Male Breast Surgery (Gynaecomastia)
Gynaecomastia, a condition of over-developed or enlarged breasts in men, is common in men of any age. It can be the result of hormonal changes, heredity conditions, disease or the use of certain drugs.
Gynaecomastia can cause emotional discomfort and impair self-confidence. Some men may even avoid certain physical activities and intimacy to hide their condition.
Gynaecomastia is characterised by:
- Excess localized fat
- Excess glandular tissue development
- A combination of both excess fat and glandular tissue +/- excess skin
- Gynaecomastia may be present unilaterally (one breast) or bilaterally (both breasts)
Gynaecomastia surgery, is it right for you?
Gynaecomastia surgery is a highly individualised procedure, and you should do it for yourself, not to fulfil someone else’s desires or to try to fit any sort of ideal image.
This procedure is a good option for you if:
- You are physically healthy and of relatively normal weight
- You have realistic expectations
- Your breast development has stabilized
- You are bothered by the feeling that your breasts are too large
Adolescents may benefit from surgery, although secondary procedures may be needed in the future should breast development continue.
Surgical correction of gynaecomastia is best performed on:
- Men whose condition cannot be corrected through alternative medical treatments
- Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing
- Non-smokers and non-drug users
- Body mass index <30
- Men with a positive outlook and specific goals in mind for improving the physical symptoms of gynaecomastia
Even though most gynaecomastia are physiological (i.e. part of normal hormonal changes during puberty and growth), some may be caused by underlying medical problems such as endocrine disease, or secondary to prescription or recreational drugs. If these underlying causes are not corrected and surgery is undertaken, gynaecomastia will recur and your results will be temporary and disappointing. As part of your complete assessment, your surgeon may refer you for a preoperative ultrasound of your chest wall to assess the volume, consistency and position of your breast tissue. You may also be referred to an endocrinologist to exclude any hidden causes prior to surgery.
What happens during gynaecomastia correction surgery?
Plastic surgery to correct gynaecomastia is technically called reduction mammaplasty, and reduces breast size, flattening and enhancing the chest contours. In severe cases of gynaecomastia, the weight of excess breast tissue may cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple). In these cases the position and size of the areola can be surgically improved, and excess skin may be reduced.
Gynaecomastia Surgery is performed under general anaesthesia for both safety and comfort.
In cases where gynaecomastia is primarily the result of excess fatty tissue, liposuction techniques alone may be used. This requires insertion of a cannula, a thin hollow tube, through several small incisions. The cannula is moved back and forth in a controlled motion to loosen the excess fat, which is then removed from the body by vacuum suction. This is not suitable if the breast tissue is dense and fibrous.
Excision techniques are recommended where glandular breast tissue or excess skin must be removed to correct gynaecomastia. Excision also is necessary if the areola will be reduced, or the nipple repositioned to a more natural male contour. Incision patterns vary depending on the specific conditions and surgical preference. Sometimes gynaecomastia is treated with both liposuction and excision.
Will there be scars?
Any surgical treatment to correct gynaecomastia will require incisions. While most incision lines are concealed within natural contours, some may be visible and are a necessary result of breast reduction surgery.
Specific Risks of Gynaecomastia Surgery
The decision to have gynaecomastia surgery is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable.
Your surgeon will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks or potential complications.
The risks include:
- Unfavourable scarring
- Bleeding (hematoma)
- Blood clots
- Poor wound healing
- Changes in nipple or breast sensation may be temporary or permanent
- If liposuction is used, additional risks include uneven contours, rippling or loose skin, irregular pigmentation, excessive fluid loss or fluid accumulation
- Anaesthesia risks
- Breast contour and shape irregularities
- Inverted nipples
- Skin discoloration, permanent pigmentation changes, swelling and bruising
- Damage to deeper structures - such as nerves, blood vessels, muscles, and lungs - can occur and may be temporary or permanent
- Allergies to tape, suture materials, glues, blood products, topical preparations or injected agents
- Breast asymmetry
- Fatty tissue found deep in the skin might die (fat necrosis)
- Seroma or fluid accumulation
- Deep vein thrombosis, cardiac and pulmonary complications
- Pain, which may persist
- Possibility of revisional surgery
After surgery, dressings and an elastic foamy tape will be applied to your incisions. Small thin tubes may be temporarily placed under the skin in the breasts to drain any excess blood or fluid that may collect. You may be required to stay in hospital for 1-3 nights dependent on your drainage output.
You will be required to wear a garment for 2-4 weeks to minimize swelling and support your new chest contour as it heals. You should not do any strenuous or heavy activities for at least 6 weeks.
To read more about postoperative recovery, please head to our Postoperative Care page.
Results and Expectations
The final results of gynaecomastia surgery in men are permanent in many cases. However, if gynaecomastia resulted from the use of certain prescription medications, drugs including steroids or weight gain you must be fully free from these substances and remain at a stable weight in order to maintain your results.
All scars are permanent, even though some scars may be concealed in the natural contours of the breast. Despite the visible scarring, the upper body contour will likely be improved, whether in a shirt or without a shirt.
Costs associated with Gynaecomastia Surgery
Gynaecomastia surgery may be covered by private health insurance. We will provide you with an item number if you fit the criteria for a medical rebate. Please contact your insurer and check your policy details.
Vocabulary to know
- Areola: Pigmented skin surrounding the nipple.
- Bilateral gynaecomastia: A condition of over-developed or enlarged breasts in men affecting both breasts.
- Endocrine system: A group of glands that make hormones which help to control activities in your body such as reproduction, metabolism, growth and development. Testing of your endocrine system may be done to look for signs of diabetes, thyroid disorders, growth hormone deficiency, osteoporosis, hypertension and obesity.
- Excision: To remove the skin.
- General anaesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness.
- Haematoma: Blood pooling beneath the skin.
- Liposuction: Also called lipoplasty or suction lipectomy, this procedure vacuums out fat from beneath the skin’s surface to reduce fullness.
- Reduction mammaplasty: The surgical removal of breast tissue to reduce the size of breasts.
- Sutures: Stitches used by surgeons to hold skin and tissue together.
- Unilateral gynaecomastia: A condition of over-developed or enlarged breasts in men affecting just one breast.
(Some Information & Illustrations are courtesy of the American Society of Plastic Surgeons).