Description of the problem
Gynaecomastia is a condition that occurs in men, in which excess breast tissue forms behind the nipple. The volume may increase to such an extent that it may resemble a female breast and it can affect just one or both sides. This problem is essentially cosmetic, but can be very psychologically disturbing for the patient. There is however, no increase in the risk of developing cancer just because the breast tissue is larger.
The condition is quite common, affecting up to a third of the male population to some extent. The cause in the majority of cases is unknown. It happens because of sensitivity of the breast tissue to the hormones which circulate during puberty. An imbalance between male and female hormones occurs during puberty and also as testosterone levels dwindle in later life. Specific causes for gynaecomastia include congenital abnormalities, hormone-secreting tumours and some medications.
There is an important distinction in gynaecomastia between ‘true’ where the breast gland itself has caused the enlargement and pseudo-gynaecomastia where there is a general increase of fatty tissue in the area leading to the appearance of breasts. These two forms often combine.
The disease can appear as a slight bulge in the nipple region or go on to develop a fully formed breast. The condition can often resolve by itself, particularly where the underlying cause can be treated. If, however, the appearance persists, a plastic surgeon can help to remove the excess tissue.
Purpose of the procedure
If all underlying causes have been ruled out or treated and the disease has persisted for over a year, it is appropriate to proceed with surgical intervention. The goal of surgery is to remove the glandular tissu , excess fat and leave only a small scar under the nipple.
Fat and some of the glandular tissue can be removed by liposuction, but if residual glandular tissue still needs to be removed, this is done through a small scar along the lower edge of the nipple. After the gland has been removed, the excess skin can often be left to contract by itself, though it may initially appear wrinkled at first. Sometimes excess skin may also need to be removed. The tissue is sent to the pathologist to check for any abnormalities.
Figure: (above) Mixed type of gynaecomastia. (below) Partial gland resection combined with liposuction generates good results.
What to expect after surgery
Sometimes a drainage tube must be left underneath the skin. This usually stays in for 1-3 days. Tight elastic bandage is used to compress the area after surgery. Some normal occurrences after the surgery include:
- Bruising: especially after more extensive surgery
- Temporary loss of sensation (chest and nipple)
- Mild pain and discomfort: The pressure bandage often worsens this, but it is an essential part of the postoperative care.
- Restricted movement: partly caused by the bandage and partly by discomfort
Length of Stay
Mild forms can be treated as day cases, others may need to stay for 1-3 days
What can you expect after the surgery?
The elastic bandage needs to stay on for about 10 days. If the wound has been sealed with glue, the area can be showered after 3 days and the elastic bandage replaced. You are advised to restrict vigorous arm movements over the first 3 weeks. Hard work and sports are not advisable for the first 4 weeks. How long you feel uncomfortable for afterwards depends on the extent of the disease and your surgery.
- Wound healing problems
- Skin irritation
- Late complications
- Permanent sensory changes
- Nipple flattening