Gynaecomastia - Male Chest Reduction

The breast, whether male or female, is made up of basically two components. These are the glandular tissue component (firm and dense) and the fatty tissue component (softer tissue). The ratio of glandular to fatty tissue in any breast varies from individual to individual. Although strictly speaking gynaecomastia refers to enlargement of the glandular component of the breast, in reality for most patients there is both an excess of fat and glandular tissue.

The term gynaecomastia (pronounced guy-nee-co-mastia) is greek for woman's breast and it was first coined by Galen a second century AD physician. A description of a surgical procedure to cure this condition was subsequently first documented during the 7th century AD by Paulis of Aegina, a Greek physician, who described it as an effeminacy of men.

Although sometimes this condition appears at birth the main cause is puberty. Some studies suggest that as many as 65% of boys in the 14-15 year age group encounter this. Within 2-3 years the incidence drops radically so that the condition affects only about 8% of males of 18 years of age. However the incidence rises again with progressive age reaching an incidence of about 30% in older men. Although the cause of male breast enlargement is not as yet entirely clear, there can be no doubt that it is basically a result of the actions of circulating hormones on specific cells in the breast area. Some researchers feel an imbalance in the male to female hormone ratio of the male body(yes, males do have quantities of female hormones circulating in their bodies!) rather than the absolute level of these hormones is significant in the development of this condition. Predictably therefore there are large variations between the degrees of breast enlargement encountered.

The surgery

To begin the operation a tiny incision (about 3-4mm) is made in the skin in each armpit area. Subsequently the chest areas are injected with the tumescent solution mentioned in the Liposuction section. This solution is then allowed to diffuse and take effect (about 10-15mins) throughout the target fat. As mentioned previously the solution will numb the areas as well as reduce bleeding by temporarily closing down the regional blood vessels. The appropriate cannulaes are inserted into the fat, then through backward and forward stroking motions, along with the help of the power assisted liposuction handle, the fat is loosened and drawn off by a strong vacuum pump.

You'll lose some fluid along with the fat during liposuction, therefore during the procedure it is normal practise for the anaesthetist to give intravenous fluids to replace those lost in the procedure.

Throughout this procedure the plastic surgeon is always conscious of leaving a smooth layered thin blanket of fat attached to the underside of the skin, in order to minimise the possibility of any irregularities or rippling of the skin. Once the required amount of fat is suctioned from around the breast gland, the gland is then more easily accessible and can be “pulled through” more readily with a small, usually about 7-8 mm, incision at the bottom part of the areola(red area around the nipple) and is usually removed piecemeal. This piecemeal removal avoids the need for a larger incision which would have been required to remove the whole gland in one piece. During the removal of the breast gland, about 95% of the gland is removed. A small amount of breast gland must be maintained in order to support the areola and to avoid unsightly dips and irregularities in the region. As the incisions are tiny, they do not require sutures and are left to heal on their own. A compression vest is then supplied for you in order to apply some pressure to the region for about 10 days.

When skin excision is also required, due to excessive sagging, the ensuing scar size and positioning will be explained to you at the time of the consultation. In these situations the operation details are more along the lines of female breast reduction (see breast reduction section).

Risks

Complications that can occur include thickened, deeply coloured or unattractive scars at the site of the small incisions; irregularities of contour or dimpling of the area treated; unevenness or asymmetry between sides; prolonged numbness and swelling; haematoma or seroma formation (a collection of blood and fluid under the skin that must usually be drained by the surgeon), and infections. In extremely rare cases, skin loss resulting in permanent scarring has been reported.

Despite any surgeons best efforts, it is possible that a small number of patients may require a  secondary tidy up procedure, usually after 9-12 months, to correct or improve any residual uneven contour or shape irregularity. This will be determined at the follow up checks

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