How are you? Today we’re going to share a first here at Creafam. Gynecomastia is common in adolescence, and it’s the growth of the mammary gland, also in men. Sometimes the areola or nipple grows a little, there’s some sensitivity or increased sensitivity, and pain. This is very common in boys starting puberty, so we shouldn’t panic. The most important thing in this case is that this patient came to me. He’s 18 years old. He was in a lot of pain, but he felt a lump behind the mammary gland, or rather, on the nipple, and he came to the consultation.

This is the first time I’ve seen gynecomastia where there’s discomfort greater than just a growth. It didn’t subside with painkillers or ointments. We treated him, and the discomfort continued, but the lump also persisted. So today we’re going to perform surgery for this gynecomastia.

It’s super important because we shouldn’t panic. A tumor is a disordered growth, perhaps, of the mammary gland behind the areola, and this makes it much more sensitive and very painful. I sent him to Dr. Carlos Cortés, who has surely had many cases throughout his professional career because he’s an oncologic surgeon, so he’s the one who is indicated to perform this type of surgery. We’re going to do it together because it’s a patient who came to me, but he’s in charge of the surgery. I’m going to help him, and you’ll be able to observe the surgery, which is minimally invasive. It’s an outpatient procedure. But the most important thing is also to try to preserve the aesthetics. Although it may not seem important, it is important for someone young because he still exercises, goes to the gym, sometimes likes to walk around in the sun, and that means that we’ll see that he doesn’t have a scar where the surgery can be seen.

So look, this is what’s bothering her. If you look closely, does it hurt? No, and the nipple also changes color. I think it’s because it’s activating the glands. We’ll see how it goes with corticosteroids later.

Upstairs? – Yes.

So as not to overdo it, so as not to remove the fat. The incision is about 4 centimeters.

– Of the tumor. – Of the breast, there it is, it’s all concentrated there, it’s large… See…

This is the nipple. Here we have the tumor behind the nipple of the areola, the nipple of the other breast, of the right breast. This is the left breast. Look, this is the tumor we’re going to remove, and you’ll see the surgery in a moment.

4 centimeters…

How many surgeries have you done like this, Doc?
– In women… – In men. – In men, ah, they’re very rare, we must have… 3 cases in men. This young man has a growth in his left mammary gland, called gynecomastia. It’s rare and is caused by hormonal changes after adolescence. In his case, the gland remained enlarged and is causing discomfort, so it needs to be removed. Oh! We’re detaching it from the skin. That’s the tissue behind the areola and the nipple. Vascularity reaches the areola through this area, but also through the skin. Lend me the scissors, Iris. If it were cancer, we’d have to completely detach it behind the areola and take a biopsy.

Lend me the wick.
– Do you want me to pull this out with something? – I’ll put it here with an Allis,
I’ll detach it further… Allis, please.

The gland, there’s no lump here. – Is the entire gland removed? – Yes, in this case, yes, because it’s not normal for the gland to grow in men. So if we let it, 2% of the gland could remain, but it could grow back, as if there were more… From some other problem.

– In any case, does he have to continue attending annual checkups, I suppose?

– No, only the post-surgical checkups. The tissue is sent for pathology, and once there are no other additional problems, the patient is discharged.

What size should a man’s gland normally be? – It’s atrophic, it’s flat… Nothing! I mean, just like that, the nipple itself, it shouldn’t be anything.

There’s a little bit of fatty tissue around it.

What are you looking for? What are you examining?

The limit… Gland, a little bit of fatty tissue, that’s the gland, covered in fat.

But is that why you removed the gland, as you said? So it doesn’t come back…

We can put it here. – Why are you trimming the edge? We’re… It’s called rejuvenating the edges. It’s removing the part of the skin that, due to the stretching of the separation, is left without blood supply so that the edges we suture heal better. Okay, but aren’t you going to remove it? – This – Oh yeah?

What’s that little tube? It’s a closed drain to extract all the fluid that forms in the resection area. – Oh, I suppose that’s going to be left in for a few days. – Yes, one or two weeks. It prevents seromas from forming, as they’re called.

Well, we’ve finished the surgery. As you can see, this isn’t a simple procedure. It’s important to consult with specialists, like at Creafam, where we have a multidisciplinary team. For me, this would be like saying “I can do it.” No, the truth is, we don’t have that training. It’s always important to rely on someone who is much more skilled.

Yes, we did the surgery because he’s a patient of mine, and we always like to learn every day. Every surgery is a learning experience, and this is a case, as you heard with Dr. Cortés. He’s only seen three gynecomastia cases that require surgery. Not all gynecomastia is the same as surgery. They usually tend to disappear. In this particular case, if you saw, the breast should be, as I mentioned, the size of a coin. Here, a large amount of breast tissue was removed. We even surrounded that mammary gland a little bit more to prevent it from reappearing, mainly due to hormonal activity.

Normally, between the ages of 13 and 15, 16, the breast bud, which we call the breast, begins to grow a little, just like the thelarche in women. However, in men, there is a slight nipple swelling, discomfort, tenderness, and itching, but this tends to disappear over a period of perhaps a year.

In this patient, the main complaint was pain, followed by increased tenderness. He exercised or does exercise a lot, and even the rubbing of a shirt bothered him, and he also experienced a slight scaling of the areola area. So, all these symptoms of pain, growth, and tenderness are not entirely normal. When you experience these symptoms, you can come to us for a checkup. It’s not all about obstetrics and gynecology; we can also assess pubertal development. Why? Because it’s part of gynecological development in women, just as puberty is in men. We can also see and rely on other specialists.