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Gynaecomastia

Surgery

Gynaecomastia (male breast enlargement) is quite common, but it is rarely talked about. It is estimated that 40-60% of men are affected by this. We would always recommend excluding pathological causes such as hormonal imbalances, abnormal breast lumps, testicular or thyroid problems before considering surgery. Gynaecomastia can also develop as a result of anabolic steroid use (in body builders), recreational drug use and can persist even after stopping taking these drugs. 

 

That said, in most cases gynaecomastia does not have any obvious cause (so called idiopathic form). 

Men with gynaecomastia might be affected differently by the tissues involved. For instance, some men might have excess skin and fatty tissue whereas other men might have excess breast and fatty tissue with good quality skin with no obvious excess. In severe cases, men can have feminine appearance of the breast including sagging and enlarged areolas. 

Men can be physically and psychologically affected by the appearance of their breasts caused by gynaecomastia. 

Surgical procedures designed to improve the appearance would depend on which component of the breast tissue is affected. In principle, gynaecomastia surgery removes fat and / or glandular tissue from the breast. In extreme circumstances, excess skin also has to be removed and areolas reduced. Surgical treatments are designed to improve the contour and make the chest look firmer, flatter and tighter. 

Surgical procedures would range from liposuction, open excision, reduction or mastectomy with free nipple grafts in extreme cases. Every effort will be made to achieve best possible improvement in the contour of the chest using appropriate technique or their combination to make sure best possible outcome with minimal scarring. 

Before arranging a consultation, it is important to think carefully about what one would like to achieve to be able to discuss specific concerns and desires in detail. 

What to expect from the consultation

Surgery for gynaecomastia can be performed in men of any age who are physically and mentally healthy who are not taking any recreational drugs, anabolic steroids, alcoholic beverages, smoke and have healthy body mass index (BMI). Best candidates are those who have good quality skin. If your BMI is high, you might be asked to reduce it with nutritional rearrangement and regular exercise before considering surgery. 

During the consultation, Ms Majdak-Paredes will examine the chest and breast tissue and check for causes for gynaecomastia such as liver function, breast lumps, thyroid problems, use of the aforementioned drugs. If there is any concern that there might be a pathological cause for gynaecomastia she will refer you to the appropriate specialist. In certain cases, a mammogram or ultrasound might be required. This will not only rule out any breast abnormality, but also reveal breast composition. 

 

During the consultation, you will be asked about your concerns and anything related to the appearance of the breast that you feel is important to you. This will help the doctor to understand your expectations and determine whether they can realistically be achieved. You will be asked about your medical history, current medications, drug allergies, smoking and history of breast disease including family history. It might be possible to create 3D simulations to give you a rough idea of how the chest would look after surgery. 

 

Explanation will be given as to which techniques would be most appropriate depending on the assessment and desires. You will receive a letter summarizing the consultation along with surgery fees.  

Clinical psychology consultation might be suggested in order to better assess your expectations and the degree the problem is affecting you. Joined effort from multidisciplinary team helps to improve the overall outcome of surgery. 

The information below will provide basic explanation about what is involved in surgical procedures used to improve gynaecomastia. If you have more questions, please do not hesitate to get in touch. 

What does the surgery entail

If excess fatty tissue is the primary cause for enlargement, liposuction alone might be sufficient to improve the contour of the chest. Many times, however, there is also excess breast tissue which liposuction alone will be unlikely to address. In such cases, open excision would be required in addition. 

In a typical procedure, an incision is made in an inconspicuous location - either in the edge of the areola or the breast fold. Working through a small incision Ms Ewa Majdak-Paredes will remove the excess glandular tissue and fat from around the areola and / or the bottom of the breast using also liposuction. 

If your gynaecomastia is composed of primarily excessive fatty tissue, liposuction alone should be effective. Small incisions (5-10mm) are typically placed on the side of the chest at the level of the breast fold and specific areas of the fatty tissue in the breast are sculpt in that way to tighten up the appearance of the chest. 

A slim hollow tube (cannula) attached to a vacuum pump is then inserted into the incision. The tissue beneath the skin will be removed using stong, deliberate strokes and excess fatty tissue would melt and escape through the cannula and vacuum. 

The procedure is typically carried out under light general anaesthesia and takes 1-2 hours. It can be done as a daycase procedure. Recovery takes 2-6 weeks depending on the combination of procedures. Pressure garment will be required for 4-6 weeks which will help to support the breast, reduce the swelling and provide comfort. 

You would require a nurse appointment a week after surgery and a consultant appointments 4-6 weeks after surgery or earlier if required.​

Risks and implications will be discussed in detail during your consultation. 

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