Gynecomastia is a medical condition describing males with overdeveloped breast tissue. It is typically caused by hormonal changes and imbalances, where there is insufficient production of male hormones like testosterone, or excessive production of female hormones like oestrogen.
Gynecomastia can be treated with hormonal therapy. However, surgery is often the most effective treatment.
Causes of gynecomastia
Natural hormonal changes
In many cases, the hormonal changes causing gynecomastia are natural fluctuations. Some of these will subside naturally, while some tend to be more persistent.
- Infants can have enlarged breast tissue caused by leftover oestrogen from the mother. This will usually subside in 2 to 3 weeks.
- Pubescent males can develop gynecomastia from natural hormone fluctuations caused by puberty. This is common and will usually subside in 6 months to 2 years.
- Male adults from age 50 onwards can developed gynecomastia due to reduced production of testosterone. In general, about 25% of males in this age group are affected.
Some medication has effects that alter the body’s hormone levels or cause other changes that can lead to gynecomastia. Some examples include:
- Anti-androgens used in treating prostate diseases
- Certain HIV/AIDS medication
- Anti-anxiety medication like diazepam
Other health conditions and diseases
Certain health conditions and disease can cause hormonal imbalances in the body, which can lead to gynecomastia. Some of these include:
- Hypogonadism, where testosterone production is impeded
- Kidney failure
- Liver failure and cirrhosis
Gynecomastia can be treated surgically by removing the excess breast tissue.
Before any surgery is performed, the surgeon may request for a mammogram to investigate the tissue composition of the excess breast tissue. Depending on this composition and other conditions, different approaches may be used to remove the excess tissue.
If the excess breast tissue causing gynecomastia is mostly fat and there is not much excess/sagging skin, liposuction can be used to achieve the intended results. The surgeon will make a small incision, usually in hard-to-see locations such as the armpits or where the areola meets regular skin. A cannula is inserted via this incision to break up the fat tissue and suction them out. The incision is finally closed with sutures.
For cases where there is excess skin, large amounts of glandular tissue, or the breast is exceptionally large, surgical excision or a subcutaneous mastectomy may be required to remove the breast tissue. In this case, excess breast tissue will be removed via open incisions and some excess skin may be excised as required. The exact pattern of incisions will depend on the surgeon and the patient’s conditions. Sometimes, the nipple may need to be repositioned to a more natural position.
Gynecomastia surgery will be performed under local or general anaesthesia. Also, depending on the complexity of the surgery, either approach may take 1 to 3 hours to complete.
Possible risks and complications
Surgical methods may be one of the most effective ways to treat gynecomastia, but it comes with certain risks and potential complications. All patients considering surgery should understand these inherent risks before undergoing the procedure
- Temporary or permanent change in/loss of sensation around the areola and nipples, especially if the nipples are repositioned.
- Damage to other tissues, such as chest muscles, vascular tissue and nerves
- Conspicuous scarring, especially if skin is excised during the surgery
- Asymmetrical chest contours
- Inflammation and infection of surgery wounds
- Anaesthesia complications
Nonetheless, the risks of developing these complications can be reduced in the hands of a skilled and experienced plastic surgeon.
Gynecomastia surgery typically takes 1 to 3 hours to complete, depending on the complexity of the surgery.
Most patients are able to resume sedentary work in 1 to 3 days, or within a week depending on individual recovery.
Recurrence of gynecomastia is unlikely. Specifically, the fibrous glandular tissue will not grow back once it is removed surgically.
However, weight gain can cause fat to be deposited at the same areas again. Hence it is important to maintain your weight after the surgery.
Depending on the exact approach, any scars may be inconspicuous.
Scars from the liposuction approach are usually well concealed at the edge of the areola or under the armpits
However, if the nipples are repositioned or skin is excised, visible scars may be unavoidable most, if not all current approaches involve incisions at somewhat exposed sites.
- Hydrate yourself well starting about one week before the surgery.
- If you smoke or consume tobacco products, please cease about 4 weeks before the surgery. This will reduce the risk of developing complications
- Inform your surgeon of any medication and health supplements you are taking. You may be asked to stop certain blood thinners to prevent excessive bleeding during surgery
- Continue to hydrate yourself after the surgery to replace any loss of fluid from the surgery
- Avoid strenuous activities and exercise for about 4 weeks
- You may need to wear a compression garment to reduce swelling cause by the surgery
- Adhere to any post-care instructions given by the doctor/surgeon closely.