Mr Neil Toft

Consultant Plastic Surgeon

BSc MBChB MD FRCS (Plast)

 

0845 094 5657

 

 

GYNAECOMASTIA INFORMATION

General Background

Gynaecomastia is the development of female breasts in male patients. It is also unkindly known as "man-boobs". Many patients find this extremely socially embarrassing and very depressing with loss of self-confidence. It is often most noticeable in the summer months when people wish to wear T -shirts or go swimming on holiday. Patients find that no matter how much they go to the gym they cannot shift the breast tissue and alter their appearance satisfactorily.

In most cases the cause of the gynaecomastia is unknown (i.e. it just happens). Other causes include obesity, puberty, drugs (steroids, diuretics, recreational drugs), and hormone imbalance. It is important to exclude any of these causes of gynaecomastia as these may be reversible without surgery. However, the vast majority of cases no identifiable cause is found, and patients proceed to surgery to correct the shape of their chest.


Before the operation

There is nothing special or complicated to be done by the patient. If you smoke it would be a good ideal to try to stop for a month before and two weeks after as this will significantly improve wound healing and your post-operative recovery. It would be advisable to stop any herbal medicines and avoid aspirin or ibuprofen-like drugs for 2 weeks before the operation.


The operation itself

Patients come into the hospital on the morning of surgery. The operation is performed under general anaesthetic and takes about two hours. The excess breast tissue is a mixture of fat tissue and true breast tissue, often in differing proportions. There are two surgical options. The first is liposuction alone, and this is called a "closed" procedure, which leaves tiny scars. This is good for breast enlargement due to excess fat deposition. The second is an operation which involves a cut below or around the nipple and excision of the breast tissue, is known as the "open" operation. The "closed" technique (liposuction) is a day case operation, with no overnight stay. The longer "open" procedure requires an overnight stay and surgical drains which are removed the following day. In both operations an elastic compression binder is fitted routinely around the chest -this is a tight elastic garment with a velcro zip.


Post-operative follow-up and after care.

If you have had the "closed" liposuction technique you will be discharged later that day. "Open" procedures necessitate an overnight stay in hospital. All being well, you will be discharged home the following day with some painkillers, after the drains have been removed. It is import to leave the dressing alone and wear the chest binder 24 hours a day. At home you should take life easy for the first few days. At between 5 and 7 days you will be seen in the clinic and the dressings removed and the wounds checked. You wound be advised to take to 1 to 2 weeks off work and it is essential to avoid all strenuous activity during this period. The binder needs to be worn day and night for a month to give the best result possible, and failure to wear it without doubt diminishes the final appearance. Vigorous sport such as jogging or the gym should be avoided for 4 weeks. A check up clinic appointment at 3 months after the surgery will be arranged for you. The final result of the gynaecomastia correction is best viewed 3 months after the surgery.


Complications

All operations carry a risk of complications, and gynaecomastia surgery is no exception. The risk of infection is less than 5% and precautions are taken to avoid this with antibiotics. The most significant problem is a haematoma - a collection of blood under the skin, on the first night after the operation. This is easily detected and requires a trip back to the operating theatre to have this removed. This occurs in less than 10% of cases, and is the reason for staying overnight in hospital after the surgery. In virtually all patients with "open" procedures drains are inserted at the time of surgery. These drains are removed on the ward the following day and their function is to remove any excess fluid that has accumulated under the skin. In a small group of patients, typically less than 5 %, a collection of fluid persists and this is called a "seroma". It is completely harmless and does not affect the final outcome. This "seroma" is easily treated in the clinic with a syringe. It is impossible to perform any gynaecomastia operation with out a scar. Occasionally, scars may be red and thickened for a few months but they usually settle down by themselves without any treatment. Keloid scars may occur in predisposed individuals. Unevenness between the two sides or areas of lumpiness may occur. This is unusual, and most settle with time following the resolution of any tissue swelling post-operatively. Exceptionally, areas of unevenness may require revisional surgery.


Summary

Correction of gynaecomastia can be performed by "open" or "closed" techniques. Not all patients are suitable for the simpler "closed" technique. Both operations have low complication rates. Patients are usually very happy with the outcome of the surgery allowing them to wear T-shirts without worry, and to go swimming on holiday without embarrassment.


Operation Time 2 hours
Anaesthetic General
Nights in hospital 0 or 1
Time off work 2 weeks
Return to normality/exercise 4 - 6 weeks