Male Breast Reduction Surgery for Gynaecomastia by Jan Stanek at Surgical Aesthetics
Gynaecomastia is broadly defined as “abnormal enlargement of the breast in a male”. Women with flat chests are embarrassed and feel unfeminine while men with gynaecomastia feel embarrassed and feminized.
Gynaecomastia is thought to affect up to 60% of men at some point of their lives but most commonly appears in mid teens with 60 % of them peaking at 15 years of age. The second peak occurs at around the age of 60. The enlargement is thought to be caused by hormonal imbalance with an alteration in the ratio of testosterone to oestrogen in the body. It is known that some drugs can produce the same effect. However, treatment with drugs is unlikely to produce reduction in breast volume. In obesity fat gets deposited around breasts and therefore overweight men have large breasts. Weight loss will achieve breast volume reduction.
The only secure way to reduce the size of breast tissue is by surgical removal. Liposuction can remove fat only and will not remove any breast tissue. Unless there is excessive fat around the breast liposuction is not the mainstay of gynaecomastia treatment.
Gynaecomastia: The Procedure
The surgery is carried out in a hospital setting on a day-care basis under general anaesthesia, although sedation with local anaesthesia is possible. Preoperatively the outline of breast tissue is marked. Under general anaesthesia both breasts are infiltrated with a solution of dilute local anaesthetic and through a short incision in the lower periphery of the areola of the nipple the tissue of the breast is dissected off the subcutaneous layer of the skin and off the pectoralis major muscle. A small disk of breast tissue is left under the nipple to prevent it from being attached to the muscle. The pocket that results from removing breast tissue is cauterized for bleeding using special fibreoptic retractor and the wound is closed leaving a suction drain inside the pocket. Pressure dressings ensure that the breast pockets is compressed against the chest.
Post-operatively there is very little discomfort apart from numbness and tightness. Providing that all is well the drains are removed and you are discharged home with painkillers and antibiotics. The dressings should be undisturbed until the removal of sutures some 7 days later.
During the first week following your operation it is important that you take things easy and do not use your arms excessively for lifting. Otherwise you should lead near- normal life.
Gynaecomastia: The Risks and Possible Complications
All surgical procedures carry risks and surgical removal of male breast tissue is no exception. If you are concerned about any of these complications you should discuss them with your surgeon
- Infection: Infection is very uncommon after this operation because the surgery is “clean” and antibiotics are used to prevent it during and after surgery. Should infection occur it is treated with drainage and/or appropriate antibiotics.
- Bleeding: Bleeding inside the breast pocket leads to collection of blood which clots and is called haematoma. The presence of a large volume of blood is not desirable and usually means that bleeding is continuing. For that reason the patient is taken back to operating theatre, the wound opened and bleeding stopped. The the blood collection is small it can be treated conservatively.
- Scarring: The incision is approximately 2-3 cms long and is hidden in the pigmented area of the areola. On the whole the scar is barely perceptible.. However, some individuals can develop hypertrophic scarring or, worse, keloid scarring. This type of scarring may have to be treated with steroids or even further surgical revision of the scar.
- Loss of sensation to the nipple and chest wall: After most surgical procedures there is temporary loss of sensation which may become permanent. In this procedure it is more likely to happen to nipple sensation. If nipple sensation does not return within 12-18 months following surgery then it is unlikely that it will ever return.
- Nipple necrosis: Blood supply to the nipple becomes diminished with age and smoking. The imposition of surgery that is accessed through the nipple and removal of some of the blood vessels from the breast tissue reduces the amount of blood supplying the nipple. For that reason smokers must stop smoking for four week before surgery and for 10 days after. It is very rare to lose blood supply to the nipple completely. Should this unlikely event occur the nipple can be reconstructed.
- Surface irregularities: Patients with very thin subcutaneous fat can sometimes see surface skin irregularities.
- Asymmetry: Although breast tissue volume varies from side to side the chest wall behind may also be asymmetrical. The surgeon will try to remove most of the breast tissue to prevent “recurrence” of gynaecomastia”. Should there be a difference in the size of the pectoralis muscle or the rib cage he can do very little about it.
- Post-operative pain: Although pain is very unusual after the removal of male breast tissue it can occur and can persist for some time. The cause is unknown and this type of pain can occur after any surgical operation. It is usually called “neuropathic” pain and is treated with special painkillers. The prognosis is good.
- Recurrence of gynaecomastia: This “complication” is unlikely to occur if the surgeon aims to remove most of the breast tissue. It is more likely to happen if only some of the tissue is removed, especially if the procedure is liposuction based. Further removal of breast tissue should resolve the problem.
It is essential that you see a surgeon who will be able to explain in detail pros and cons of the operation. Only then you are in a position to make a decision whether or not you want to go ahead with surgery .