Areas of Surgery

Male breast reduction - Gynaecomastia

Q: What is Gynaecomastia (enlarged male breast)?

Though derived from the greek word Gynaec (meaning feminine) and Mastos (meaning breast), it literally means any condition that results in excessive growth of breast tissue in males. It may consist of excess glandular tissue, fat or both.

Q: What are the different types of Gynaecomastia?

Puffy Nipples-the glandular enlargement is restricted to the areola or slightly beyond, giving it a dome shaped appearance.

Adolescent-though seen in 30-60% of all boys in the age 12-18, it settles spontaneously without any treatment in almost all within 2 years of onset. It needs treatment when severe.

Adult- this is the most common type, containing both glandular and adipose (fatty) tissue.

Pseudo-(false) Gynaecomastia: this looks like the real Gynaecomastia, but consists of only excess fat tissue. This type can be completely corrected by liposuction alone.

Unilateral/Asymmetrical Gynaecomastia - this involves only one side breast, or both sides but in different degrees of severity.

Severe- involves severely enlarged breasts with excess/saggy breasts. This is more likely to happen in older people. Treatment may need removal of some skin along with the tissue below.

Q: What are the problems due to this breast enlargement?

Problems due to this abnormal breast enlargement are both functional & psychological. The deformity can be exquisitely painful. When small, it will be seen in situations such as gym class or swimming- when the child/adolescent needs to remove the shirt in the presence of others. This puts the person in a risk of not only embarrassment, but also physical harm

Individuals with no regression or even progression of the deformity often receive little or no understanding about the shame and humiliation they experience. Coaches, physicians, parents, and peers (both boys and girls) can inflict damage out of ignorance, cruelty, or both. Postural and clothing modifications to mask the deformity are the norm in these patients from puberty through adulthood.

Q: What is the cause of this problem?

Usually it occurs due to minor hormonal imbalance which is temporary. However, the changes in the breast stay long after the hormonal levels become normal. Rarely, it may be due do other illness or problems which the surgeon will identify during a consultation.

Q:When is treatment necessary/Who is a suitable candidate?

Treatment by surgery is usually needed when the problem stay for more than 2 years, or even earlier when relief from the physical deformity is needed to enhance the psychological & physical wellbeing.

These patients seek treatment because they find that the condition, which is readily apparent in everyday life, adversely impacts day-to-day activities under various circumstances. The physical deformation necessitates behavioral modifications that have numerous implications in the lives of the patients who are affected. Patients wear loose clothing and often avoid exposure in showers and swimming pools. Patients in high school and college are reticent to participate in any athletic activity that may directly or inadvertently require removal of one's shirt, exposing the chest.

Patients with Gynaecomastia typically slouch forward and roll the shoulders toward the midline in an effort to camouflage the deformation. The aforementioned posturing has a submissive connotation to the public with whom they interact. Patients return for postoperative appointments standing tall. In cases involving teenagers, parents typically remark "I have been trying to have him stand up straight for years!" The postural changes alone, which result at all age levels both sitting and standing, have numerous positive implications in peer-to-peer interactions.

Other details about the procedure.
Duration-1 to 1.5hrs
Anaesthesia- General or local with sedation
Period of stay-24 hrs after surgery in hospital

What to expect immediately after the operation
Usually a tight vest called pressure garment is applied on completing the surgery, needs to be used for about 6weeks from within regular clothing. Once recovery from anaesthesia is complete in a few hours, minimal stiffness/soreness of the chest may be felt, though all personal activity can be started.

Recovery
Back to work: 3-5 days
Strenuous activity: 2-3 weeks
Swelling & bruising: (if any) 3-6months

Some possible side-effects and complication
Infection, bleeding, fluid accumulation, skin injury/bruising, skin bagginess/rippling and asymmetry.

Long term outlook be after the surgery
Though the results of the surgery are permanent, problem may recur rarely with use of certain drugs or weight-gain.

Any other forms of treatment: On some occasions, in the presence of specific underlying cause, medicines do have a role.