Gynaecomastia (Male Breast Surgery)

The condition is probably caused by a variety of factors at different stages in life. The most common age for gynaecomastia to present itself is in the peri-pubertal male or teenage years. During this time, gynaecomastia very rarely represents measurable abnormal hormones. Instead, it is presumed to be caused by an imbalance between the hormones and receptors.

Gynaecomastia may occur in one or both breasts and can be tender due to the active gland. In older patients the gynaecomastia may be due to slight metabolism changes, although these are rarely of any pathological significance, and tends to be more an accumulation of fat, in contrast to the true dense glandular tissue of younger individuals.

Another common cause of gynaecomastia is the use of anabolic steroids. It is the hormonal metabolites of these steroids that cause the excessive female hormones and the breast tissue production.

Other causes for gynaecomastia include liver disease, medications taken for other health problems, marijuana, and very rarely tumours that may affect hormone production.

Fortunately, gynaecomastia at any stage, and due to any cause, can be treated with male breast reduction surgery.

For over 20 years Dr Perkins has used a procedure that utilises incisions remote from the breast, and that are deliberately asymmetrical if both left and right sides are affected.

Males, as a generalisation, don’t worry about scars as long as they don’t have significance or meaning i.e. are obviously due to breast surgery. The remote keyhole incisions, if visible at all, look like mole excisions or sprig marks from football. The periareolar incisions as classically used commonly give a good scar but “scream” breast surgery if visible.

Apart from more satisfactory scars, the liposuction and avulsion technique via remote incisions allows better contouring of the whole chest with liposuction, and has lower rates of bleeding, seroma and the need for a drain (rare). It results in better skin contraction and less tethering at the scar site.

The critical issue in correcting gynaecomastia is excess skin. The body has a limited ability to re-absorb or “shrink” skin after volume is removed either by surgery or weight loss. Large amounts of excess skin may require surgical removal, but of course this results in scars on the chest. This is not aesthetically ideal as the scars cannot be hidden outside of wearing clothes.

Thus the aim and hope is to remove the abnormal glandular breast tissue and fat through small keyhole incisions and to avoid tell-tale scars where possible to give no indication that “breast surgery” has been performed. This is where the remote keyhole incision technique excels.

Hopefully, once the breast tissue is removed, then the body has enough capacity to take up any resultant loose skin and avoid the need for skin excision.

After massive weight loss where grossly excess skin mandates removal, patients will have scars that are visible with clothes off, but will have an improved contour in their clothes and swimming vests.

• There is no muscle repair involved in correcting gynaecomastia. The muscle is deep to the breast tissue and fat and is not touched as part of the procedure. As such recovery is relatively short with no specific need to protect a sutured repair. As with all operations a period of downtime is required to minimise swelling, bruising and the risk of bleeding. Of course, recovery varies among individuals depending on the technique used, magnitude of the procedure performed and individual healing.
• Upon completion of the surgery patients are placed in a compression vest, which will be worn for two weeks routinely, but longer if required. This compression vest is not visible under clothes, like a singlet.
• Once recovered and ready for discharge, post-operative instructions covering wound care, medications and booked follow up appointments will be given.
• If a drain is used, this would usually be removed around the one week mark. Instruction on use is given.
• It is essential that a responsible adult collect the patient and stay with them for the first 24 hours following the surgery.
• In the first few days following surgery patients describe feeling some discomfort, more like a bruised stiffness rather than acute stabbing pain. A bit like going to the gym after a long break and doing too much.
• Bruising and swelling are normal following the surgery and will subside over the first few weeks.
• A patient would be able to work on a computer after a few days. If a patient works on a building site there are occupational health and safety issues to consider.
• Patients may drive a car when not impaired, usually 2 to 3 days post-op.
• Routine activities can generally be resumed 2 – 3 weeks following the surgery.
• Over several months the scars will slowly fade and become less noticeable.
• Attendance at your follow up appointments is essential to allow Dr Perkins to guide you through your recovery process.

Even with the highest standards of practice, all surgical procedures carry a level of risk and the potential for complications. In addition, every individual will have a different risk profile depending on their general health, age and the complexity of the procedure.

During the consultation Dr Perkins will explain the possible complications and risks of the specific procedure to provide the necessary information to enable patients to weigh up the benefits, risks and limitations of the surgery.  The following are some of the risks associated with this procedure.

• Specific risks of surgery for gynaecomastia include scarring, asymmetry in contour or nipple position, changes in sensation, and recurrence of gynaecomastia.  In some cases,revisionary surgery may be required if there is not sufficient take up of excess skin.
• General risks involved in any surgery include post-operative infection, excessive bleeding, haematoma (blood collection), seroma (fluid collection), adverse reaction to anaesthetic, unsatisfactory scarring. Read more about general risks and complications of surgery.

There are Medicare item numbers which cover gynaecomastia. As such, if the patient is in a private health fund with appropriate cover, a proportion of the costs will be rebated by Medicare and the health fund.

An estimate of costs will be provided following the consultation with Dr Perkins.