Male breast reduction for the treatment of gynaecomastia.

The basics

Male breast enlargement is a surprisingly common and distressing condition for many men. Surgical correction is a very worthwhile treatment for it.

Male breast development can happen for several reasons and at different ages. Often there is no real explanation for its occurrence.

It often occurs during male puberty, when the chest becomes temporarily enlarged. This normally goes away spontaneously, but sometimes it doesn’t. Certain hormone and chromosomal disorders can also cause breast enlargement. Obesity is another cause and even if weight is lost, the breast area may stay large.

The use of anabolic steroids can cause breast development.

As males age, some medications can cause enlarged breasts, including hormone treatments, cardiac and blood pressure medications, and others.

Further, as we age, many men simply lose skin elasticity, and if they’re a little overweight, can develop a pendulous chest appearance which can create embarrassment.

There are usually no non-surgical options for treatment. If you’re overweight, weight loss may help and it is important to do this before surgery.

The goal of gynecomastia treatment is to reduce breast size in men who are embarrassed by overly large breasts. Reduction methods include liposuction only, cutting out excess glandular tissue, or using a combination of liposuction and excision.

Enlarged male breasts can be effectively and safely improved or corrected completely, usually with minimal visible scarring.

Where there has been massive weight loss with a lot of excess skin resulting, it might be necessary to remove skin too. If it is, there will be a long scar across the chest.

Gynecomastia is not usually caused by serious medical problems, but it is a possibility, so it’s best to talk with your GP before coming for a consultation to rule this out.

If you are in good general health, have a positive attitude and realistic expectations, and you’re a healthy weight, you are likely to be a good candidate for this procedure.

What happens before surgery?

During your consultation, I’ll evaluate you as a candidate for gynecomastia surgery and clarify what this procedure can do for you. Once I understand your goals and medical health, I’ll let you know whether surgery can meet your goals, and describe the result you can expect to achieve, including the scars you will have.

You should come prepared to discuss your complete medical history and any drugs, medical or recreational, that you are taking or have taken.

We’ll discuss the risks and complications, how to prepare for the surgery, and what you can expect to experience after surgery.

I’ll show you before-and-after photos of cases similar to yours and answer any questions you have.

What happens during surgery?

The goal of gynecomastia surgery is to restore a normal male breast contour and to correct deformities of the breast, nipple or areola. Surgery reduces the glandular tissue, and the excess surrounding fat of the chest wall is removed by liposuction.

Skin does not usually need to be removed as it takes up the shape of the new breast contour.

Results are reliable, and the rate of complication is low. 1% of breast cancer occurs in males, so all breast tissue that is removed should be sent to pathology for testing.

In my practice, the most common surgical method is initial liposuction to the entire chest and armpit area affected. Then a small incision is made at the lower edge of the nipple, and the dense hard breast tissue behind the nipple is carefully removed through this. The aim is not to remove it all – but to leave a smooth looking chest. There is a small scar at the bottom of the nipple (called the Webster incision – no relation!), which heals very well and is usually hard to see over time.

I always use a general anaesthetic for Gynecomastia surgery. Local anaesthetic is then injected all around the operative area to make it numb.

After the tissue is removed, I use stitches that are buried and dissolving. A compression vest is worn to minimise the risk of postoperative bleeding or haematoma. When you wake up, the area feels bruised, but not too sore. It is usually a day procedure, so you can go home later in the day to rest. You will be prescribed painkillers for postoperative pain.

Occasionally, liposuction alone is used.

In all cases, surgery normally makes the nipple numb or partially numb permanently.

What happens after surgery?

You can expect to wear a compression garment. I don’t use drain tubes. The first three postoperative days are the most important to your recovery. You must be at full rest at home, but not necessarily in bed. Sitting, walking and light activities around the house are fine, but take care not to move your arms around too much.

When the anesthesia wears off, you may have some pain. It shouldn’t be too severe. If the pain is severe and not relieved by the painkillers you’re prescribed, contact me. You will also have some bruising and swelling after surgery.

I usually dress the incisions with a waterproof dressing. This can stay on for up to two weeks. On top of this there will probably be some foam or padding, then on top of all that, the compression garment.

We’ll instruct you leave everything alone for 48 hours. Then, you can remove the garment and discard any pads or foam under the garment – you don’t need these anymore. Leave the small plastic skin dressing at the nipples on the skin – it will stay for a week or two.

Have a shower, and replace the garment. You’ll wear the garment 24/7 for about 2 weeks except for showering.

How long will results last?

Gynecomastia surgical results are permanent, assuming your weight is stable. If your condition arose from the use of medication or anabolic steroids, further use could lead to recurrence.

Possible complications

All the general risks of plastic surgery, plus haematoma, poor scarring, asymmetry, poor contour, abnormal looking nipple.

Which drugs can cause gynecomastia?

Below is a list of drugs that can cause gynecomastia¹.

  • Antiandrogens
  • Bicalutamide, flutamide, finasteride, dutasteride
  • AntihypertensiveSpironolactone
  • Antiretroviral
  • Protease inhibitors (saquinavir, indinavir, nelfinavir, ritonavir, lopinavir), reverse transcriptase inhibitors (stavudine, zidovudine, lamivudine)
  • Environmental exposure
  • Phenothrin (antiparasitical)
  • Exogenous hormones
  • Oestrogens, prednisone (male teenagers)
  • Gastrointestinal drugs
  • H2 histamine receptor blockers (cimetidine)

Drugs possibly causing gynecomastia¹

  • Antifungal
  • Ketoconazole (prolonged oral use)
  • Antihypertensive
  • Calcium channel blockers (amlodipine, diltiazem, felodipine, nifedipine, verapamil)
  • Antipsychotic (first generation)
  • Haloperidol, olanzapine, paliperidone (high doses), risperidone (high doses), ziprasidone
  • Antiretroviral
  • Efavirenz
  • Chemotherapy drugs
  • Methotrexate, cyclophosphamide, carmustine, etoposide, cytarabine, melphalan, bleomycin, cisplatin, vincristine, procarbazine
  • Exogenous hormones
  • Androgens (athletes abuse)
  • Gastrointestinal drugs
  • Proton pump inhibitors (omeprazole)
  • Cardiovascular drugs
  • Phytoestrogens (soya-based products, high quantity)

Drugs rarely or very unlikely causing gynecomastia¹

  • Miscellany
  • Amiodarone, amphetamine, aripiprazole, atorvastatin, captopril, cetirizine, clonidine, cyproterone acetate, dasatinib, diazepam, diethylstilbestrol, digoxin, domperidone, entecavir, ethanol, fenofibrate, fluoxetine, gabapentin, heroin, imatinib, lisinopril, loratadine, marijuana, methadone, metronidazole, misoprostol, MyTosterone®, paroxetine, penicillamine, phthalates, pravastatin, pregabalin, ranitidine, rosuvastatin, sulindac, sulpiride, sunitinib, theophylline, venlafaxine

¹ Contents adapted from Pharmacotherapy 2012;32:1123-40

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