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Males are born with a small amount of breast gland tissue and in most cases these glands remain undeveloped. Obesity may cause the breast glands may enlarge (gynecomastia) and this may be distressing to the individual. Weight loss may result in physical changes that are unaesthetic and may adversely affect individuals’ body image and self-confidence.
Weight loss often leads to formation of loose skin folds in the lower chest, which may extend outwards to the outer chest. This may obscure the underlying contour of the pectoralis muscle. 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 gynecomastia cases 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.
Obesity stimulates adipocytes (fat storage cells) to convert some of their lipids into estrogen-related hormones, which are released into the circulation and stimulate breast gland and subcutaneous fat growth. When individuals lose weight, the breast and subcutaneous volume is reduced resulting in skin excess. The fat tissue may still be present in sufficient volume and cause a downward droop, creating the appearance of a pseudo breast fold beneath the nipple.
Gynecomastia and chest wall contouring removes the abnormal breast gland and fat overgrowth and excises the excess skin. It usually sites the scar in inconspicuous locations and minimize the scar length where possible. The overall aim is restoration of the appearance of a normal male chest, thereby impoving the individual’s body image and self-confidence. Gynecomastia and chest contouring surgery is usually a day surgery procedure performed under intravenous sedation or general anesthesia.
The following are good candidates for chest wall contouring:
Individuals who have a high BMI may wish to consider other forms of weight loss interventions (e.g. diet and exercise interventions, or bariatric surgery) to achieve ideal weight prior to chest wall contouring and gynecomastia excision for best results.
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 performed through small incisions in the chest wall for the reduction of excess subcutaneous fat. Specialized liposuction cannulas are used to break up the breast pseudofold to recreate the appearance of a normal male chest. The breast gland and excess skin are normally excised through an incision at the fold. Nipple-areolar complex repositioning, if required, may be performed after the inframammary incision is closed.
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 to prevent formation of irregular skin folds.
