By Dr Allen Rezai MD, founder of Elite Plastic & Cosmetic Surgery Group, Dubai, UAE, and one of UK’s leading specialists in Breast Surgery.
Gynecomastia comes from the Greek words gyne meaning “woman” and mastos meaning “breast.” In practical terms, this means a female type breast present on a man. It is the most common form of breast problem in men. The condition is relatively common in adolescent boys, and 90% of the time symptoms disappear with maturity but for 10% the problem persists into adulthood. Losing weight, and ageing, also cause the skin to sag across the chest.
Gynecomastia is generally considered to be of one of three types:-
- Just made up of fatty tissue
- Just made up of breast gland tissue
- Made up of a combination of both fatty and glandular tissueIt is important to distinguish between these three forms as the cause of treatment of each is different. The most common form of gynecomastia is a simple accumulation of fatty tissue, often related to overall obesity (pseudo-gynecomastia). So long as there is little or no excess redundant skin over the breast, all that is required in these circumstances is liposuction.In a few cases, there are additional aspects to consider. If there is significant glandular tissue present, this may require surgical excision. Whether the gynecomastia is fatty or glandular, if there is significant skin excess over the chest, a form of breast uplift is necessary.True glandular gynecomastia is a medical condition and must first be investigated to find its cause. In true gynecomastia, there is an imbalance between the normal male and female hormones that circulate in all men, which may occur:-
- Normally at certain times of life (new-born, puberty, with ageing ) – ‘physiological’, or
- Abnormally due to a wide range of causes (idiopathic, diseases of the hormonesystem, drugs, alcohol) – ‘pathological gynecomastia’Whatever the cause, medical treatment aimed at the originating condition relatively rarely results in full reduction in breast size. For these patients, surgery is the only option.In the great majority of patients with glandular gynecomastia, it is possible to remove the gland through an incision placed around the lower half of the areolar. This operation is called Subcutaneous Mastectomy. Some plastic surgeons do utilise other incisions, such as extending out from the areolar, or even under the crease of the breast. However, we consider these to be unacceptable as they frequently result in painful excessive scarring, and a cosmetic appearance that is more embarrassing for the patient than the gynecomastia he presented with.
It is important to leave some glandular tissue behind in order to prevent a concave appearance and to provide a more aesthetic chest contour.
Male breast Reduction surgery is performed under general anaesthetic, often as a day case. However, if drains are used, an overnight stay is normal. An adhesive dressing and a Lycra vest are worn for about one week, after which time any sutures will be removed. Most patients are able to return to work after one week, and resume normal activity within four weeks.
In a small number of cases, there is so much breast tissue that the gynecomastia hangs and looks like a female breast. In these cases, mere removal of the gland would result in a marked excess of skin. For these patients, a more formal breast uplift procedure is required. It may be possible to perform this merely via an incision placed around the areolar. However, in certain circumstances incision as used for breast uplift in women will have to be used, involving incisions placed away from the areolar.
These procedures are undertaken under general anaesthetic. Drains are likely to be used and one or two nights in hospital may be advised. Otherwise, care is as for Subcutaneous Mastectomy.
As with all scars, the scars will fade over a period of time. They heal to form very faint lines. However, it is important to remember that no surgical scar ever totally disappears.
Although cosmetic surgery is amongst the very safest of medical procedures it is important to understand and accept that no surgical procedure is absolutely free from risk and the surgeon should explain these possible risks and complication in detail during the initial consultation.
Meeting up with a consultant plastic surgeon before you actually decide to undergo surgery is the preferred route for many reasons, not least amongst which is that you can avoid having any unrealistic expectations of the outcome of your operation.
At your first meeting with your Elite Plastic & Cosmetic Surgery Group consultant you will be able to:
- Discuss your needs and wishes in absolute detail
- Decide whether the operation you are considering is right for you
- Learn from your consultant what is achievable and, importantly, not achievable for you depending upon your precise circumstances. i.e. the likely outcome of your operation
- Discuss any concerns you might have about your operation
- Discuss the potential for any side-effects or complications related to your procedure
- View before and after photos of patients who have undergone a similar procedure
- Learn how you will need to prepare for your operation and what will happen afterwards
- Form an opinion as to whether your Elite Plastic & Cosmetic Surgery Group surgeon is the right surgeon for you (the importance of feeling comfortable with your surgeon should not be overlooked)
- With many pre-operative consultations, a second meeting will ensure you and the surgeon have similar aims and expectations and you are fully aware of the implications of surgery. It will give you another opportunity to ask any questions you may have forgotten at the first meeting.
Exceptional surgical results are paramount in our practice, so is maintaining the highest of professional standards and safety. We believe not only in educating each one of our patients as to what is available and appropriate, but also in formulating a customized plan for each person. Everyone has a slightly different physical anatomy, different lifestyles, goals, personal circumstances, and differing viewpoints about plastic surgery. We believe that a truly successful result is not only achieving technical perfection, but also achieving the result that best fits your needs and desires.