Gynecomastia is a common adverse effect of bicalutamide (Casodex) therapy that may prompt some men to discontinue prostate cancer treatment. Tamoxifen has been recommended as a preventive agent for gynecomastia in these patients. A double-blind study of 282 men randomized to receive 20 mg of tamoxifen once per day with bicalutamide or bicalutamide alone found that after six months, gynecomastia and breast pain were significantly reduced in men who received tamoxifen ( versus percent in the control group). 41 An Italian randomized controlled trial of 80 participants also found that 20 mg of tamoxifen once per week is as effective as 20 mg once per day. 42
The surgical procedure removes both glandular tissues and excessive fat. Through a small cut along the margins of the nipple entire tissues causing the bulge are removed by combination of direct excision and or Liposuction along with excessive skin if present. In some cases a negative pressure drain tube is kept under the skin for next 24 hour or to remove any excessive collection of fluid or blood. Most of the cases are sent back home the same evening with dressings applied over the chest wall. Stitches are removed after about 7 to 10 days and a pressure supportive band or elasticized vest like garment is worn for next 3 to 6 weeks to ensure proper healing.
Dr. Gardner tailors the male breast reduction surgery to each patient’s needs. If the enlarged breast tissue is mostly fat, tiny incisions are made in the nipple and underarm, and liposuction is done to remove the excess fat. If there is excess breast tissue, an incision is placed around the lower part of the nipple at the junction of the skin and the pigmented part of the nipple to hide the scar. The excess breast tissue is then completely removed allowing the pectoralis muscle to become more defined. If there is fat and excess breast tissue, liposuction is done on the remaining fatty tissues. The skin is then allowed to re-drape over the chest wall, re-shaping the breast to a more pleasing contour.