Most men have some degree of breast tissue behind the nipple. This breast tissue can occasionally enlarge (called gynaecomastia) due to a number of factors.
It is often tender and may become a cosmetic problem. There is long list of possible causes for gynaecomastia, however it is very important to exclude male breast cancer.
This can be easily done with imaging such as an ultrasound. If a discrete lump is identified and cancer suspected then a biopsy under local anaesthetic is warranted.
Some of the common causes for gynaecomastia include:
- Anabolic steroids
- Variety of medications
- Alcohol excess
- Chronic illness such as liver and kidney disease
Gynaecomastia is also very common at the time of puberty and also in old age. Occasionally are hormone secreting tumours can cause this condition and will need to be excluded.
For many men no treatment is necessary or the underlying cause can be identified and treated. Tablets can be used to treat the tenderness and in some men they also help resolve the swelling. Gynaecomastia related to excess alcohol intake often gradually improves with cessation of drinking. Gynaecomastia associated with anabolic steroids is often persistent if not permanent and usually very tender.
For persistent gynaecomastia or in cases in which the swelling is a cosmetic problem, surgery can be performed. Surgery that may be recommended includes either liposuction, subcutaneous mastectomy, breast reduction surgery or a combination of surgical techniques mentioned above.
As with all surgical procedures breast surgery does have some risk. Serious complications after surgery are rare. It is not usual to outline every possible and rare complication from an operation, however it is important that you have enough information to make an informed decision.
Any operation can be complicated by infection, bleeding, seroma and wound healing problems. Wound healing can be particularly affected by infection and smoking. Any operation can be associated with anaesthetic problems (nausea in particular), venous thrombosis and allergic reaction to drugs or dressings. Every effort is made to avoid these problems.
Some problems from breast surgery include (but not limited to) the following:
Incomplete excision – this particularly the case with liposuction when the entire breast bud cannot be removed. In such situations gynaecomastia can recur.
Bleeding — All visible bleeding is stopped during the operation, but sometimes blood vessels can reopen and bleeding can restart. A bit of bruising is common and is nothing to worry about. A lot of bleeding causing a lump underneath the wound may require another operation to find and stop the bleeding vessel.
Seroma — This is fluid that collects under the wound. It produces a swelling and sometimes some tightness. Some degree of seroma is desired to provide adequate chest wall contouring. However if this is a problem it can be easily treated by removing the fluid with a needle and syringe in a relatively painless procedure under ultrasound guidance.
Infection — Any operation site can become infected. This occurs in less than 0.5% of patients. If it were to occur then it will usually happen in the first week after surgery. The wound becomes red, swollen and tender, and there may be a discharge through the wound. It is usually treated with antibiotics alone, but sometimes the wound has to be re-opened to allow the discharge to drain.
Contour abnormality – Surgery can be associated with bruising and sometimes a little unevenness in the chest wall. This contour abnormality usually setlles. However occasionally one may not be satisfied with the cosmetic outcome and request surgical revision.
Surgical scars – The surgical wound is generally centred around the nipple. These scars are prone to stretching and thickening. Occasionally it becomes necessary to perform a scar revision at a later date.
Altered nipple sensation, pain, position and shape – The surgical wound is generally centred around the nipple. The nerves supplying the skin and nipple around the wound will have to be cut in this operation and that may leave an area of permanent numbness or altered sensation around the wound. This may get better with time, but may not completely go away.
Most patients will have some pain after the operation and this will be treated with pain medication. Only a small number will have persisting pain that requires further treatment. Very occasionally the nipple may change in position or shape as a result of the surgery and scarring.