Male Breast Reduction
Introduction
What is gynaecomastia?
‘Gynaecomastia’ is enlargement of male breast tissue. It’s a common condition which is benign (not cancer). It affects men at any age but particularly teenage boys and older men. The breasts may be tender, and patients often present with a lump or tenderness or sensitivity of the nipple, as well as enlargement of the breasts.
The extent of enlargement is very variable, from a small thickening or lump felt behind the nipple to large droopy breasts. Gynaecomastia may affect one or both breasts. In some patients, there is increased breast tissue as well as increased fatty tissue, which may be more prominent in over weight patients.
This condition is often referred to as ‘man boobs’.
What causes gynaecomastia?
Puberty in boys usually starts in teenage years. There is a rise in hormone levels – testosterone (male hormone) and oestrogen (female hormone). If the female hormone is predominant, enlargement of the breast ensues. In the later teenage years testosterone starts to settle at a constant level (higher than oestrogen) and this stops the breast growing. The chest broadens and the breasts flatten out. It can take some time before the breasts flatten out and if this is troublesome, your GP may refer you to a specialist for assessment.
In older age, testosterone levels drop and body fat increases and this may cause the breasts to enlarge. Any weight gain may be visible on the breasts.
Medication – some drugs cause gynaecomastia as a side effect. for example – spironolactone, digoxin, prostate medication
Cannabis
Anabolic steroids taken to build up muscle
Obesity – due to more fat tissue
Alcohol – affects the liver which stops breaking down oestrogen
Diagnosis
You will see a specialist for assessment. This will include clinical examination of the breasts and may also include examination of the abdomen and testes.
Tests may be carried out, including blood tests, mammograms (X-ray of the breasts), ultrasound scans, and biopsies if needed.
Treatment
Treatment is variable according to symptoms.
Most of the time, reassurance is adequate, and no treatment is required.
It may be possible to stop the cause, if known, such as changing medication, stopping alcohol, cannabis, or steroids.
Some drugs which are hormone blockers can be used to treat gynaecomastia, but these are for short term use and have numerous side effects.
Surgery – removal of the tissue
Some patients are very conscious of their breast tissue, and this may affect their quality of life. In these patients surgery can be performed to remove the excess breast and fatty tissue. This is usually for cosmetic purposes.
Surgery
Surgery offers two options.
- Excision of the breast and fatty tissue (this is sometimes referred to as subcutaneous mastectomy, where the breast tissue is removed from under the skin)
- LiposuctionSometimes a combination of these may be required.
The surgery is not simple and sometimes further operations may be required. This may include further excision and / or liposuction, depending on how the tissue heals
Excision may be done at the first operation and liposuction used later to remove more fat if there are any ‘lumpy’ areas
The aim of surgery is to remove the breast tissue and achieve a ‘normal’ male breast size and shape. Due to the nature of the surgery, there may a ‘dip’ or indentation where the tissue is removed. A small amount of tissue is retained behind the nipple to support the nipple and areola, and provide blood supply to the nipple.
During consultation, you will be shown the incisions that would be used.
You may also see pictures of previous patients, before and after surgery, to enable you to form a realistic expectation of surgical outcome.
Photographs are usually taken before and after surgery for your records.
Please note that further surgery for adjustment is chargeable, as the price quoted is for the first surgery only.
The Operation
Surgery is performed under general anaesthetic.
An incision is usually made around part of the areola (dark area around the nipple) and may be extended over the breast. The tissue is removed from under the skin.
If there is a lot of excess skin, this may also need excision.
Some surrounding fatty tissue may need to be removed to obtain a suitable cosmetic result, with gentle sloping.
The nipple may be partly excised if it is too big and reduction is desired.
A drain will be inserted into the breast cavity to allow reaction fluid to drain and this will be monitored after surgery. The drains are removed when the fluid drainage is minimal. You may be discharged from hospital with the drain in place, depending on the amount of drainage fluid.
The wound will have surgical tape and dressings. You will have waterproof dressings which allow you to shower and then dab dry. Keep the wounds dry to help the healing process.
A compression jacket will be applied, and this should be worn for up to 6 weeks
Complications
Infection – may require antibiotics
Bleeding – if there is bleeding after surgery, this will be assessed. A collection of blood clot is called a haematoma. If there is a large collection, you may need to return to theatre for removal of the clot and stop the bleeding.
Bruising, Swelling – some swelling is expected. This will gradually resolve.
Asymmetry – this may require further surgery to correct differences between the two sides. Liposuction or surgery for adjustment may be required, depending on tissue healing
Numbness of the nipple and areola: This may partially recover in the long term.
Scarring – thick scars may form depending on how your skin heals.
DVT or PE- clots on the legs or lungs. You will be given compression stockings to reduce this risk. You should also get mobile and walking soon after your surgery to minimise the chance of clots.
Recovery
You will be in hospital for one night.
You should not drive for 2 weeks, or at least until you can safely perform an ‘emergency stop’. Try to apply your safety belt and make sure you are comfortable and safe before driving.
Avoid any strenuous activity or exercise for 6 weeks
Because all these procedures leave some breast tissue (although minimal), your gynaecomastia could recur and malignant transformation can also occur.
Post–operation
You will be seen in the outpatient department for wound check and change of dressings about one week after surgery.
You will also be seen by your surgeon about 2 weeks after surgery.
If there are any queries or problems, you can contact the nurses or hospital.
Please do not hesitate to contact the doctor or nurses if you have any concerns or queries.