Gynecomastia Surgery

Gynecomastia is also called enlarged male breasts or man boobs. It is a benign enlargement of breast glands.

Both men and women have breast glands. While in women they are very well developed, in men they are only rudimentary.

But not Always. Let me explain.

During puberty, a boy undergoes many changes. Changes in voice and a sudden increase in height are external changes caused by the changing internal hormone balance. In girls, the breast glands begin to develop under the influence of rising female hormones.

Sometimes in men, the transient imbalance in the hormonal levels may stimulate male breast gland growth. In up to 60 per cent of boys, there is a noticeable increase in the male breast tissue to varying extents. The growth of excess breast tissue ceases as soon as the hormone levels stabilise. And as the chest enlarges the glands flatten out and become imperceptible. However, in a small percentage of boys undergoing puberty, the glands develop to such an extent that they remain perceptible even in adult life. This remnant, small female breasts-like presence is called gynecomastia.

Gynecomastia glands develop from breast tissue but they are not the same as normal breast glands. They are firm and fibrous.

Enlargement of breasts on both sides is more common, it is called Bilateral Gynecomastia. Enlargement on one side only is called unilateral gynecomastia.

The most common cause of gynecomastia is idiopathic. That means male breast development happens on its own as I have explained above (it is not your fault). This is also called Pubertal gynecomastia.

Other causes of gynecomastia include diseases and medications. The breast gland grows in the presence of female hormones hence any disease which increases the levels of female hormones in a male can likely cause gynecomastia. All the diseases that result in low testosterone levels(decreased male hormones) may also result in gynecomastia.

Also, all the drugs and medications that affect the normal balance of male hormones vs female hormones may also result in gynecomastia.

Gynecomastia looks like a small breast gland which has just started to develop. There is a palpable lumpish glandular tissue structure behind the nipple and areola. Sometimes the nipples may also be slightly enlarged. Breast enlargement may be present on only one side or on both sides. Boys often complain of pain in the nipples or tenderness to touch when gynecomastia is actively growing.

Gynecomastia is graded depending on its size. There are four grades.

Grade1 is small gynecomastia which appears as puffiness below the nipple and areola commonly referred to as puffy nipples. Grade 3 spans the entire chest, grade 2 is between grade 1 and grade 3, and grade 4 is like grade 3 but bigger and with excess skin. 

If you would like to know more head over to this detailed article on gynecomastia and its anatomy.

The answer is pretty simple you will know it when you see it. Just hold your hips and press on them to tighten the chest muscle. With the opposite hand feel the breast between fingers and thumb. You can roll the glandular tissue between the fingers and it feels rubbery. 

A better way is to ask your plastic surgeon. Other than a physical examination your surgeon might order a couple of radiological tests or an ultrasound to confirm the diagnosis.

There is another condition that increases the chest skin and makes it look like gynecomastia and that is weight gain. But there is no gland development, there is only excess fat. Fat deposition in obesity or chest skin laxity after massive weight loss mimics gynecomastia and is called pseudo-gynecomastia. The Surgical treatment is almost similar to the surgery for grade 4 gynecomastia. There is extra skin that needs to be removed. Read about the surgery for pseudo-gynecomastia here.

Although gynecomastia is not a disease it is not aesthetically pleasing either. An ideal male chest for a masculine appearance is flat with skin tightly applied over the muscles. If the muscle contour is appreciable below the skin it looks even better. 

A major issue concerning gynecomastia is having a female-like chest can cause a lot of insecurity in young men, especially during the formative years of life. Young boys are very impressionable and sometimes emotionally labile. Teasing by the pears and inability to speak about the condition freely with family due to hesitation can adversely affect self-confidence. Lack of self-confidence and prolonged inferiority can cause serious issues such as clinical depression.

Gynecomastia patients often avoid bare-chested sports activities. They may wear loose clothes and walk in an awkward fashion bending forwards to hide their condition. 

Correcting gynecomastia with the help of cosmetic surgery procedures is safe.

Male breast reduction surgery is a type of cosmetic surgery that gets rid of gynecomastia permanently. Surgical removal of gynecomastia can help treat inferiority complex and develop positive feelings toward one’s body.

Gynecomastia surgery includes all the plastic surgery procedures that help treat gynecomastia. This includes Liposuction (all kinds) to remove excess fatty tissue and excision of the gynecomastia gland. There are variations between the specific technique used by the surgeon depending upon expertise and the grade of gynecomastia.

Gynecomastia Surgery can be performed under general anaesthesia as well as local anaesthesia. The advantage of surgery under general anaesthesia is that you will remain asleep throughout the procedure although it increases the cost a bit. When undergoing the procedure under local anaesthesia you remain awake throughout the procedure You can go home the same day but there will be discomfort when the local anaesthesia is being infiltrated.

The gynecomastia gland lies in between the chest muscles and the skin. The intention of surgery is to safely remove the gland without disturbing the underlying muscle, without leaving any tell-tale signs on the chest and making sure that the skin contracts in the right way.

• First step: Infiltration of anaesthetic Tumescent fluid. Whether the procedure is done under general anaesthesia or local anaesthesia the first step is to infiltrate the chest with tumescent liquid or Klien’s solution. This help with liposuction and helps to loosen the gland above the chest muscles. It also numbs the chest for further procedures.

• Step two: Liposuction. Liposuction is performed to remove extra breast fat around the gland and contour the chest. Liposuction may be performed using traditional liposuction or any of the assisted liposuction techniques. Liposuction also helps to lift the gynecomastia gland away from the underlying muscles.

• Step Three: Gland excision. A smile-shaped 4 to 5 cm incision is given at the border of the areola and adjoining normal skin. The advantage of such small incisions is that after healing the incision scars remain hidden in the border of the areola. The gland is dissected with sharp dissection and removed completely. Then the incision is closed with subcutaneous sutures. If the gland is big then the dissection required would also be more extensive, in such cases a drain may be placed for a few days.

• Step four: Dressing. Although there are no external sutures Gynecomastia surgery requires a special kind of dressing called compression dressing. The suture line is covered with gauze and Then a snuggly fitting compression garment is applied. The compression garment may be an elastic wraparound or an elastic compression vest. Usually, the pressure garment has to be customised for each patient prior to the surgery.

Any adult male with gynecomastia who is in relatively good health can opt for gynecomastia surgery. Irrespective of whether you have pubertal gynecomastia or gynecomastia because of an underlying disease the gynecomastia glands can be removed without any untoward effect. 

The immediate post-operative period following surgery is critical for healing and getting aesthetically pleasing results. For the first 5 to 7 days you will be advised to avoid any movement of the shoulder joint.

After getting rid of the gynecomastia gland the skin should contract nicely and adhere to the underlying muscle as soon as possible. For that, a compression garment is placed which gives enough pressure to allow the skin to contract. Pressure garment also prevents fluid collection below the skin. At the same time, the muscle needs to stay put for the skin to adhere.

The pressure garment has to be worn 24/7 for a month. You may remove it only while bathing.

Gentle movements at the shoulder may begin from the 7th day onwards. 

And you may resume full activity after 4 weeks.

Yes, you will have a scar from gynecomastia surgery but the scar will not be perceptible. It will be hidden in plain sight. The scar lies in the line between the areola and normal skin. You will know where the scar is but other people will not be aware of its presence and hence will not be able to see it.

No gynecomastia does not go away with exercise or dieting. In fact, exercising can make it worse. Sure exercise and dieting will get rid of all the extra fat but the glands will remain as it is. Gynecomastia is not extra fat. It is a glandular structure made up of breast tissue. Moderate amounts of fat around the gland and tummy hide gynecomastia glands but as soon as the fat disappears the gland will be clearly visible over the chest muscles. I have answered this question in detail here.

You may return to your work 2 to 4 weeks after undergoing gynecomastia surgery. You will have to refrain from using your shoulder joints for the first 5 to 7 days. Thereafter movement at the shoulders is gradually started and around 2 after the procedure, you will be able to go about doing day-to-day work. You will be able to go back to your exercise routine after a month. Now depending upon how physically demanding your work is you may resume work within 2 to 4 weeks.

Gynecomastia surgery results will last forever. Once the gland is removed it does not come back again. But the gland needs to be excised and liposuction alone will not suffice as it only removes excess fat. If only Liposuction is performed then the enlarged breasts will reduce in size initially. But since the gland is left behind gradually more fat will accumulate and you may feel that the gynecomastia has come back again. Only a gland excision surgical procedure will remove glandular breast tissue.