Male Breast Reduction (Gynaecomastia)

The medical terminology for over developed breast tissue in men is gynaecomastia - It is an enlargement of the male breast as a result of an abnormal increase in the glandular tissue. It is common affecting an estimated 40% to 60% of men to different extremes. Surgery can be a great aid to someone who feels self-conscious due to this. Liposuction is used to remove the excess fatty tissue under a general anaesthetic to give a flatter, more contoured looking chest.

An individual will have their own specific reasons for wanting to undergo this procedure:

Reduction in the size of the male breast development to normal giving a more contoured looking chest.

To improve body-shape and subsequent body-image leading to increased self-confidence and self-esteem.

Hair Loss

Androgenetic alopecia or common male pattern baldness (MPB) accounts for more than 95% of hair loss in men. By the age of thirty-five two-thirds of American men will experience some degree of appreciable hair loss and by the age of 50 approximately 85% of men have significantly thinning hair. Approximately twenty five percent of men who suffer with male pattern baldness begin the painful process before they reach the age of twenty-one.

Contrary to societal belief most men who suffer from male pattern baldness are extremely unhappy with their situation and would do anything to change it. Hair loss affects every aspect of the hair loss suffers life. It affects interpersonal relationships as well as the professional lives of those suffering. It is not uncommon for men to change their career paths because of their hair loss.

 

Androgenic alopecia or male pattern baldness (MPB) is responsible for the vast majority of hair loss in men. While there are many possible reasons people lose hair including serious disease, reaction to certain medications and in rare cases extremely stressful events, most hair loss is men can be blamed on heredity.

What male pattern baldness sufferers are actually inheriting are hair follicles with a genetic sensitivity to Dihydrotestosterone (DHT). Hair follicles that are sensitive to DHT begin to miniaturize, shortening the lifespan of each hair follicle affected. Eventually, these affected follicles stop producing cosmetically acceptable hair.

Male pattern baldness is generally characterized with the onset of a receding hairline and thinning crown. Hair in these areas including the temples and mid-anterior scalp appear to be the most sensitive to DHT. This pattern eventually progresses into more apparent baldness throughout the entire top of the scalp, leaving only a rim or "horseshoe" pattern of hair remaining in the more advanced stages of MPB. For some men even this remaining rim of hair can be affected by DHT.

Dihydrotestosterone (DHT) is a derivative or by-product of testosterone. Testosterone converts to DHT with the aid of the enzyme Type II 5-alpha-reductace, which is held in the hair follicle's oil glands. While the entire genetic process of male pattern baldness is not completely understood scientists do know that DHT shrinks hair follicles, and that when DHT is suppressed, hair follicles continue to thrive. Hair follicles that are sensitive to DHT must be exposed to the hormone for a prolonged period of time in order for the effected follicle to complete the miniaturization process. Today, with proper intervention this process can be slowed or even stopped if caught early enough.

Typical male pattern baldness is usually diagnosed based on the appearance and pattern of the hair loss along with a detailed medical history, including questions about the prevalence of hair loss in your family. An experienced dermatologist should examine the scalp under magnification (preferably with a device called a densitometer), in order to assess the degree of miniaturization of the hair follicles. This assessment is very important when recommending the proper course of treatment.

Some advertised "clinics" might recommend a costly hair analysis or a scalp biopsy to properly diagnose your hair loss. The only reason to have a hair analysis is to assess the possibility of poison induced hair loss. A hair analysis may reveal substances such as arsenic or lead, however, hair loss caused by poising does not present itself in a typical male pattern. You should avoid these clinics and seek the advice of a board certified dermatologist who can properly examine you and help you treat your hair loss

In the past few years, medicine has made tremendous strides in the treatment of men's hair loss. With the advent of 5-a-reductase inhibitors such as Propecia and the evolution of surgical hair restoration, for many, living with noticeable hair loss is no longer inevitable. For the first time in the history of mankind it is now possible to stop or slow the progression of hair loss and to replace lost hair through surgery with completely natural results. However, with that said the vast majority of hair loss treatments being marketed today are still nothing but "snake oils."

You've all seen the ads in the back of men's magazines, you've heard the commercials on the radio and you've seen the infomercials promoting miracle treatments for hair loss. The bottom line is that the vast majority of advertised "treatments" do not work for the prevention and treatment of hair loss. If a hair loss treatment is not approved by the FDA or recommended by The American Hair Loss Association, chances are you are wasting your precious time and money. Remember that successful treatment of hair loss is greatly dependent on early intervention. It is critical to begin treatment with an effective product as soon as you notice the onset of hair loss.

The following two treatments have been clinically proven to successfully treat hair loss in men to varying degrees.

Finasteride is the generic name for the brand name drugs Proscar and Propecia Finasteride was originally developed by Merck as a drug to treat enlarged prostate glands (Proscar). During the trials on men with prostate problems an intriguing side effect of hair growth was observed. Since finasteride had already been approved by the FDA to treat enlarged prostates in men, Merck and Company decided to pursue the possibility of developing finasteride as the first pill to treat male pattern baldness.

On December 22, 1997 the FDA approved a 1mg dose of finasteride for the treatment of androgenic alopecia in men (male pattern baldness). Propecia is the first drug in history to effectively treat male pattern baldness in the vast majority of men who use it.

Finasteride's hair-raising success is due to its ability to specifically inhibit Type II 5-alpha-reductace, the enzyme that converts testosterone into a more potent androgen dihydrotestosterone (DHT). Propecia's 1 mg dose of finasteride can effectively lower DHT levels by as much as 60% when taken daily. It is DHT that shrinks or miniaturizes the hair follicle, which eventually leads to baldness .This 60% reduction in DHT has proven to stop the progression of hair loss in 86% of men taking it the drug during clinical trials. 65% of trial participants experienced what was considered a substantial increase of hair growth.

At this point, the only truly effective medically proven way to arrest the hair loss process is to lower DHT levels. The American Hair Loss Association recommends finasteride as the first line of attack for all men interested in treating their male pattern baldness.

Minoxidil (loniten) was the first drug approved by the FDA for the treatment of male pattern baldness. For many years, minoxidill, in pill form, was widely used to treat high blood pressure. Just like finasteride researchers discovered a very interesting side effect of the drug. People taking the medication were growing hair in unexpected places like on their cheeks and the back of their hands, some even grew hair on their foreheads.

Some enterprising researchers had the notion that applying minoxidil topically, directly on the head, might grow hair on balding areas. Well it did to varying digress depending on the extent of the hair loss, but at the time it was revolutionary.

While minoxidil has been clinically proven to slow the progression of hair loss and regrow some hair, most informed experts see it as a relatively marginally effective drug in the fight against hair loss. Since minoxidil has no effect on the hormonal process of hair loss it's positive effects are at best temporary and usually yield somewhat disappointing long-term results.

With the said, The American Hair Loss Association still recommends the drug for those who have not responded favorably to finasteride treatment or for those who would like to add another product to their regime. The AHLA does not recommend minoxidil as the first line of attract for men suffering with male pattern baldness, but does recognize it as an effective treatment for a small percentage of its users.

Penile Implant (Prosthesis) Surgery

Many men with Erectile Dysfunction (ED) have limited success with medications, and many men are unsure that they will be able to have intercourse successfully on any given day. Because of the uncertainty of success, and to prevent disappointment for their partners and themselves, many men are reluctant to initiate sex. A device implanted into the penis, known as a penile prosthesis, can restore erections in most men with ED. Many men don't realize until after penile implant surgery that they had been avoiding sexual relations because they feared that they would be unsuccessful. After implant surgery men are confident that they will be able to have intercourse successfully whenever they wish to.

 

Figure 1. With an inflatable implant, erection is produced by squeezing a small pump implanted in a scrotum. The pump causes fluid to flow from a reservoir residing in the lower pelvis to two cylinders residing in the penis. The cylinders expand to create the erection.

Penile prosthesis surgery has been performed for more than 30 years since it was developed at Baylor College of Medicine in Houston by Brantley Scott, M.D. The surgical techniques and implant devices have undergone a number of improvements over the years, so that it is now a very reliable and satisfying treatment for men with ED. Most men try less invasive approaches before they have implant surgery, but more than 80% of men who have surgery are very satisfied with the results.

There are two main types of penile implants, inflatable and malleable (also called semi-rigid). Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see figures 1 and 2). Tubes connect the cylinders to a fluid reservoir and a pump, which are also surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants expand the length and width of the penis when the device is inflated. They also leave the penis in a more natural state when not inflated. MBUA urologists recommend impantation of prostheses from Mentor Corporation or American Medical Systems.

 

Figure 2. An inflatable penile prosthesis has 3 components; 2 paired cylinders, a pump, and a reservoir.

Malleable implants consist of paired rods, which are inserted surgically into the corpora cavernosa. The patient manually adjusts the position of the penis and, therefore the rods, by bending the penis straight to have intercourse and down when he is dressed. Adjustment does not affect the width or length of the penis. This type of implant has no moving parts so it is very reliable, but it does not provide as realistic an erection as the inflatable penile implant.

After penile prosthesis surgery, men are able to have intercourse with confidence that they will be able to have an adequate erection. The pump in the scrotum is pumped until the penis is hard enough for intercourse, and men keep an erection until they decide to deflate the prosthesis. There is no pain during pumping of the device. The feeling of the erect penis may be slightly different than a natural erection because the penis is filled by the prosthesis, not blood, but it should not feel any different to the sexual partner. The feeling of climax, or orgasm, is exactly the same as it was with a natural erection. The overwhelming majority of men are extrememly satisfied with the results of penile implant surgery. We have a number of patients who are willing to share their experience with men who are considering this type of treatment.

Penile implant surgery is performed as outpatient surgery; patients do not need to stay in the hospital. The surgery is performed under spinal or general anesthesia. An incision is made accross the top of the scrotum at the base of the penis, and in most men the entire operation is performed through this one incision. In some men who have had previous surgery it may be necessary to make a small incision in the groin area to place the reservoir that holds the fluid. The prosthesis is left inflated overnight after surgery and a catheter is left in the penis so that men do not need to urinate. The prosthesis is deflated in the office the next day and the catheter is removed. We recommend that men place an ice pack on the penis and scrotum for the first 2-4 hours after they go home from surgery. Men will take antibiotic tablets for 4-5 days after surgery, and will usually use pain medication for the first 2 weeks. Most men say that the pain level after this type of surgery is moderate. It is common to have some bruising and swelling of the penis and scrotum after surgery, and it will resolve like a bruise anywhere else in the body. When the swelling and tenderness of the pump have decreased the patient will be taught how to inflate and deflate the prosthesis twice a day. Men are usually able to start to have intercourse 6-8 weeks after surgery, but it is not uncommon to have some discomfort for up to 12 weeks.

Risks of penile implant surgery

Infection

The main risk of penile implant surgery is infection of the device. The overall infection rate is less than 5%, but it is slightly higher in men with diabetes. Men who require revision or replacement of the prosthesis have an 8-10% risk of infection. If a patient has infection of the device it is initially treated with oral medications, but it some cases the prosthesis needs to be removed and a new one placed during the same operation or later.

Malfunction

The implant devices have become very reliable, but with time they can have mechanical malfunction; 85% or more are working well 5 years after implant and 67% are working at 10 years. If there is mechanical malfunction an operation is performed to replace the device.

Bruising and swelling

Pain

Other risks

In rare cases there can be an injury to the urethra during surgery, and this may require that the surgery be stopped. There have also been rare cases of erosion of the prosthesis through the skin; these cases are usually caused by infection.

Testicle/Scrotal Enlargement

Scrotal size, while not a concern to most men, is important to those who are frequently seen in tight slacks or revealing swimwear (entertainers, bodybuilders, swimmers, etc.). An under endowed man can feel quite self-conscious if his "basket" is woefully deficient. Increasing the size of the testes can go in a long way toward filling out in his anatomical bulge.

Several studies have described the negative psychological effects of the loss or absence of a testicle. These and other studies have suggested that testicular implants (also called testicular prostheses) lead to improved body image and are associated with a high levels of patient satisfaction.