Gynaecomastia

Gynaecomastia is breast development in the male. All males normally have some breast tissue, but when there is excess it is called gynaecomastia.

Breast development can occur in newborns (due to maternal hormones), in teenage years (hormones again) and in old age when oestrogen levels go up and testosterone levels decline. Typically gynaecomastia can occur in families. Gynaecomastia can be made worse by certain drugs and medication, including steroids (body builders beware). Rarely gynaecomastia is caused by serious disease (liver or testicular cancer) but then the gynaecomastia is just one of the symptoms.

The options for gynaecomastia treatment are either conventional open surgery or liposuction or a combination of both. There is no non surgical treatment for gynaecomastia. Whichever procedure is performed it is done in my own clinic as day case surgery under sedation and local anaesthesia. The procedure usually takes about an hour and you will be discharged later in the day. Removal of gynaecomastia tissue is usually permanent.

Conventional surgery may be required if the gynaecomastia is large or if there is hard tissue present, usually under the nipple. Incisions are made either around or through the nipple or areola. At the edge of the excision liposuction will be done to try and avoid contour irregularities.

Liposuction with a special cannula (the hollow rigid pipe which sucks out fat and other tissue) can be appropriate for most cases of gynaecomastia. It is performed usually through 2 small incisions below each breast. It is difficult to remove fibrous or glandular tissue with liposuction (although the special cannula I use facilitates this) and the risk is a persistent knob of hard tissue below the nipple. This hard tissue (stoneys) can be excised.

Whether liposuction alone or in combination with open surgery is used, there will be some bruising and swelling. Bruising usually subsides at around 2 weeks post-operatively. Swelling can take longer to settle and often with gynaecomastia the final result is only evident 6 months or more after surgery.

Before and after gynaecomastia treatment with liposuction

An enlarged nipple or areola (the pigmented part around the nipple) can be associated with gynaecomastia. Both can be reduced/corrected at the time of gynaecomastia surgery.

Before and after nipple reduction

Accumulation of fat in certain areas is unattractive and can give men a female or gynecoid appearance. A masculine shape is more desirable and this can usually be achieved simply with liposuction. Men frequently request liposuction of tummy, love handles and perhaps other areas too. While good results can be obtained it is important to understand about the two types of fat.

Subcutaneous fat is fat beneath the skin. It is what you feel when you pinch. Subcutaneous fat is what is treated with liposuction.

Deeper fat, around the internal organs, is called visceral fat. Visceral fat is not treated with liposution.

Women typically accumulate subcutaneous fat. While men also do, frequently men have visceral fat which is inaccessible to liposuction. Because of visceral fat accumulation it is possible to get an inferior result with lipo in men.

Males make up about 12% of my liposuction patients. Liposuction can be done to one or multiple areas in one surgery. Liposuction leaves minimal stigmata – it is done through tiny stab incisions hidden in natural body lines. Over time, these usually heal with inconspicuous scars. The surgery is performed in my own clinic under sedation and local anaesthesia. Patients are done as day cases, discharged home on the day of surgery. Recovery is relatively quick with some swelling and bruising for about 10 days post op. Complications are rare.

Before and after liposuction