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Male Breast Reduction/ Gynaecomastia Surgery

What is Gynaecomastia?

Most men have a small amount of breast tissue behind the nipple. In some cases, this tissue can enlarge, leading to a condition known as gynaecomastia. This may be tender or cause cosmetic concern.

Gynaecomastia can result from a variety of causes, and it is essential to exclude male breast cancer, which, though rare, must be ruled out. Evaluation typically involves a clinical examination and imaging such as an ultrasound or mammogram. If a suspicious lump is found, a core needle biopsy under local anaesthetic may be recommended.

Common Causes of Gynaecomastia:

  • Anabolic steroid use
  • A variety of medications (e.g., anti-androgens, some antidepressants, heart medications)
  • Excessive alcohol consumption
  • Chronic liver or kidney disease
  • Hormonal changes during puberty or older age
  • Hormone-secreting tumours (e.g., testicular or adrenal) – these are rare but important to exclude

Treatment Options

In many cases, no treatment is needed once the underlying cause is identified and addressed. Medications may be used to manage tenderness. In some cases, the swelling resolves over time, particularly when alcohol intake is reduced or causative medications are discontinued.

If gynaecomastia persists or causes significant cosmetic concern, surgery may be offered. Surgical techniques include:

  • Liposuction
  • Subcutaneous mastectomy
  • Breast reduction surgery
  • A combination of the above

The surgical approach depends on the size and location of the tissue, skin laxity, and cosmetic goals. Dr Noushi will recommend the most appropriate method following clinical assessment.

Recovery and Aftercare

Gynaecomastia surgery is typically performed as day surgery. A compression garment may be provided to reduce swelling and help shape the chest. Mild to moderate pain is common and managed with oral pain relief. Most patients can resume normal daily activities within a few days, although strenuous activity involving the chest should be avoided for 2–3 weeks. Scars are usually placed around the nipple or chest crease for optimal healing.

Complications

As with any surgery, there are risks. Serious complications are rare, but possible issues include:

General surgical risks include infection, bleeding, seroma (fluid accumulation), wound healing issues, anaesthetic reactions (e.g., nausea), venous thrombosis

Specific risks of gynaecomastia surgery include:

  • Incomplete Excision: Particularly with liposuction alone, residual glandular tissue may remain and lead to recurrence.
  • Bleeding: Minor bruising is expected. Significant bleeding under the skin may require surgical drainage.
  • Seroma: Fluid accumulation under the wound can occur. A moderate amount may aid contouring. If needed, fluid can be drained with a needle under ultrasound guidance.
  • Infection: Occurs in <0.5% of cases. Signs include redness, swelling, tenderness, and discharge. Typically managed with antibiotics, though drainage may occasionally be needed.
  • Contour Irregularity: Some unevenness or indentations may be present initially. These usually settle, but in some cases revision surgery may be requested for aesthetic improvement.
  • Scarring: Scars are commonly around the nipple and may stretch or thicken. In rare cases, scar revision is required.
  • Altered Nipple Sensation or Position: Numbness or altered feeling is common and may be permanent. Rarely, the nipple may shift in position or shape due to scarring.
  • Persistent Pain: Usually mild and temporary. Rarely, pain may persist and require further treatment.
  • BREAST SURGERY
  • GENERAL SURGERY
  • SURGICAL ONCOLOGY
  • ENDOSCOPY

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