Gynecomastia (male breast reduction)
Gynecomastia is a medical term for enlargement of male breast. In the majority of cases there is no known cause and although rarely talked about, it is a common condition. For men who feel self-conscious about their appearance, breast-reduction surgery can be extremely helpful.
The breast is made up of two main components, glandular tissue (firm and dense) and fatty tissue (soft). The ratio of glandular to fatty tissue in any breast varies from individual to individual and in gynaecomastia, there may be an excess of both. In general, mild forms (Picture 1) present with excess of fat tissue only, whereas enlargement of both fat and skin can be moderate (Picture 2) or severe (Picture 3), pending weather the surplus tissue is in excess or not of 300g per side.
Exact causes remain poorly understood.
Most teenage boys experience some degree of breast enlargement affecting one or both breasts. However, by early adulthood less than 10% have a residual problem. This incidence rises with age, reaching approximately 30% in order men.
The breast enlargement can be caused by medicines (for high blood pressure, heart disease and prostate cancer), drugs (such as marijuana and anabolic steroids) or some diseases (such as liver failure and some cancers). These causes should be excluded before operation. This is why you are likely to be sent for some investigations and blood testing prior to surgery (tests have been arranged by you GP ahead of consultation).
Gynaecomastia presentations vary from case to case.
If there is predominantly a diffuse fatty enlargement of the breast, liposuction is the usual treatment. This involves an insertion of a small canulla via a 3-4mm skin incisions (almost a key hole approach) which then remove fatty tissue by means of aspiration using a negative pressure. Operation is most usually carried out under general anaesthetic on a day care basis. Only very small, localised enlargements can be dealt with under local anaesthesia, but this is seldom appropriate.
If enlargement is mainly due to excess glandular tissue correction should be done by cutting out (excising) excess tissue via conventional surgery. Liposuction is not good for aspiration of glandular (breast) tissue. Incision is made around the nipple edge with small extensions on each side of it aiming for as inconspicuous scars as possible. Open surgery can be performed alone or in conjunction with liposuction. Major reductions that involve the removal of a significant amount of tissue and skin may require larger incisions and more obvious scars.
- Anticoagulation medication (Aspirin, Brufen, Warfarin, Clopidrogel) should ideally be stopped few days before the operation to reduce the risk of bleeding, but advise from the clinician who prescribed them is wise beforehand. I would strongly advise you to stop smoking prior to surgery as this can badly affect the outcome of surgery and increase complication rates
- Please make sure that you arrange to be collected from the hospital as you will not be able to drive after the surgery
- Plan your time off school / work / sports
- Allow at least few weeks after surgery before considering a holiday
Following surgery the chest is swollen and bruised for a while. It can be difficult to access the full effect of the operation for few weeks, until swelling settles.
- To help reduce oedema, patients are often instructed to wear an elastic pressure garment continuously for 2-4 weeks – This is usually purchased in advance and I can advise you on this during preoperative consultation.
- Showering and bath are possible after 1 week
- Sutures are removed after 2 weeks
- It is advisable to refrain from exercise for about three weeks
Complications and risk factors
Unfortunately, complications can occur following any surgery and patients need to be fully aware of this. Below are the most common complications associated with gynaecomastia surgery:
- Bleeding and haematoma (sometimes requiring return to the theatre in order to drain it)
- Seroma (accumulation of tissue fluid)
- Wound healing problems
- inadequate or overzealous removal of tissue
- Soft tissue irregularities
- Altered nipple sensation
- Scars including lumpy (hypertrophic) scarring around nipples
This leaflet provides only basic and generic information. Full details and explanations are provided at the consultation as no two patients are the same and personal circumstances are highly individual. Patients will be provided with detailed leaflet, comprehensive informed consent on risks and complications associated with this operation, few of which are mentioned above.
If you have any concerns following your surgery please contact:
- Hospital where you were operated:
Ashtead 01372 221 442; St Anthony’s 020 8337 6691; Parkside 020 8971 8000
- Your GP practice
- My secretary on 0845 026 7776 (Monday – Friday, 9.30 – 18.00)
|Hospital stay||Day care|
|Surgery time||1-2 hours|
|Wound healing||7-10 days|
|Shower / Bath||from week 1|
|Time off work||2 week|
|Sports and exercise||from week 3|
|Full recovery||4-6 weeks|