Gynaecomastia is the enlargement of male breast tissue. It is ultimately due to an imbalance of hormones with a higher level of estrogen and a relative reduction of testosterone. This leads the male breast becoming bigger in size.
This can lead to feelings of poor self-image, anxiety, depression and avoidance of social situations and relationships. Some men will be embarrassed to wear tight T-shirts and sports tops. They may try to avoid undressing in front of friends or undress at the pool or the beach. In 2022 it was the 2nd most common operating performed on men in the UK and has been increasing performed as a procedure for the last few years.
At Profile Aesthetic in Aberdeen, we can treat this condition with a combination of excision of the breast tissue and laser-assisted liposuction. This is a surgical procedure performed by our GMC Specialist Registered plastic surgeons who are recognised by the British Association of Aesthetic Surgeons (BAAPS) using the latest techniques and surgical devices
Gynaecomastia can happen naturally in newborn babies as they process the maternal oestrogen they received from the placenta before being born. This resolves fairly quickly. It can next naturally occur with puberty, affecting approximately half of all adolescent boys . Finally, it will affect men over the age of 60 where it can affect up to 35-57% of men due to the reduction in testosterone production seen with the age.
Whilst gynaecomastia can be common in childhood, most will disappear as they become adults as their hormone levels settle down. Other causes can be due to:
· being overweight
· alcohol excess
· many medications used for everyday conditions such as blood pressure, heart disease, enlarged prostate, heartburn and epilepsy
· advanced liver or kidney disease
· tumours of the endocrine system such as the pituitary or adrenal gland.
· testicular tumours
· recreational drugs such as cannabis or heroin and anabolic steroids.
In the vast majority of men, it is a benign condition, albeit at times embarrassing. You should not be worried. However, there are times when you should get checked out.
Gynaecomastia can affect both or just one breast. When unilateral, this should always be assessed to make sure there isn’t an underlying tumour causing this.
Male breast cancer is rare accounting for 1% of all breast cancers. Around 350 men are diagnosed with this every year in the UK giving a lifetime risk of 1 in 870 compared to 1 in 8 women. If you have any of the following, you should get checked out urgently:
· rapid breast enlargement
· a painful, tender breast
· a palpable lump in the breast
· overlying skin changes such as discolouration, bruising or skin tethering
· nipple discharge
You should ask you GP to refer you to the rapid access breast clinic for assessment if you have any of these problems.
In cases of physiological gynaecomastia such as in teenagers, it is sensible to wait and see if the boy will grow out of this as he gets older. If the gynaecomastia is related to being overweight, we may advise you to looking to reduce your weight first before seeking surgical options. If due to prescribed medications, it may be worth discussing this with your GP to see if alternative drugs are available.
Some men will take anti-androgen drugs for treatment of their prostate cancer. In some men this may cause a rapid-onset non-pathological gynaecomastia. There may be a role in using drugs such as tamoxifen or anastrozole as a medical therapy to combat the effects of the anti-androgen drugs. This is an unlicenced treatment and should be undertaken by the oncology team treating the prostate cancer.
At Profile Aesthetic we are looking at what surgical options are possible as ultimately there are situations where our patients are unhappy with the appearance of their chest and would like this changed.
The mainstay of treatment is liposuction to reduce the volume of the breast tissue under the skin. We are the first in the UK to use the cutting-edge Alma laser-assisted liposuction machine which gives us significant advantages over other traditional liposuction techniques. It is effective in reducing both the fatty and glandular component in gynaecomastia. The same device will also cause skin tightening when treating the deep surface of the breast skin. This combined role means that when there isn’t significant skin excess, it may be possible to treat the gynaecomastia with a minimal scar technique with only 1-2 small 5mm incisions on each breast.
There are times when we have to make larger scars. Typically, this is when we have performed the liposuction and see that there is some residual glandular tissue under the nipple that will not reduce with liposuction alone. In this instance, we will make a cut from the 3 o’clock to the 9 o’clock part of the edge of the areola (the coloured part around the nipple). This will allow us to lift the nipple up like a hatch and cut out the residual breast tissue underneath.
In the most extreme cases, the breast enlargement is associated with a significant amount of skin excess. This can lead to a feminisation of the chest. We may need to discuss some form of mastectomy which is a resection of breast tissue and overlying skin. This will lead to significantly more scarring but is only necessary in the most extreme cases.
My colleagues and I can guide you through our proposed surgical plan and explain the reasoning behind this. We will guide you through the recovery period. We like you to wear a compression vest which we will supply for 6 weeks after surgery. This will make a huge difference to the surgical result. Our nursing team will manage your dressings as often as is needed. We would advise you to refrain from exercise for 4 weeks and you will find that you are back to most activities by 6 weeks. Depending on your job and the extent of the surgery, you may be off work for a minimum of a couple of weeks but this
could be longer or may need a return to light duties for 4-6 weeks depending on how physically exertive your job is.
At Profile Aesthetic we are used to treating men of all ages, from different causes and of varying degrees of the condition. We have our own day case operating facility on site and are continually looking at the latest advanced surgical techniques and devices such as our laser-assisted liposuction machine to provide a bespoke surgical solution. Safety is at the heart of all we do with our surgeons recognised by the GMC, BAPRAS and BAAPS as being fully qualified, trained and experienced plastic surgeons.
Gynaecomastia can be an embarrassing condition but one we would like to help with. If you wish to be assessed for surgery, contact Profile Aesthetic today and we can arrange an appointment with one of our surgeons.
