Gynecomastia – Male Breast Reduction
Gynecomastia is the clinical term applied to excess development of breast tissue in men. The cause is not generally known and can cause significant anxiety, social inhibition and self-consciousness for men who suffer from this condition.
Male breast reduction, or gynecomastia surgery, removes tissue from the breasts, and in extreme cases excess skin, and can improve the appearance of the chest in cases where diet and exercise have failed. The results of the procedure are significant and permanent.
It is advisable that you first discuss this procedure with your General Practitioner (GP), who may then refer you to the Consultant Plastic Surgeon of your choice. Sharing your expectations with your GP and surgeon is the best way to increase the possibility of achieving your desired outcomes.
Most teenage boys experience some degree of breast enlargement which affects one or both breasts. However, by early adulthood less than 10% have a residual problem. This incidence rises with age, reaching approximately 30% (1 in 3) in older men. Although the cause of gynecomastia is largely unknown some possible causes include: medicines (for high blood pressure, heart disease and prostate cancer), drugs (such as marijuana and anabolic steroids), some diseases (such as liver failure and some cancers) and some very rare congenital abnormalities. These causes should be excluded by the Consultant Plastic Surgeon during an initial consultation.
The decision to have gynecomastia surgery is extremely personal and you will have to decide if the expected benefits will fulfil your goals and if the risks and potential complications are acceptable.
The purpose of your discussion with a Consultant Plastic Surgeon is to evaluate your general health condition and for the surgeon to clearly understand your expectations for gynecomastia surgery. The surgeon will ensure that you are well informed of the benefits, possible risks and potential complications of this particular operation.
In general, the most suitable candidates for male breast reduction surgery are:
- Mature enough to fully understand the procedure
- Experiencing embarrassment and/or social inhibition due to breast enlargement
- Informed about the surgery
- Fortunate to have good skin elasticity
- In good physical and psychological health
- Eager to improve their appearance and/or comfort
- Realistic in their expectations of the surgical outcomes
- Willing to initially try dieting and exercising as first options prior to resorting to surgery
- Non-smokers or able to stop smoking during the healing process
- Not using marijuana or anabolic steroids
- Not heavy users of alcohol
Please note that it is important to be aware that the above list is only an indication of general pre-requisites. Ultimately it is the responsibility of the Consultant Plastic Surgeon to determine if each candidate is suitable for this particular operation.
Either general anaesthesia or a combination of intravenous sedation and local anaesthesia are used. The attending Anaesthetist will explain the type and risks of the particular form of anaesthesia for your operation.
The surgical technique performed by your Consultant Plastic Surgeon will depend on the degree and extent of the breast enlargement. The options include removal of the tissue under the breast, or liposuction of the chest wall. In both instances, a small elliptical incision is made on the lower half of the nipple area (areola). For those men with tissue that is more glandular in nature, all breast tissue directly under the nipple is removed.
If the tissue is more fatty in nature, liposuction can provide excellent results. In some people, ultrasonic assisted liposuction is an excellent approach. During liposuction, a small suction rod or cannula is inserted into the incision to remove fat and other tissue.
In some cases, a repeat procedure is necessary to remove tissue that was missed during the first procedure. In a few cases, if there is a large amount of extra skin, it may be necessary to remove this tissue, which may result in a large scar.
This procedure should be performed in a hospital and can last from 1 ½ to 3 hours. You may be allowed to return home within a few hours of the surgery, and spend the night in the comfort of your own home, or it may be necessary to spend a night in the hospital so your recovery process can be monitored by a medical staff.
You may feel some pain the extent of which can vary from minimal to moderate, and will last from several days to two weeks.
After the operation the chest is usually temporarily swollen and bruised after the surgery and it may be difficult to assess the full effect of the surgery. You may also experience numbness or a burning sensation. You may be given a compression garment to wear for several weeks after the surgery.
If you have severe pain or discharge in the surgical area, or if you experience muscle aches, dizziness or a general ill feeling with fever, nausea or vomiting, you should contact your Surgeon or nursing staff immediately.
Light activities can be resumed within a few days, although your chest will be sore. Most people are able to return to non-strenuous work within three to seven days, and resume more strenuous activities in two to three weeks. You should avoid exposing the operated area to the sun for at least six months to prevent permanently altering the skin pigmentation.
Routine physical activity and exercising (especially lifting, pulling and pushing motions) should be avoided for at least 6 weeks. This will help the scars to heal. Your surgeon will advise you on the level of physical activity that is appropriate for you. Some degree of swelling and bruising may last for 3 to 6 months.
The improvement from this procedure is permanent, but weight gain or use of certain drugs could result in recurrence of the enlarged breasts.
All surgery has some potential risks, including the risks of bleeding, reaction to the anaesthetic, and infection. In gynecomastia, serious complications are quite rare. Other risks include:
- Injury to the skin
- Rippling of the skin
- Contour defects
- Excessive scarring
- Pigmentation changes
- Altered sensation
- Insuffi cient tissue removed, necessitating second operation
Please note: that with all procedures there is a possibility dissatisfaction with the outcome.
Allergic reaction to anaesthetic
In very rare cases anaesthetics can cause allergic reactions.current estimate is that a life-threatening allergic reaction (anaphylaxis) happens during one in 10,000 to one in 20,000. Your anaesthetist will choose the drugs for your anaesthetic account many different factors, in particular, the type of operation, physical condition, and whether you are allergic to anything.
Most people make a full recovery from anaphylaxis. It isn’t how many anaphylactic reactions during anaesthesia lead to permanent disability. One review article suggests that one reactions can lead to death. This in effect implies that the chance as a result of an anaphylactic reaction during anaesthesia is in 200,000 and one in 400,000 anaesthetic procedures.
For additional information regarding this operation please contact your Consultant Plastic Surgeon.