in size is seen in upto60-70% males at time of puberty due to the fluctuating hormonal levels. However, in most of these people, the growth is temporary and settles in a few weeks or months. It is only in an unfortunate few that the initial growth has progressed to such an extent that the mass does not reverse even though the hormonal fluctuation has settled long back. This has led to the wrong notion that the problem will settle without any treatment even when the breasts have become embarrassingly large, as in most people. Rarely, the abnormal enlargement can be due do other illness or problems which the surgeon will identify during a consultation.

Problems due to this abnormal breast enlargement are both functional & psychological.The deformity can be exquisitely painful. When small, it will be seen in situations such as gym class or swimming- when the child/adolescent needs to remove the shirt in the presence of others. This puts the person in a risk of not only embarrassment, but also physical harm.

Individuals with no regression or even progression of the deformity often receive little or no understanding about the shame and humiliation they experience.[/color] Coaches, physicians, parents, and peers (both boys and girls) can inflict damage out of ignorance, cruelty, or both. Postural and clothing modifications to mask the deformity are the norm in these patients from puberty through adulthood.

The problem is seen in a variety of patterns, in a wide range of ages. Puffy Nipples-the glandular enlargement is restricted to the areola or slightly beyond, giving it a dome shaped appearance.

Adolescent-though seen in 30-60% of all boys in the age 12-18, it settles spontaneously without any treatment in almost all within 2 years of onset. It needs treatment when severe.

Adult- this is the most common type, containing both glandular and adipose (fatty) tissue.

Pseudo-(false) Gynaecomastia: this looks like the real Gynaecomastia, but consists of only excess fat tissue. This type can be completely corrected by liposuction alone.

Unilateral/Asymmetrical Gynaecomastia - this involves only one side breast, or both sides but in different degrees of severity.

Severe- involves severely enlarged breasts with excess/saggy breasts. This is more likely to happen in older people. Treatment may need removal of some skin along with the tissue below.

Treatment by surgery is usually needed when the problem staysbeyond 2 years, or even earlier when relief from the physical deformity is needed to restore the psychological & physical wellbeing.

These patients seek treatment because they find that the condition, which is readily apparent in everyday life, adversely impacts day-to-day activities under various circumstances. The physical deformity necessitates behavioral modifications that have numerous implications in the lives of the patients who are affected. Patients wear loose clothing and often avoid exposure in showers and swimming pools. Patients in high school and college are reluctant to participate in any athletic activity that may directly or inadvertently require removal of one's shirt, exposing the chest.

Patients with Gynaecomastia typically slouch forward and roll the shoulders toward the midline in an effort to camouflage the deformation. This posturing has a submissive connotation to the people with whom they interact. Patients return for postoperative appointments standing tall. In cases involving teenagers, parents typically remark "I have been trying to have him stand up straight for years!" The postural changes alone, which result at all age levels both sitting and standing, have numerous positive implications in peer-to-peer interactions.

Treatment involves an hour long surgery, usually under general anaesthesia. A day or two of stay in the hospital is followed by return to work and any light to moderate level activity after another additional day at home. Pain is not usually a problem at all; modern medicine has simple safe drugs to ensure this problem does not arise at all.

In spite of all these issues for the person suffering from the problem, there exists a false notion that since the problem does not affect the person's health, is treatment required at all?Previously, about a decade ago, there was also the problem of extensive scars due to the surgery; however, thanks to modern Keyhole Surgery by the technique of Liposuction, treatment today does not leave any visible scars that would otherwise defeat the very purpose of the surgery.

Improved awareness among the common people and the medical fraternity is needed about this problem and treatment available. This alone with provide youngsters having this problem with an opportunity to restore their self confidence and enthusiasm in life. They can thus get on with their life and play a meaningful role in society.

For more information, visit www.lineacosmeticsurgery.in OR mail to drbhatsp@gmail.com