What is gynaecomastia?
Gynaecomastia (female breast) is a condition in which men develop a female breast.
Why does gynaecomastia happen?
When children are born, male and female children both have a nipple and a small pad of tissue underneath the nipple called the breast plate. This breast plate is sensitive to circulating hormones and will enlarge when the hormone oestrogen is present. In females at puberty, oestrogen circulates and a breast develops. In males at puberty, both oestrogen and testosterone circulate and usually no breast develops, but the breast plate often swells a little and may become tender. This slight enlargement lasts for a year or two and then settles. It does not usually require any treatment.
Occasionally, however, either an abnormally high oestrogen level occurs in boys OR the breast plate may be abnormally sensitive to oestrogen and a breast develops in males.
What should I do if I think I have gynaecomastia?
In the first instance you should contact your family doctor who will need to rule out an underlying cause for this condition. There are many possible causes. Once all possible treatable causes have been dealt with, the gynaecomastia may disappear on its own. If there are no identifiable causes, we can then treat the breast itself.
What if I am overweight?
Obese males often develop fat deposits which resemble breasts. Losing weight will usually result in these breasts disappearing. As all surgery is potentially dangerous, it is far better to lose weight by a combination of diet and exercise than undergo an operation to remove fatty breasts from an obese person. However, some people find that despite losing weight, the breasts persist. After careful examination to exclude other causes, these breasts can then be treated as above.
How do you treat gynaecomastia?
There are two main surgical options to reduce the breast.
1. Liposuction: The simplest surgical method to treat the breast is to use liposuction to suck out the breast tissue and fat. The skin will usually retract to take up the slack. This results in the least scarring and probably offers the best cosmetic outcome in most cases.
Very big breasts can be treated with liposuction, but it may take several procedures, six months apart, to allow the skin time to retract between treatments. Occasionally the skin does not retract fully and the excess skin has to be surgically removed. This can result in unsightly scars. Occasionally the breast tissue is so firm that liposuction cannot break it up. If liposuction fails the next treatment option is to try open surgery.
2. Surgery: A small incision is made around the bottom half of the areola (see picture) and through this hole, the entire breast plate is cut out.
Is gynaecomastia treatment available on the NHS?
Gynaecomastia treatment is usually available on the NHS. However, in some areas funding is no longer available. You should discuss this with your GP.
How is the operation done?
Surgical excision of gynaecomastia is done under general anaesthetic (with you asleep). The extent of the breast tissue is marked out on your skin with a pen, and then a small incision is made around the bottom half of the areola and through this hole, the entire breast plate is cut out. A small drain is inserted into the resulting space which emerges from the skin close to the armpit. The incision is closed with buried dissolvable stitches and surgical tapes applied. Finally the skin is taped into position to encourage it to shrink up and stick, and to prevent any fluid from accumulating in the spaces where the fat has been removed. A tight elasticated pressure garment is then put on over the surgical tapes to add further compression.
Alternatively the breast fat/tissue can be removed by liposuction via a small (less than 1cm) incision placed on the side of the chest wall. Again, this is done under general anaesthetic. After the procedure the small wound is closed with a buried dissolvable suture and the skin is taped to the chest wall and further supported with a tight elasticated garment.
What are the limitations of the procedure?
Occasionally the breast may be very large and the skin may not fully retract to take up the slack. In this case, this excess skin may have to be surgically removed which may results in unsightly scarring.
How long is the operation?
Surgical excision of a gynaecomastia takes 1 hour.
How many days in hospital?
You would normally stay in hospital overnight, and provided the drain is not producing too much fluid, the drain is removed the following day and you may go home.
Postoperative Follow Up
After discharge you will be provided with written information to explain the postoperative course. An appointment will be made to see my Cosmetic Nurse one week after your operation. She will remove your dressings and inspect your wounds, which may or may not have healed at this time. If the wounds have healed you will be given advice on wound care, bathing and exercise advice. If they have not quite healed by this one week visit, she will reapply the dressings and arrange to see you again the following week. Once your wounds have healed you will be given an appointment to see me six weeks after your operation. You should continue to wear your pressure garment until you see me. At this appointment I will check on the early outcome of surgery; if all is settling satisfactorily I shall arrange to see you for a final visit six months later.
What are the possible risks?
Any surgery has the potential for complications. Although gynaecomastia is generally a very safe operative procedure, it does carry the following risks:
- Infection: Infection is a fairly rare complication and can result in swelling, redness and tenderness either spreading out from the stab incision scar or may develop anywhere over the liposuctioned area at any time for up to 3 weeks after surgery. This usually responds well to a course of antibiotics.
- Bruising: Bruising almost always happens with liposuction and should be considered inevitable. The bruising may range from very minor to black and blue. It usually settles within 2-3 weeks.
- Bleeding: Bleeding can occur at any time over the first ten days after surgery, and therefore it is wise to avoid any strenuous exercise over this time. For the first week after surgery you should try to limit movements at the liposuction site. Should a bleed occur under the skin, the area may swell quite dramatically, it can be quite painful and tender. If this happens you may need to return to theatre to have the blood removed and the bleeding stopped.
- Ugly Scarring: The small incisions will initially be red and a little thickened for the first six months or so, but will eventually settle very nicely to leave a thin, pale, flat scar which is well hidden at the edge of the areola. Occasionally however, scars may become red, raised, wide, itchy or ugly. This is fairly uncommon.
- Numbness: The nerves to the skin can be stretched or even cut during the operation resulting in numbness of the overlying skin. This is quite common and it usually recovers, though there is a small chance that a small area of numbness may be permanent.
- Seroma: Occasionally fluid can collect in the area beneath the breast skin. This results in a bulge or swelling. It is treated by inserting a needle and sucking the fluid out, though it may recur and can take several months to settle. This seroma may lead to internal scarring and create ugly folds and irregularities in the overlying skin. To reduce the risk of a seroma, you should wear the compression garment for the first 6 weeks after surgery.
- Irregularity: Great care will be taken to ensure the remaining fat is left smooth to form a natural contour. However, internal scarring, seroma formation, bleeding etc can result in irregularity and unevenness at the operation site. This is difficult to correct, but deep massage over several months may help to smooth it out.