Gynecomastia is classified in four grades, according to its gravity:

• Grade 1: slight enlargement of breasts without skin excess
• Grade 2: moderate enlargement of breasts without skin excess
• Grade 3: moderate enlargement of breasts with skin excess
• Grade 4: important enlargement of breasts with important skin excess

The most frequent cause is the increase of estrogenic hormones and the decrease of androgen hormones. These hormonal disturbances are determined by liver, lung diseases, testicular, suprarenal, prostate gland tumors, drug abuse or congenital afflictions.

It is very important the differentiation between the gynecomastia forms of systemic aetiology and the idiopathic, benign ones (constitutional). It was found a connection between gynecomastia and the administration of some medicines (anabolisants, spironolactone), the alcohol and drug abuse, as well as fatness.

Gynecomastia is due the most frequent to some fat tissue accumulations in the breasts, the surgical solutions belonging to the plastic surgeon. If the glandular tissue is well represented (visible especially through mammography) the surgical solution consists in unilateral or bilateral mammectomy, the biopsy being histopathological examined. Postoperatively the skin excess is retracted gradually and the possible residual excess can be eliminated by a subsequent intervention.

The surgical intervention is carried out by mammary gland fat tissue absorption, operation performed by means of canullae and an aspirator through small incisions in the low area of the mammary gland.

The surgery is carried out under general anesthesia, after the performing of the examinations requested by the surgeon. It is required the aspiration drain and this is removed after 24-72 hours, when the patient can be sent at home.
The operation generally takes 2-3 hours to complete.

The possible complications following this surgical intervention are the infections, the changes of nipple sensitivity, soft tissue necrosis, nipple invagination, the insufficient skin retraction.

After operation, the patient should wear a special bra for 2-3 weeks. The initial discomfort is controlled with pain-killers. The stitches will be removed 7-14 days after surgery.

The scars will be completely healed in about one year after the operation, period in which the sun exposure is contraindicated. The normal activity of the patient can be resumed 2-3 days after the operation, and it is recommended the avoidance of activities that challenge the arms. The gynecomastia reduction causes the diminution of the mammary glands as much as possible in order to achieve an aesthetic equilibrium of the body and a masculine appearance.