When a man has an enlarged chest area, or man boobs, it is called gynaecomastia. It is normal at puberty but when it fails to resolve then it becomes a problem. There can sometimes be other medical reasons for the problem but it has usually been persistent for several years, and poor diet and a lack of exercise do not help. This is a very common problem for men, nowadays, and the treatment for gynaecomastia can be very successful sometimes.
Surgery for gynaecomastia is often a combination of liposuction and excision. The liposuction removes the excess fat and excision removes the excess glandular tissue. A combination of the two is often used to create a balance between the areas that need to be removed and the surrounding chest and abdomen that will remain untouched. In the example shown on the right, the result is with aggressive liposuction alone to the tissues marked in the preoperative photograph.
An intraoperative decision is sometimes made as to whether we will need to make a scar on the undersurface of the nipple/areolar or not. If there is a lot of firm tissue behind the areola this increases the chance that we need to make this incision. If you have a lot of excess skin which will not redrape itself well after removal of the excess tissue, then you may need skin reduction as well. Skin removal is rare, and may be done at the time of the initial surgery or you can wait and see what the final result is at 6-12 months before making a decision to have further surgery.
What You Need to Know About Gynaecomastia Surgery
Because of the swelling that occurs after the operation, the final results are not seen for six months, and although the majority of people are very happy with their results, there are some risks associated with the procedure. These include:
- Wound healing delays
- Altered sensation around the chest wall
- Over-reduction (causing a dish-shaped result)
- Changes with weight loss/ gain and time.
After your treatment you will be kept in hospital until you are fit to go home. Often this will involve an overnight stay in hospital, especially if a large area is being treated.
Sometimes, especially when small areas are being treated, you may go home shortly after your operation. You will need to wear a compression garment if possible. The garment should be worn for four to six weeks until all bruising and swelling has subsided and should only be removed when showering or bathing.
You can buy a garment from us whether we are performing your surgery or not. If your surgery is with someone else, you are welcome to buy the garment from our clinic on Wilson Street, or have one delivered to you by ordering one on the phone.
Your stitches should be removed after around 10 days and you should attend for a follow up appointment around 4-6 weeks after the treatment. The final result is not seen until around 6 months after the surgery once all the swelling has settled down.
Causes of Gynaecomastia
There are two main types of gynaecomastia – physiological and pathological – and there are different grades of gynaecomastia.
Physiological gynaecomastia is normal and occurs at three phases of life – in the newborn, in the adolescent and in the elderly gentleman. In the newborn, it is normal because the child has been exposed to oestrogens (female hormones) in the uterus (the womb). Shortly after birth, the baby’s breast tissue regresses and the chest wall flattens out.
In the adolescent, physiological gynaecomastia occurs because there is a general surge in the amount of circulating hormones in the blood stream. Men produce both female (oestrogens) and male (testosterones) hormones, but more testosterones than oestrogens. So, in adolescents there is an increase in the amount of circulating oestrogens. These have an effect on the usually minimal breast tissue in the teenage male and cause enlargement. It is normal for this to occur and normal for this to gradually subside over the course of a few years.
The majority of people who consult for treatment of true gynaecomastia do so because the tissue failed to subside. There is usually nothing that can be done for this other than surgery. Weight loss, exercise, diets and any other treatments usually do not work in cases of true gynaecomastia.
The third phase of life when the problem arises is in the elderly male, where physiological gynaecomastia can occur because there is a general reduction of the amount of male hormones that are produced by the testes. However, the same amount of female hormones are still being produced in the body by the adrenal glands and so the female hormones are relatively unopposed. This leads to gynaecomastia.
Pathological gynaecomastia occurs when there is an associated medical problem. This can happen in cases of liver disease, testicular tumours, marijuana use, with some medications (including spironolactone, cimetidine, hormone therapy, etc). You will be asked during your consultation how long you have had the problem and whether you have any risk factors.
There are different grades of severity of gynaecomastia. These grades are related to the amount of excess skin that is present and whether the nipple has also started to droop as a result of the excess tissue. If there is excess skin and the nipple has dropped, the exact method of surgery may be altered or you may be advised of a need for additional surgery after several months if the skin elasticity is not sufficient to redrape over the newly shaped chest wall.
Find Out More
If you are interested in finding out more, please come for a consultation and speak to Mr Shoaib, the plastic surgeon, about how we can try and help make you feel better about your chest shape. For a consultation please call 0141 552 0828 or fill out an enquiry form and we will contact you.