Gynecomastia
Gynecomastia is the general term for breast enlargement in men. It is not a disease, but a physical examination is essential to establish whether a mass is present within the breast tissue. Gynecomastia surgery should be performed by a plastic surgeon.
Causes
Breast enlargement in men has many causes, the most common being hormonal changes and genetic predisposition. Certain medications and supplements such as steroids, some systemic illnesses and significant weight gain also lead to it.
Symptoms
The complaint raised most often is having a breast shape that reads as feminine. Some patients are troubled instead by the shape showing through their clothes.
Gynecomastia begins to appear around puberty. Enlargement that develops after puberty — particularly if it is rapid or asymmetrical — should have its underlying cause investigated. Any palpable mass in the breast must be assessed with imaging and, if necessary, biopsy.
Is Surgery Necessary?
If an illness or a medication is causing the gynecomastia, that cause should be addressed first; if the complaint persists, surgery becomes an option. For patients carrying excess weight, exercise and diet come first. Hormonal treatments have been discussed more recently, but an endocrinologist’s opinion is needed on suitability, and only a very small group benefits from them. Surgery is recommended after puberty is complete.
How Is the Operation Done?
Gynecomastia surgery may use liposuction, an open technique, or a combination of the two. Liposuction substantially reduces the excess in the breast area; however, removing the dense glandular tissue directly beneath the nipple through a semicircular incision under the areola gives a better result. Depending on how much excess skin there is, a ring of skin may be removed around the nipple; where the excess is considerable, techniques that leave scars need to be discussed. Depending on the technique chosen, surgery takes between one and two hours.
Recovery
A compression garment is worn for about a month after surgery. At the end of that period, a further two weeks of night-time-only use is recommended.
Pain and bruising afterwards are entirely normal, and a burning sensation in the chest can occur. Bear in mind that severe one-sided pain and bruising may indicate a collection of blood (haematoma).
Where only liposuction is used, small line-like marks remain at the entry points. Where more tissue must be removed, there is a semicircular scar just beneath the nipple; healing well, it draws little attention because it sits exactly at the change in colour. Where skin must be removed, there are additional scars where it was taken.
You can start gentle walks as soon as you feel ready. By the end of the first month you can resume almost all physical activity apart from heavy lifting, and from the sixth week you can return to full exercise. Listen to your body at every stage and avoid anything that causes discomfort, regardless of how much time has passed.
Returning to sex follows the same timeline as returning to physical activity.
Smoking is one of the most damaging influences on healing. Impaired circulation leads to wound-healing problems, infection and poorer scar quality. Ideally you should not smoke for three weeks before and three weeks after surgery.
If nothing about your recovery requires monitoring, there is no obstacle to travelling after surgery.
Risks and Complications
As with any surgery, bleeding, infection and wound-healing problems can occur. Loss of sensation in the nipple develops after the operation and returns with time; permanent nipple numbness has rarely been reported. As swelling subsides, irregularities, adhesions and indentation or hollowing at the nipple or across the chest may appear. Significant weight gain can bring the appearance of gynecomastia back. Scars may heal raised.