Gynaecomastia is a medical condition that might not be widely discussed, but it’s more common than many realise. In simple terms, it’s the enlargement of breast tissue in males. This condition can affect men and boys at different stages of their lives, and it’s important to understand that it’s not just a cosmetic concern but a medical one. In this blog, Sydney Plastic Surgeon Dr Michael Kernohan will explore what causes gynaecomastia and look at the various solutions available to those who are dealing with it.
At its core, gynaecomastia involves the development of excess glandular tissue in the male breast, a condition distinct from pseudo gynaecomastia, where fat deposition occurs in overweight individuals. This enlargement in gynaecomastia is primarily due to an imbalance between the hormones oestrogen and testosterone, both of which are present in men and women. Oestrogen stimulates breast tissue growth, while testosterone works to inhibit it. When the balance shifts towards oestrogen, breast tissue can grow. Gynaecomastia can manifest at any stage of life: in newborns, it’s often caused by maternal oestrogen; during puberty, hormonal changes can lead to temporary imbalances; and in older men, a decrease in testosterone levels coupled with increased body fat can elevate oestrogen levels. Additionally, certain medications, illegal drugs, and various health conditions can also trigger the development of gynaecomastia.
The primary cause of gynaecomastia is an imbalance between the hormones oestrogen and testosterone. Both men and women have these hormones, but in different proportions. Oestrogen controls breast tissue growth, while testosterone inhibits it. When the balance shifts in favour of oestrogen, breast tissue can grow. This imbalance can occur naturally at different life stages, such as during infancy, puberty, and older age. However, certain conditions and lifestyle choices can also disrupt this hormonal balance.
Various medications and substances can contribute to the development of gynaecomastia. These include:
It’s important to review any medications you’re taking with your surgeon if you’re concerned about gynaecomastia.
Several health conditions can lead to the development of gynaecomastia, including:
Gynaecomastia can also be a part of normal ageing. As men get older, testosterone levels naturally decline while body fat, which can produce oestrogen, tends to increase. These changes can upset the hormonal balance and lead to breast tissue growth.
It’s essential to distinguish gynaecomastia from other conditions that cause breast enlargement in males. The most common confusion is with pseudo gynaecomastia, which, as mentioned, is due to excess fat and not glandular tissue growth. Pseudo gynaecomastia is often associated with obesity and doesn’t have the same hormonal underpinnings as gynaecomastia.
Another condition to be aware of is breast cancer, which, although rare in men, can be mistaken for gynaecomastia. Breast cancer in men typically presents as a hard, one-sided lump in the breast tissue, unlike the more uniform enlargement seen in gynaecomastia.
Knowing whether you’re dealing with gynaecomastia or another condition is key to choosing the right treatment approach. For instance, weight loss might reduce breast size in pseudo gynaecomastia, but it won’t have the same effect on gynaecomastia. Similarly, while most cases of gynaecomastia are benign, identifying and treating breast cancer early is critical for health outcomes.
Male breast surgery, often referred to as male breast reduction or gynaecomastia surgery, is a medical procedure aimed at reducing breast size in men, flattening and enhancing the chest contours. In most cases, this surgery involves the removal of excess fat, glandular tissue, and sometimes skin.
Preparing for male breast surgery involves several steps to ensure your safety and the success of the procedure. Firstly, a medical evaluation is conducted to confirm your fitness for surgery. This might include a range of lab tests to assess your overall health status. Additionally, you may need to adjust your current medication regimen, either by modifying dosages or temporarily stopping certain medications, as recommended by Dr Kernohan. This is to minimise any potential risks during and after the surgery. Another vital aspect of preparation involves lifestyle changes, particularly ceasing smoking and reducing alcohol intake. Smoking can impede healing and increase the risk of complications, while alcohol can affect your body’s response to anaesthesia and recovery. Lastly, it’s important to plan for post-surgery assistance. This means arranging for someone reliable to drive you home after the procedure and to provide support during the initial recovery phase, when you might not be fully mobile or able to perform regular activities.
The techniques used in this surgery are diverse, each chosen based on the extent of breast tissue to be removed and your unique body structure. Primarily, the procedure may involve liposuction, excision, or a combination of both. Liposuction is particularly effective for removing excess fatty tissue. In this technique, a cannula (a thin tube) is inserted through small incisions, and fat is suctioned out. This method is less invasive and typically used when there is a significant amount of fatty tissue, but minimal glandular tissue. On the other hand, excision techniques are necessary when the removal of glandular breast tissue or excess skin is required. This might be the case if you’re experiencing sagging or stretching of the areola.
Generally, male breast surgery is performed under general anaesthesia, which means you’ll be asleep throughout the procedure. Dr Kernohan will make incisions around the areola or within the natural creases of your chest, striving to minimise visible scarring. The location and length of these incisions depend on the amount and location of excess tissue and your specific anatomy.
Throughout the procedure, Dr Kernohan’s priority is not only to achieve a more masculine chest contour but also to ensure symmetry, natural appearance, and minimal scarring. You’ll be provided with detailed post-operative care instructions, which are integral to a smooth and successful recovery. It’s important to follow these guidelines closely to ensure optimal healing and achieve the best possible results.
If you’re dealing with gynaecomastia, it’s understandable that you might be seeking effective ways to manage or treat the condition. Fortunately, there are several approaches you can take, ranging from lifestyle changes to medical treatments: