Gynaecomastia (male chest reduction)
Male chest enlargement is a normal occurrence among men of three different age groups, the newborn boy, adolescents and the elderly. The most common reason for seeing a plastic surgeon is when the male chest fails to reduce after the adolescent period but there can sometimes be other medical reasons for the problem. All these will be discussed at your appointment, and a tailored solution to your problem will be formulated.
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.
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:
- infection
- bleeding
- bruising
- scarring
- wound healing delays
- altered sensation around the chest wall
- over-reduction (causing a dish-shaped result)
- under-correction
- asymmetry
- changes with weight loss/ gain and time
Aftercare
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 two to four weeks until all bruising and swelling has subsided and should only be removed when showering or bathing. 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.
