Gynaecomastia is a common disorder of the male breast in which there is a benign glandular enlargement of that breast, often associated with abnormal fat deposition around the breast. The result is the appearance of so-called “man-boobs”, which may be unilateral or bilateral, symmetric or asymmetric. The causes of this condition are legion but most commonly, in our practice are related to developmental hormonal changes and weight gain.
Gynaecomastia affects an estimated 40 to 60 percent of men. It usually consists of two types of tissue: the solid, glandular breast tissue proper and fatty tissue in and around the breast; the proportion of each will vary from case to case.
The surgery is performed under general anaesthetic and takes about two hours to complete. An overnight stay in hospital may be required though day surgery is sometimes suitable. Drains may be inserted at the time of surgery, along with a compression bandage to reduce the effects of swelling in the breast tissue.
If excess glandular tissue is the primary cause of the breast enlargement, it will be excised with a scalpel. The incision is usually made around the areola and the excision may be performed either alone or in conjunction with liposuction.
If the gynaecomastia is due to an excess of fatty tissue, this may be removed by liposuction. An incision for liposuction is made at the edge of the areola or higher up in the armpit. A cannula attached to a vacuum pump, is then inserted into the incision and moved through the different layers beneath the skin to break up the fat and suction it out. Ultrasound-assisted liposuction is usually ideally suited for addressing the fibrous fat in the male breast.
In some cases large volumes of fat or glandular tissue are removed and the skin may not contract back around the smaller breast. In this case excess skin may need to be removed in order to re contour the breast. In this case, one of a number of possible surgical resection plans may be considered. In one option, a transverse incision, placed horizontally across the breast may be considered. Alternatively, a “do-nut” incison, placed around the areola, may allow adequate skin resection. In still other cases, a vertical scar may be designed to run from the areola to the base of the breast to meet a horizontal scar, as is more commonly done in female breast reduction. These significant resection patterns are kept only for those rare individuals who present with significant, female-like hypertrophy of the breast. The vast majority of cases however, require only a simple incision, running along the edge of the inferior half of the areola; the scar from this procedure is virtually invisible.
Recovery after gynaecomastia surgery is gradual. You would expect to take things very easy for the first week to minimise the risks of bleeding after surgery However, after the first week, progress is usually quite rapid. You will usually get back into light exercise after about three weeks and should be able to do most forms of physical activity including contact sports after six to eight weeks.