Male breast development, known scientifically as Gynaecomastia, is defined as excessive development or growth of the male breast. This condition affects up to 36% of males and usually affects both breasts. The cause of the male breast enlargement is usually a hormonal imbalance, with relative reduction of male hormones (androgens) and relative excess of female hormones (estrogens). In majority of patients, the cause of this imbalance remains unknown, with most patients having a normal hormonal profile.
Gynaecomastia Treatment
Male Breast Reduction
Natural History of Gynaecomastia
Many patients are affected by gynaecomastia during puberty, and in majority of patients, the condition usually spontaneously regress over 3 to 18 months. Weight loss may help in some patients.
Patients with gynaecomastia for longer than this duration and into early adulthood rarely regress and is an indication for surgical removal.
It has been proven that adolescent gynaecomastia has a significant negative impact on the psychological well-being of affected patients, specifically with regards to social functioning, mental health and self-esteem. Of note, the negative impact was not affected by the severity or grade of the gynaecomastia. Early treatment is therefore recommended regardless of the severity of the gynaecomastia in adolescent patients.
Indications for surgery
Patients may consider surgical treatment for the gynaecomastia if:
- The condition has been present for more than 12 – 18 months without regression.
- It is causing the patient psychological stress and affecting social activities
- If it is impeding his daily activities like exercises
Physical Examination
The breast is examined to determine the tissue characteristics of the individual patient’s enlarged breast. The nipple disc is palpated to determine the extent of enlargement of the breast tissues. This is generally firmer and harder than the surrounding tissues, which is primarily fat and therefore much softer.
Surgical Techniques
Depending on the severity of the breast enlargement, tissue characteristic of the individual patient’s breast as well the extent of skin excess (drooping) of the breast, one of several techniques may be used alone or in combination.
Minimally Invasive Techniques
LIPOSUCTION & MICRODEBRIDER technique
Liposuction is used to remove the fatty tissue around the enlarged breast. Power assisted liposuction or Ultra sound assisted (VASER) liposuction may be used with good effect. The use of the microdebrider is primarily to enable more effective and complete removal of the firm breast disc behind the nipple. While liposuction alone does remove the disc to some extent, I have found the combine use of liposuction and microdebrider give a more even and predictable reduction/ flattening of the male breast. This combination of techniques is the most commonly used approach today as it is effective while being done with minimal incisions (2 stab incisions only per chest) thereby minimizing the scarring associated with the procedure.
Open Techniques
Breast Lift
This is for patients with more severe forms of breast enlargement usually seen in massive weight loss patients where the degree of sagging is beyond what contraction of the skin after the liposuction can predictably correct. In these patients, a skin tightening procedure call a breast lift is needed to remove the excess skin. Incisions or cuts will be needed to remove the excess skin and to flatten the chest and the placement of these incisions will be discussed with the patients.
Post Operative care
After surgery, to promote more rapid wound healing and contraction of the skin, a course of radiofrequency treatment to the treated areas would be prescribed. Patients will be encouraged to wear a firm compressive pressure garments for up to 2 months after the procedure and be taught to perform firm massages on the area.
In Summary
Male breast reduction is a predictable and safe procedure. It had profound physchological as well as aesthetic benefits for patients affected for this condition. To discuss more in detail about your specific needs as well as review some before and after photos of our patients, please come in for a consultation.