Gynaecomastia is the medical term for the over-development of “breasts” in men
Gynaecomastia is characterised by excessive 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 which can be embarrassing to the individual but is rarely malignant.
Gynaecomastia is common in men of any age, particularly pubescent males. Whilst it is known that particular drugs, medical issues and obesity can seemingly contribute to male breast overdevelopment, there is no known cause for most cases.
With the boom in bariatric surgery and patients with massive weight loss, there is also a subgroup of male patients who come to 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 to 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 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 the fifth 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.
Gynaecomastia is usually a combination of fatty and glandular tissue, therefore different surgical modalities need to be implemented 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 most 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. This results in an inverted T shaped scar, and in some rare cases the nipples removed and grafted.