Male breast reduction for gynaecomastia
Gynaecomastia, or excessive breast growth in males, can be due to a number of causes. Hormonal imbalance is a major cause commonly due to the onset of puberty or rarely, a hormone-secreting tumour (eg. pituitary or testicular tumour). Gynaecomastia can be a side-effect of certain treatments such as treatments used for prostate cancer or sickle-cell disease. Other drugs may cause gynaecomastia such as marijuana or steroids, but the most common cause is ‘idiopathic.’ This means that no cause is found.
Gynaecomastia can cause psychological and emotional distress as men can feel unable to take their shirt off in public and often feel uncomfortable wearing T-shirts or any tight top that may show the contour of the chest.
Male breast reduction for obese patients
Gynaecomastia is certainly more obvious in obese patients and losing weight is the first line of treatment in this group. For those patients that are not overweight, surgery is the most effective means of tackling the problem. The surgical option used depends on the degree of gynaecomastia and whether or not there is skin excess.
Male breast reduction for mild gynaecomastia with no skin excess
For this patient group, liposuction is an effective treatment. It leaves minimal scarring with only small incisions and will effectively remove the excess breast tissue as long as it is predominantly fatty. Sometimes there is dense breast tissue behind the nipple that cannot be removed with liposuction. In these cases, the tissue needs to be removed through an infra-areolar incision. This is a half-moon shape incision below the nipple. The scar is planned at the junction between the pigmented areolar skin and the paler skin of the chest wall. By leaving the scar here, it is well hidden and is often difficult to see once the initial redness has faded.
Male breast reduction for mild gynaecomastia with moderate skin excess
To reduce breasts with moderate skin excess, again liposuction forms the mainstay of treatment for these cases, usually combined with the small incision below the nipple to remove the dense breast tissue behind the nipple. A modest amount of skin excess in a young healthy patient with good skin quality (non-smoker) would be expected to shrink and recoil once the underlying tissue was removed. Alternatively, skin can be removed and the breast skin tightened, but this involves more scars. The scars involved in a modest skin reduction would be all the way around the nipple. Again, this scar is relatively well hidden as it sits at the junction between the areolar and chest skin, but it is often puckered initially. This puckered appearance will settle and flatten after some months.
Male breast reduction for severe gynaecomastia with skin excess
Severe gynaecomastia with skin excess, can be equivalent to a female breast reduction. In these situations, there is a significant excess of both breast tissue and skin and it is difficult to address this without causing more extensive scarring. The pattern of scars may vary, but the techniques all involve scars that extend on to the chest wall and so will be more visible than the infra-areolar (underneath the nipple) or circumareolar scars (all the way around the nipple) scars.