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Males are born with a small amount of breast gland tissue and in most cases these glands remain undeveloped. In a minority of men, the breast glands may enlarge (gynecomastia) and this may be distressing to the individual.
Gynecomastia may manifest only as a discrete breast gland enlargement just beneath the nipple, or together with generalized increase in subcutaneous fat tissue of the chest. In some cases, the increase in fat tissue may be of sufficient volume to cause a downward droop, creating the appearance of a pseudo breast fold beneath the nipple.
Most cases of gynecomastia have a combination of gland enlargement and fat overgrowth. In some individuals, gynecomastia may be associated with enlargement of the areola or overgrowth of the nipple. Rarely, gynecomastia may be the result of hormone secreting tumors elsewhere in the body, and there may be associated visual symptoms (loss of peripheral vision), testicular enlargement, or signs of liver disease (jaundice, liver enlargement etc).
Gynecomastia may be associated with enlargement of the nipple, the areola, or both. In cases where bloody discharge is noted originating from the nipple, male breast cancer may be possible, and associated investigations may be required. This is a rare occurrence.
Most cases of gynecomastia arise without a known cause and occur during puberty, or as a result of obesity. Uncommon causes of gynecomastia may include chronic use of certain medications, liver disease, and hormone secreting tumors of the pituitary gland, adrenal gland, or the testes.
Clinical assessment of gynecomastia involves examining the chest and relevant organ systems to exclude other causes. The individual’s medicine intake history is also sought. Clinical differentiation between breast gland enlargement and chest fat overgrowth helps to determine the ideal treatment methods. A clinical severity score may be assigned to the gynecomastia to guide treatment decision.
Gynecomastia surgery is usually a day surgery procedure performed under intravenous sedation or general anesthesia. Gynecomastia surgery removes the abnormal gland and fat overgrowth, improves the appearance of the chest, and restores the individuals’ body image and self-confidence.
Individuals in good health and able to tolerate a short sedation procedure are suitable candidates for gynecomastia reduction.
Individuals are advised to stop herbal supplements and traditional medicine, and start special medications 7 days prior to surgery to minimize bruising and swelling.
Liposuction is a useful tool where subcutaneous fat overgrowth is present. It is used to aspirate the excess fat, and also to break up the pseudo breast fold that may exist in cases of moderate to severe gynecomastia. Open excision of the breast gland is often required following liposuction of the chest. The incision used for breast gland excision is often made within the areola itself, and the gland removed. Nipple and/or areolar reduction, if required, may be performed at the same surgery in many cases and is often simple reduction surgery.
Minor swelling and bruising is expected after surgery, and will mostly resolve by the 7th postoperative day. Stitch removal is performed on the 10th postoperative day. Most individuals are able to return to work on the 3rd to 5th postoperative day, if desired.
Showering is possible on the second postoperative day in most cases. Postoperative bruising is minimized by avoidance of strenuous activity for the first 2 weeks. Specific post-operative compression garments may be required in the first 2 weeks to minimize postoperative bruising and swelling, and to guide the shrinkage of the skin and prevention of irregular skin folds.
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