This is a condition which presents as swelling of the male breast area – sometimes referred to as ‘moobs’ or ‘man boobs’ in the popular press. It is a common condition and can present at any age. In many cases it occurs at around the time of puberty and after a short growth period the excess tissue remains relatively unchanged thereafter. It is also more common in those who are overweight or obese. Gynaecomastia is also associated with some medical conditions and can be a side effect of some medications. However, in the vast majority there is no specific cause for the condition and hormone profiles are entirely normal.
There are two components to the swelling of the male breast: fat and firmer breast gland tissue. The latter is often referred to as a breast disc and sits behind the nipple as a firm lump. There is a huge spectrum of the condition, from very mild swelling to formation of a fully developed breast.
The mainstay of treatment is surgery. There is no medical treatment or medication that can be taken to eliminate the gynaecomastia. Whilst in the overweight patient it is essential to lose weight as a first step, once the weight is lost there will still be a residual excess that will require surgical treatment.
A common myth is that gym exercise and building up of the pectoral muscles will eliminate the gynaecomastia. Unfortunately this is not the case and can even make it more pronounced as the breast swelling is projected forward on a bulkier pectoral muscle.
Operations for gynaecomastia are generally carried out under a general anaesthetic and can be carried out either as a day case or as an overnight stay in hospital. The type of surgery depends on the extent of the gynaecomastia and on the two components which make it up, i.e. fat and gland tissue. Most surgery consists of a combination of liposuction and/or open excision of the breast disc (glandular tissue). In such cases very small incisions (3 or 4 mm) are placed carefully to allow liposuction cannulae access to the breast for suction of the fatty component. If open excision of the breast disc is required this is done via an incision around the nipple. For cases of more extensive gynaecomastia skin may also need to be reduced or excised. In cases of very large breasts it is often a two stage procedure.
Timing of treatment
There is no rule as to when this should be treated. Each case has to be assessed individually. It can be a distressing time for teenage boys who develop gynaecomastia early to go through school and puberty with the condition. Many are told that it will get better of its own or that they will ‘grow out of it’ – unfortunately this is not the case. It is advisable to seek a plastic surgery opinion early on to discuss the timing of the treatment.
Recovery from surgery
This will depend on the extent of the gynaecomastia and the type of surgery involved. For milder cases where liposuction alone is used, recovery is rapid with minimal down time. For open techniques the recovery may take longer. It is important to discuss with your surgeon these issues so that you can plan your treatment.
As with all surgery complications are possible and it is important that you have these explained to you by your surgeon. These will vary according to the procedure you have and the extent of the condition. You also need to be aware that occasionally small adjustments need to be made following your surgery to optimise the outcome.