Ductal Carcinoma in Situ (DICS) means Ductal (duct) Carcinoma (cancer) in Situ (in its original place).
DCIS is the earliest form of breast cancer. The cancer cells are confined to the ducts of the breast and not the surrounding tissue. DCIS is much less common in men than women, and only 7% of breast cancers in men are DCIS.
Most DCIS in men are of the papillary type, which refers to the microscopic shape of the cancer cells which resemble fingers or threads. It is considered stage 0, which is not a life threatening condition; it is non-invasive and can almost always be cured. However, in some cases if left untreated it could develop the ability to spread into the breast tissue surrounding the ducts. Once the cancer cells have spread outside the lining of the ducts or lobules into the surrounding tissue, it is called invasive breast cancer which accounts for 9 out of 10 breast cancer in men.
The exact cause of DCIS in men is unknown, but some causes are believed to be; family history of breast cancer, hormone exposure, alcohol consumption, obesity, lack of exercise, and age.
Most men do not experience any symptoms, but some that do, may notice:
A painless lump under the nipple or areola
Discharge or bleeding from the nipple
An inverted nipple
Rash on the nipple
If any of these symptoms occur, your doctor will most likely send you to a specialist for advice or treatment. If breast cancer is suspected the doctor may order a mammogram, breast ultrasound, biopsy, and blood tests. If the tests are positive, further tests most likely will be ordered to determine where the cancer is and at what stage.
No increase in breast cancer risk has been found associated with gynecomastia. Men are less likely to be diagnosed in the early stages than women, but due to increased awareness of breast cancer in men, early detection at the non-invasive stage has increased.
Not everyone that has DCIS will develop invasive breast cancer but it is impossible to predict who will and who won’t, most surgeons believe the preferred treatment is a customized multidisciplinary treatment plan for each patient.
Dr. Delgado states that out of many hundreds of men he has treated for gynecomastia, only one man who was in his forties, developed DCIS. That patient went on to have further treatment. This is the reason that Dr. Delgado submits breast tissue samples to pathology in most cases. This article is written to heighten the awareness of this issue.
Gynecomastia is a condition that is caused by a hormonal imbalance in the body. While it can develop at puberty for boys, it may or may not resolve itself by adulthood. Specific prescriptions, illegal drugs, or medical conditions such as hyperthyroidism, kidney failure, or cirrhosis of the liver can cause gynecomastia.
As the use of antipsychotic medications in children has become more common, doctors have seen an increase in cases of gynecomastia. Specifically, Risperdal® (risperidone) has been seen to cause gynecomastia in some children and teens that use the drug for behavior issues.
Currently, there is a movement to petition the FDA to ban Risperdal® for use in children and youn7g adults. The petition claims that long-term results have not been studied sufficiently to allow the drug to be used with these patients.
While drugs can cause gynecomastia, there is no drug to reverse the condition. Patients find that diet and exercise often have no effect and can make the condition appear worse by enlarging the chest. In many cases, plastic surgery is the only answer to resolve the condition.
Plastic surgeons often use a combination of liposuction and surgical excision of glandular tissue to correct gynecomastia, depending on the extent of the patient’s problem. Surgery is usually done under general anesthesia and takes about an hour to complete.
The majority of patients describe their recovery as uncomfortable rather than painful. They say they imagined it was going to be worse and compared it to the muscle ache experienced after a difficult gym workout. Even though some bruising and swelling after surgery is normal, most men notice an immediate improvement in their chest contouring.
If you are disappointed with the results of your original male breast reduction surgery and have lost confidence with your Plastic Surgeon, first discuss it with your surgeon and see what suggestions he or she may have. Then get a second opinion from a Board Certified Plastic Surgeon who specializes in gynecomastia surgery. If he or she agrees with your original surgeon you are probably on the right track and the revision may cost you little or nothing.
However, if the original surgery left you with a major defect such as a crater deformity or the surgeon only did liposuction and the other surgeon confirmed that you should have had excision of breast tissue as well, you may need to choose a new surgeon with more experience for a revision. In picking a new surgeon be sure the office staff makes you feel comfortable, you will be relying on them for information and support. If they are not friendly or you sense the tension in the office, go elsewhere!
Needing revision surgery can be more expensive than the original surgery, as now the surgeon has to deal with scar tissue, and the retraction of the skin may have been compromised.
One major cause for gynecomastia revision surgery is when too much of the male breast tissue has been removed leaving what is known as a “crater deformity”. A crater deformity is as it sounds a crater or depression under the nipple/areola complex with the inadequate blending of surrounding tissue for a firm smooth contour.
How to Correct a Crater Deformity
Fortunately, there are procedures that can correct the crater deformity. First, the patient must wait until he has completely healed from the original surgery. In general, the fat flap is the best choice and has become the most predictable; this is where the skin is elevated and the fat that surrounds the crater is sewn together filling in the depression. Sometimes the use of fat injections also known as fat transfer or fat grafting can take place but it all depends on the architecture of the defect.
Find a Board Certified Plastic Surgeon
It is important for the gynecomastia patient to find an experienced Board Certified Plastic Surgeon. A secondary procedure is much more difficult due to scar tissue that has formed which makes the dissection more difficult and healing less predictable. In addition to the complication of scar tissue, the skin usually does not contract as well as the first time around. I would say that 35% to 40% of my gynecomastia procedures are revision surgeries.
See video of “post-surgery” in a blog dated April 2, 2012.
Gynecomastia is an overgrowth of tissue on the male chest which is a combination of fatty tissue as well as the normal glandular tissue found in men and women. Obesity can lead to a predominance of the fatty portion of gynecomastia whereas other causes can lead to an overgrowth of the normal glandular breast tissue found in both genders. There are numerous causes of gynecomastia. Anabolic steroid use including those found over the counter without a prescription and legally sold in health food stores such as GNC, multiple prescription medications for unrelated conditions, marijuana usage, but most commonly there is no identifiable cause. Heavy alcohol use and liver conditions can also lead to gynecomastia. Gynecomastia is extremely common at the onset of puberty, and the majority of these cases reverse themselves within a year and a half.
When gynecomastia has been present for two years or longer, it is extremely unlikely to reverse itself. In this situation, surgery is indicated to relieve the unsatisfactory appearance as well as the, sometimes, encountered painful cases of gynecomastia.
Surgery for this condition formerly was not a very satisfactory one for either the surgeon or the patient. This required an incision around the border of the areolae from the 3 to 9 o’clock positions with direct excision of the tissue under direct vision by the surgeon with scissors often leading to an irregular or lumpy final result. It also required drainage tubes coming out of the sides of the torso. Most of all, however, was the appearance of two half-moon scars on the chest, which no man cares to display for the rest of his life.
This changed with the advent of ultrasonic liposuction some 10 years ago. Traditional liposuction is ineffective in removing any of the glandular components of this condition. Remember, there are two components that need to be reduced and that is the fatty tissue as well as the glandular tissue. Whereas traditional liposuction may be able to remove a portion of the fatty tissue, it takes the power of ultrasonic liposuction to have an appreciable effect.
Ultrasonic liposuction involves the use of a cannula made of titanium whose tip vibrates over 20,000 times per second. The tissue that encounters this leading probe cannot tolerate the rapid positive and negative pressure waves, and the resulting cavitation effect causes the breakdown of the tissues. This allows for more breakdown of the fatty and glandular tissue of the chest wall. Nevertheless, even ultrasonic liposuction cannot remove all of the tissue, and this is where we have an instrument that can be inserted through the small incision under the arm to remove the rest of the glandular tissue. Having said all this, the result is we can offer for most patients an operation with no scar or incision on the chest, no drainage tubes, and only a small 1.5cm incision under each arm to remove the tissue and result in a flatter, more masculine torso. Since the fatty tissue and the glandular tissue are removed, the chances of recurrence are extremely unlikely and would depend on continued stimulation from some source such as described above. Just as important as getting a flat torso is not removing too much tissue. Certainly, some glandular tissue in a small amount has to be left behind by the nipple and areola so that a depression is not left behind.
I hope this has been helpful to you. Please write down questions for your gynecomastia consultation as they arise as our staff is always anxious to help you in educating you about your condition as well as the solutions we can offer.
For personalized information about gynecomastia plastic surgery procedures, please complete Dr. Delgado’s inquiry form.
