Gynaecomastia

Gynaecomastia is the presence of excess breast tissue in males and can be confused with the fatty breasts of excess weight and obesity.

Gynaecomastia is the presence of excess breast tissue in males and can be confused with the fatty breasts of excess weight and obesity. True gynaecomastia cannot be treated with just diet alone. I believe that surgery required for excess skin on the chest after successful and significant weight loss is a different type of “breast problem” in males and may require techniques different from those used in gynaecomastia correction.

Gynaecomastia can affect both sides of the chest (bilateral) or just one side (unilateral). Hormonal changes during puberty in boys, is the most common cause of true gynaecomastia. However less frequently certain drugs (spironolactone, cimetidine, marijuana) and rare pituitary tumours in the brain (prolactinoma) can cause either unilateral or bilateral gynaecomastia. There is a range of severity from mild mounds of breast tissue (which can be easily disguised under a loose T shirt ) to severe when the breasts are difficult to hide.

Therefore the clinical history and examination for a patient with gynaecomastia needs to be thorough and accurate in order to understand the cause, the severity and the treatment strategy. Most gynaecomastia has both fatty and breast tissue components of varying proportions. Provided the skin has enough elasticity, liposuction is a very effective form of treatment as the skin re-moulds and shrinks over the subcutaneous spaces left after the fat has been removed. Less easy to treat is the hard breast tissue element and if there is a significant amount this usually requires some form of open surgery via an incision that can remain within the nipple. Sometimes in older patients, when the gynaecomastia has been of long-standing or if the gynaecomastia is particularly severe, excess skin also has to be dealt with. This can result in more extensive scars similar to those of a formal breast reduction.

Frequently Asked Questions (FAQs) View all

Can I see before and after pictures of patients considering the same procedure?

Most certainly! During consultation I am happy to share before and after photos with you of people who have had the same procedure(s) you are considering. By doing this during the consultation, and in person, I have the opportunity to relate the example specifically to your situation, highlighting outcomes and helping with expectations.

Are man breasts genetic? Will they grow back after gynaecomastia surgery?

Man breasts (gynaecomastia) are not usually due to genetic causes. The vast majority is due to a developmental problem during growth often stimulated by puberty.

It is likely that there is an oversensitivity of the developing male breast to the circulating hormone of puberty such as progesterone an oestrogen that are present in small amounts during male growth. Rarely hormonal problems can cause male breast such as excess adreno-cortical hormones and feminizing syndromes. Rarely male breasts are caused by certain drugs such as Cimetidine, Spironolactone and cannabis abuse.

Liver disease can also cause man boobs along with some very rare pituitary tumours such as prolactinomas. It is important the “man boobs” are not part of general obesity. A competent surgeon will rule out all these possible causes to reassure you. Proper surgery should then deal with the problem and there should be no recurrence.

What will happen to the excess skin after gynaecomastia surgery?

For mild to moderate gynaecomastia the skin will often shrink back. However for larger “breasts” some form of tightening surgery may be necessary resulting in external scars. Your surgeon should be able to assess this and advise accordingly.

Is there a chance that the breasts will be a different size after gynaecomastia surgery?

Perfect symmetry is difficult to achieve but most normal men will have some asymmetry occurring naturally as well. The aim of treatment is to allow the patient to regain confidence and at least be happy in T shirt or when swimming, if possible.

Do I need to build up muscle underneath the fat tissue before gynaecomastia surgery?

No. There will almost certainly be enough muscle under the breast to give a good post operative result.

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