Male gynaecomastia is the medical term for the over development or large breasts in men. Gynaecomastia is characterised by, excess localised fat underneath the nipple, enlargement of glandular breast tissue or a combination of both. Gynaecomastia may be present in one breast or both. It is a common condition that can be embarrassing to the individual, but rarely is it malignant.
It is common in men of any age, particularly pubescent males. Though certain drugs, obesity and medical problems have been linked with male breast overdevelopment, there is no known cause in the vast majority of cases.
With the boom in bariatric surgery and patients with massive weight loss, there is also a subgroup of male patients that see me with just excess breast skin and no fatty or glandular component to their gynaecomastia. In this scenario, the principles of treatment are no different than standard gynaecomastia cases.
Once all reversible causes for gynaecomastia have been sorted, my preference for treatment is similar to my approach to female breast surgery, namely addressing the breast platform, the breast mound and lastly the skin envelope.
This is the footprint that the breast makes on the chest wall, analogous to the outline a house makes on a parcel of land. The platform forms the basis or foundation of the overlying three-dimensional structure of the breast and pectoralis muscle. Fortunately in most men, there are no underlying chest wall or muscle abnormalities. The position of the male nipple on chest platform may vary individually in height and width, but generally speaking it should reside on the vertical line drawn down from halfway across to 5th rib space.
Unlike female breast surgery, where I am trying to create a breast mound. In male gynaecomastia surgery I am trying achieve the opposite and reduce the breast tissue.
Gyaecomastia is usually a combination of fatty and glandular tissue therefore different surgical modalities needs to be implanted to deal with each component.
Liposuction is usually used to remove fatty tissue and the glandular tissue is usually excised through a semicircular incision at the lower aspect of the areolar.
In the majority of cases once the breast tissue has been removed the elastic characteristics of the skin allow it to recoil to an appropriate position. This means that for the majority of men, the only scars they will have will be the semicircular ones at the base of their areolars. However, in severe cases and in those men with excess skin secondary to massive weight loss a skin excision must be performed resulting in an inverted T shaped scar and in some rare cases the nipples removed and grafted.
What are the potential risks and complications?
Potential complications and risks associated with gynaecomastia surgery include:
- Slightly mismatched breasts or nipples. Both in height and projection.
- Temporary numbness around the nipples
- Recurrence of breast growth after surgery
- Another procedure may be needed to remove excess skin. Especially in males that are having the procedure as a result of massive weight loss.
- Permanent pigment changes around the nipple
- Keloids and hypertrophic scars around the scars.
- Irregularities of the nipple and areolar complex
Gynaecomastia surgery in some circumstances can be a reconstructive procedure and may be covered by private health insurance. Review your policy carefully to determine what is covered.
Costs associated with this procedure vary between: $10000-$14000 depending on a number of factors:
- Anaesthetist’s fees
- Private hospital or day surgical facility fees
- Need for post-operative garments
- Level of private insurance cover
- Surgical assistant’s fee
After our consultation my staff will give you an itemised account of the total cost.
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