Gynaecomastia

Gynaecomastia is a condition of male breast enlargement, sometimes termed “man boobs”. Usually this is due to an increased amount of breast tissue or fatty tissue, or both. Gynaecomastia is not dangerous, but understandably most men would prefer not to have it if they could avoid it, and are very happy with the change in appearance after surgery.

What causes it?

Gynaecomastia is relatively common in teenagers and older men due to hormonal changes. It can result from anabolic steroid use, marijuana use and a variety of prescription medications. However, in most men there is no medical reason for the condition.

How can I get rid of it? 

If you’re at a healthy weight and diet and lifestyle haven’t been able to fix the problem there are good surgical options. The best type of surgery for you depends on what type of gynaecomastia you have – excess fatty tissue and skin has to be treated differently from enlarged dense breast tissue to get an optimal result. If you have a disc of enlarged breast tissue under the nipple and areola this can be cut out through a minimal access incision placed around the periphery of the areola (called a “periareolar incision”). This sort of enlarged tissue will not shrink with weight loss because it’s not fatty tissue, it’s dense and fibrous glandular tissue. Similarly, it is usually not able to be removed with liposuction because it’s too dense. The good news is that the incision we use generally heals in a manner that makes it is relatively unnoticeable after a couple of weeks.

In almost all patients we also perform liposuction through the same incision. This means there are no additional scars placed on the chest. If your gynaecomastia is due to excess fatty tissue then liposuction alone can be used to contour your chest. Liposuction scars are generally short (<1cm) and placed in areas of the chest where they will be unobtrusive. Men who have very large breasts or who have droopy breast skin after massive weight loss will usually have need the excess skin cut away to fix the chest contour. This means longer surgical scars and possibly repositioning of the nipple and areola. In this surgery the longer scars and a higher risk of altered nipple sensation are the tradeoff for a better chest contour.

What can go wrong?

Your chest contour should definitely be better after gynaecomastia surgery and you can expect to see a visible change when Dr Tomlinson checks your chest in the hours after surgery. You can expect to have small surgical scars, and due to our special incision techniques in most cases we find that these heal so well that you and others cannot notice them after a few weeks. Dr Tomlinson will advise you at the time of your consultation where these incisions will be placed and how long they will be.

Possible but uncommon complications of gynaecomastia surgery include noticeable scarring, wound infection, temporary or permanent alterations in nipple sensation, asymmetry, nipple necrosis (very rare), infection, scar sensitivity, seroma, bruising or bleeding (which may require a return to surgery to fix it), recurrence and contour deformities (for example, uneven breast appearance, nipple inversion or tethering, or a sunken-in nipple and areola).

Any operation can have complications with the anaesthetic (ranging from nausea to death) but modern anaesthesia is very safe for healthy people.General complications that can happen with any type of surgery include deep vein thrombosis (clots in the veins in the legs), pulmonary embolus (blood clots in the lungs), pneumonia and heart attack. These types of complications are rare with gynaecomastia surgery. You should not have this surgery if you are overweight (with a Body Mass Index over 30) or currently need to take medication to prevent blood clots (for example to prevent a stroke, deep vein thrombosis or pulmonary embolus).

The risk of nipple tethering relates to the surgical technique. Nipple tethering happens when the nipple and areola (the "areola" is pigmented circle of skin around the nipple) scar down to the pectoralis muscle. It can make your nipples look abnormal when you move your arms around. In the normal human body there is a layer of subcutaneous fat between the skin and the pectoralis muscle, no matter how fit you are. This tissue allows the nipple and areola to be mobile on the chest wall. If you strongly request that Dr Tomlinson try to remove every cell of fat and glandular tissue between the nipple and the pectoralis muscle then you will be at considerably higher risk of developing nipple tethering than if you agree that the aim of surgery should be to keep a thin layer of subcutaneous fat in that area. Leaving this thin layer of tissue is highly recommended, even though you may be more likely to worry in the first two weeks (when your post operative swelling is still present) that "not enough" tissue has been removed. If you develop any signs of nipple tethering after the first week then massage of the nipple and areola with or without a steroid injection can assist in breaking down any adhesions.

What is the recovery like?

The recovery period is usually straightforward. Most people do not need to take strong painkillers, and are able to manage with over the counter pain medications. We encourage you to take it easy in the first week to reduce the extent of bruising or swelling that will occur during the days after surgery. If you do too much you will have increased swelling, increased discomfort and a higher risk of post operative bleeding. Your wounds will be covered with small waterproof dressings so you can shower normally from the day of surgery. Dissolving stitches are used so there are no stitches that have to be removed. You should wear your pressure garment day and night for the first two weeks, and ideally until all bruising and swelling has settled. The pressure garment is designed to minimise post operative bruising and swelling, and to speed its resolution. You should not perform heavy lifting for six weeks after the operation.

We routinely organise appointments for you to be reviewed by Dr Tomlinson at 1 and 6 weeks. At the first visit we will instruct you on how to apply silicone tapes to your wounds to minimise scarring. These tapes can be applied once a week, or changed as you wish. There is no additional charge for these post operative visits.

If you are traveling from interstate for the surgery we require that you stay in Melbourne on the night of surgery, as you will have a general anaesthetic for the procedure and so are not able to fly or travel alone for 24 hours. We can adjust the number of post surgery visits according to how difficult it is for you to return for follow-up, but we strongly recommend that you ask your GP if he or she is agreeable to assisting with your follow-up, so that you are never far from medical assistance and advice if you should require it.

When can I get back to the gym?

To minimise the risk of bruising and bleeding at the site of surgery you need to avoid strenuous activities for 4-6 weeks. You can begin cardio activities after 2 weeks but should not do heavy upper body work until 6 weeks after surgery. This helps to minimise your post operative swelling, so you get to see the final results of surgery as soon as possible. 

What is the cost of gynaecomastia surgery?

The estimated out of pocket cost for the surgical fee, scar management products, your post surgical review appointments for eight weeks and two compression vests is approximately $3600 if you have a doctor's referral. We recommend that you contact your health insurer and the surgery facility to confirm your coverage and expected rebate for the hospital theatre and bed costs. If you do not have private health insurance we can provide you with an estimate of costs for your admission to a private facility either as a day case or with an overnight stay.

The overall costs of surgery are made up of:
- your surgical fee
- your anaesthetic fee
- the hospital bed fee and theatre fee
- the fee for the specialist histopathologist who examines the tissue after it is removed
- 2 compression garments (vests)
- scar management products (silicone tapes)
- your post surgical review appointments for eight weeks           

Before and after images

The images below are unretouched before and after images of patients treated for gynaecomastia by Dr Jill Tomlinson using glandular excision and liposuction.

To schedule an appointment to see Dr Jill Tomlinson about gynaecomastia surgery please phone (03) 9427-9596. The process of appointments, surgery and follow up is detailed in the image below:

If you would like to read more about gynaecomastia surgery from individuals who have undergone the surgery please visit the Gynecomastia Forum.

Any surgical or invasive procedure carries risks.

Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.