Q&A with Dr Karel de Jong

Q&A with Dr Karel de Jong, a board-certified plastic surgeon performing VASER Liposuction at his clinic: ‘Hercules Sculpting’ in Zurich, Switzerland.

Dr de Jong offers advanced treatments for gynecomastia tailored to meet the unique needs of every individual using VASER’s cutting-edge liposuction techniques.

Dr de Jong, why did you decide to specialise in gynecomastia?

Gynecomastia patients are very thankful for their surgical outcome. They can suffer greatly from their condition. A well-performed surgery can significantly enhance their quality of life.

I have seen tears of joy and an enormous psychological relief when they finally have a masculine chest and as a medical doctor, this is very rewarding.

What is gynecomastia?

Gynecomastia usually is caused by a benign swelling of glandular tissue, resulting in an enlargement of the male breast making it look feminine.

Furthermore, there is an atypical fat deposit in the male breast. Generally, a higher body fat percentage, results in more fat deposits in the breast making them bigger.

The fat is locally centrally under the areola and to a certain extent in the lateral chest. There also is a condition in which the enlargement of the breast is solely caused by fat accumulation.

VASER liposuction is a great choice for this condition as it utilises ultrasound energy for aesthetic body contouring that yields excellent results with less pain and downtime than traditional liposuction.¹

During a VASER procedure, the area to be treated is filled with a medicated solution. The fat tissue is then treated with ultrasound energy. This helps to loosen the fat cells, which are then gently suctioned out of the body. This method helps to preserve surrounding tissues like nerves, blood vessels, and connective tissue and has therefore less pain and recovery time than traditional liposuction.

What are the causes of gynecomastia?

There are numerous reasons why gynecomastia can develop, however, the most common cause is idiopathy. Other causes are: testicular cancer, pituitary tumors, adrenal tumors, liver disease, thyroid disease, Klinefelter syndrome, alcohol, marijuana use, certain medications, and anabolic steroids abuse.

Most people think anabolic steroid use is the most common reason. This is not the case, idiopathic reason is the most common cause. One interesting that might be underreported is contamination with microplastic. Certain chemicals in microplastics such as BPA,DEHP and MEHP can mimic the function of estrogen. ^2,3,4

The molecular structure of these chemicals closely resembles the molecular structure of estrogen and can bind to estrogen receptors. A Study showed that Plasma DEHP and MEHP levels were found to be statistically significantly higher in the pubertal gynecomastia group compared with the control group.⁵ However, the number of the pubertal gynecomastia cases and controls in the study is limited, and the study design does not allow for a direct conclusion of cause-effect.

What does gynecomastia look and feel like?

Gynecomastia feels like a normal breast, however, if the glandular is fibrosed it feels very dense almost like a stone. This is more common after steroid use and the resection is more difficult to perform.

What is the treatment for gynecomastia?

If glandular tissue is present, weight loss usually will not solve the problem.

The overall size of the breast might become smaller; however, the glandular tissue will become more visible. The camouflaging effect of the surrounding fat will no longer be there.

Heavy workouts will increase the thickness of the pectoral muscle. However, this will not affect the glandular tissue, solving the issue. The best approach will be determined by the doctor, in many cases a combined liposuction and gland removal gives optimal results.

What options are there for gynecomastia patients?

VASER-Liposuction with gland removal. If the skin has lost some of its natural elasticity, VASER liposuction can achieve better skin tightening than traditional liposuction. This is because VASER technology helps to preserve the connective tissue under the skin, which helps the skin shrink and conform more smoothly after the procedure. If more tightening is needed HPRF helium plasma radiofrequency technology will be beneficial. In certain cases, traditional skin resection is needed sometimes with free areolar grafts.

When should a person consult a medical professional about gynecomastia?

When the condition is persistent for over 2 years and someone feels disturbed about their physical appearance they should seek a medical professional.

VASER is an excellent choice for my gynecomastia patients as it provides surgeons with advanced technology compared to traditional liposuction such as decreased surgeon fatigue, enhanced skin retraction, less pain, swelling, and downtime. Also, less post-operative discomfort, and VASER can treat multiple areas in a single procedure as well as provide results that can be seen as early as 1 week with precise sculpting^.

Can surgery for gynecomastia be life-changing for patients?

Gynecomastia can be life-changing. Especially for young adults who might have low self-esteem due to their condition.

Their social life might be impaired. Social activities such as swimming and going to the beach are difficult. During the summer when most people are having fun and enjoying the nice weather, patients feel their options are limited. Even wearing normal t-shirts will make their breast more visible.

How many cases of this do you see a year?

Sometimes I have patients as young as 30 who have had this condition for way over 10 years. After surgical correction, they are overwhelmed with joy and they regret not having it done earlier.

Finally, what made you want to become a surgeon and where did you study?

I like reconstructive surgery, which is delicate surgery. It is beautiful to perform. Helping people in need. I am passionate about aesthetic surgery. Gynecomastia surgery is the best of both worlds, it is a mix of reconstructive and aesthetic surgery.

I studied medicine at the UVA; University of Amsterdam. I did my residency in Germany and finally worked as a staff member.

Visit Hercules Sculpting website.

References:

1 Garcia O Jr. Ultrasound-assisted liposuction: Current concepts and techniques. Cham, Switzerland: Springer Nature Switzerland; 2020.

2 Pérez PA, Toledo J, Sosa LDV, Peinetti N, Torres AI, De Paul AL, Gutiérrez S. The phthalate DEHP modulates the estrogen receptors α and β increasing lactotroph cell population in female pituitary glands. Chemosphere. 2020 Nov;258:127304. doi: 10.1016/j.chemosphere.2020.127304. Epub 2020 Jun 6. PMID: 32559490.

3 Gao H, Yang BJ, Li N, Feng LM, Shi XY, Zhao WH, Liu SJ. Bisphenol A and hormone-associated cancers: current progress and perspectives. Medicine (Baltimore). 2015 Jan;94(1):e211. doi: 10.1097/MD.0000000000000211. PMID: 25569640; PMCID: PMC4602822.

4 Yongfeng Deng, Zehua Yan, Ruqin Shen, Meng Wang, Yichao Huang, Hongqiang Ren, Yan Zhang, Bernardo Lemos,Microplastics release phthalate esters and cause aggravated adverse effects in the mouse gut, Environment International, Volume 143, 2020, 105916, ISSN 0160-4120, https://doi.org/10.1016/j.envint.2020.105916.

5 Plasma phthalate levels in pubertal gynecomastia Erdem Durmaz 1, Elif N Ozmert, Pinar Erkekoglu, Belma Giray, Orhan Derman, Filiz Hincal, Kadriye Yurdakök Affiliations Expand PMID: 20008419 DOI: 10.1542/peds.2009-0724