Gynecomastia Surgery

What is gynecomastia?

Gynecomastia occurs when the breast tissue in men or boys swells with glandular tissue, excess localized fat and excess breast skin. It can affect one or both breasts.

Both men and women have the hormones estrogen and testosterone, which control secondary sex characteristics. Testosterone is largely responsible for traits linked with males, such as body hair, muscle mass and bone mass. Estrogen controls such things as breast growth.

In healthy males, the levels of testosterone and estrogen are balanced, but hormonal imbalances that lead to the decrease of testosterone and the increase of estrogen can trigger gynecomastia.

This is most common in newborns, who have lingering estrogen in their systems from their mothers. Boys going through puberty also frequently suffer from gynecomastia. For them, the excess breast tissue also typically resolves without intervention as puberty ends, but this can take up to two years. Finally, older men can also have gynecomastia as a result of hormonal changes. This most commonly occurs after the age of 50 and affects as many as 25 percent of all older men.

What are the causes of gynecomastia?

Enlarged breast tissue in males can occur as a result of using certain medications, including androgens and anti-androgens, anabolic steroids, anti-anxiety medications, calcium channel blockers, certain stomach medications, chemotherapy, methadone, AIDS medications and some herbal supplements. Any health condition that can interfere with healthy hormone levels can also cause gynecomastia, as can obesity. In up to 25 percent of cases, the cause is unknown.

What does gynecomastia surgery involve?

While there are few serious physical concerns associated with gynecomastia, the condition can be psychologically and emotionally difficult for boys and men who have it. Gynecomastia surgery can help restore the desired appearance. It typically involves removing the excess tissue and, if necessary, addressing the position and appearance of the areola. Gynecomastia surgery can also be called a reduction mammaplasty.

Several techniques are available, including:

Intra-areolar

During this common technique, the incision will extend along the bottom of the areola, providing the surgeon access to remove the excess tissue.

Skin resection

The skin resection technique can be used in more severe cases. In this technique, the excess tissue is surgically removed and the nipple is transposed as needed.

Pull-through

The pull-through technique uses a small incision at the border of the areola, and the excess tissue is removed via liposuction. This technique is less invasive than some other procedures.

Ultrasonic lipo

When the gynecomastia is primarily caused by excess fatty tissue rather than skin or glandular tissue, ultrasonic liposuction may be an option. Ultrasonic lipo uses sound waves to liquefy fat so that it can be removed more easily.

How does a gynecomastia surgery work?

1. Consultation

If you are a candidate for gynecomastia surgery, you will need to schedule a consultation with your surgeon. Your surgeon will review your medical history, discuss aesthetic preferences and personal goals, address your concerns and answer any questions that you may have. Your surgeon will also typically perform a health exam. You and your surgeon will then discuss the surgery plan along with any special instructions.

2. Anaesthesia

Anaesthesia ensures patient comfort throughout the procedure. Most gynecomastia procedures are performed using general anaesthesia or local anaesthesia along with IV sedation. Sedation may be administered before you are taken back to the surgery room while general anaesthesia will only be administered in the operating room. Your vital signs will be monitored throughout the procedure.

3. Incision

Once the anaesthesia has taken effect, the surgeon will make discreet incisions in specific, pre-planned locations. If you are undergoing liposuction, only a few small incisions may be necessary to insert the cannula. Excisions involving glandular tissue can necessitate larger incisions, which are typically made along the areola or natural skin creases where they will be less noticeable as they heal.

4. Surgery

The way the surgery is performed will depend on the technique being used. During liposuction, a thin, hollow tube called a cannula will be inserted into the small incisions. The cannula will be moved to loosen the fatty tissue, and then the tissue is suctioned from the body to create the desired contours.

During an excision, the excess glandular tissue and skin are removed surgically. Your nipple and areola may also be resized or repositioned to ensure the look you want.

Some techniques involve both liposuction and excision.

5. Closing the Incision

After the surgery is complete, the surgeon will close the incisions with sutures. You may also have drainage tubes inserted beneath your skin to drain fluid, limit swelling and reduce the risk of infection.

6. Post-Anaesthesia Recovery and Care

Once the incisions are sutured, you will be moved from the operating room to an observation area. You will have bandages applied to your incisions, and you will be helped into a binder or compression garment, which aids in healing.

Gynecomastia surgery can be performed on either an inpatient or outpatient basis, depending on the amount of tissue being removed. The drain tubes will be removed in about 7 to 10 days, and if necessary, sutures will also be removed at this time.

What should I expect from gynecomastia surgery?

Results should be immediately noticeable. However, some swelling is common and can linger for several weeks or months. As the swelling declines, the contours of your figure will become more evident. Your full results will be evident 3 to 6 months after gynecomastia surgery. You may have some scarring from the incision, but this should fade over time. Additionally, placement of the incisions is typically considered carefully to minimize scarring.

Eating and drinking well and resting often are important after any surgery. You may have tenderness, and as the swelling subsides, you might notice small lumps or bumps in your chest, too. Wearing compression as prescribed and gentle massage can help these lumps resorb.

Most patients enjoy excellent results after their gynecomastia surgery along with improved self-confidence.