Male Breast Swelling (Gynaecomastia)
What is gynaecomastia?
All men have breast tissue made up of glandular tissue and fatty tissue. Gynaecomastia is a condition where too much breast tissue has developed. It can affect one or both breasts.
What are the causes of gynaecomastia?
Gynaecomastia is common and happens in 1 in 3 men. In half of men there is no known cause. The condition is also more common in men aged over 40. It is commonly caused by a hormone imbalance or increased oestogen hormone. Other causes include medication, recreational drugs drinking too much alcohol and an overactive thyroid. Very rarely, it is the first sign of testicular cancer and breast swelling is caused by release of hormones from the testicular tumors.
Do I need to see a doctor?
All males with breast swelling require thorough and comprehensive assessment. It requires taking accurate history complete clinical examination to identify the underlying cause. Most patients require blood tests and imaging (ultrasound, mammogram or both). Very rarely a biopsy is needed to exclude a cancer. This is usually done in a one stop breast assessment clinic.
Is gynaecomastia surgery suitable for me?
For most patients, gynaecomastia settles without surgery. However, in some men the condition is permanent. If there is an underlying cause, than its treatment is necessary. Gynaecomastia is not life threatening but you may want to have the excess tissue removed if you feel embarrassed by the condition, then you are likely to benefit from cosmetic surgery.
What are the benefits of surgery?
Your chest should have a more male appearance and both sides should look similar to each other.
Are there any alternatives to surgery?
- Weight reduction for fatty gynaecomastia
- Changing the medication causing male breast swelling
- Medical treatment with drugs like Danasol or Tamoxifen
What does the operation involve?
- Liposuction for small and fatty gynaecomastia
- Open Surgery
- Combination of both
The operation is usually performed under a general anaesthetic. If you have only a small amount of excess tissue and good skin elasticity, the operation may involve only liposuction. It is done with a suction device to remove the fat through one or two small cuts. We use cannulas with high frequency ultrasound to break up the tissue. Open Surgery is used for firm gynaecomastia and moderate to large gynaecomastia, where there is a lot of excess skin. The procedure varies from simple removal of lump to complex reduction techniques that allow centralising nipple, reduction of the size of areola and excess of skin. There are more than six male breast reduction techniques depending on size and type of male breast swelling and relative position of the nipple to give best aesthetic results. It is also combined with liposuction.
What is the recovery period?
For liposuction alone you are likely to have your surgery as a day case procedure. Otherwise, you will stay in hospital overnight after the surgery.
How long before daily activities may be resumed?
Strenuous activity should be avoided for at least 2-weeks. Driving should be avoided for 2 weeks. You should continue to wear compression vest for 4-6 weeks.
What complications can happen?
- Bleeding, bruise or haematoma (a collection of blood in the wound)
- Unsightly scarring of your skin. Hypertrophic or keloid scar
- Change in nipple sensation (usually less sensitive, but occasionally more)
- Nipple ischaemia or loss of blood supply resulting into complete or partial loss of your nipple. Fortunately, it is very rare.
- Fat embolus. Liposuction can sometimes cause the fat to enter your blood stream
- Fat necrosis (Loss of blood supply to some areas of fat within the breast) – also called oil cyst.
- Asymmetry or cosmetic problems- Further surgery may be needed to make adjustments to correct asymmetry (rates may be up to 12-15%)
What are the success rates?
Gynaecomastia surgery has a high success rate. Some patients may require small revision procedures.