Gynaecomastia is an excessive enlargement of the male breast and may be present in one breast (unilaterally) or in both breasts (bilaterally).

Gynaecomastia is common in men of any age and may develop as a result of:

• Hormonal changes
• Weight gain
• Hereditary conditions
• Disease, such as liver disease
• Certain medication
• Use of non-prescription or recreational drugs, including anabolic steroids and marijuana

Gynaecomastia can cause emotional discomfort and may affect a man’s self-confidence. Excess breast tissue can also cause a man’s breasts to sag and stretch the areola (the dark skin surrounding the nipple).

In some cases, gynaecomastia can be improved with non-surgical treatments, such as changing a medication or by medically treating the cause of the abnormal hormone levels. For some men, however, surgery to remove the excess breast tissue may be the best treatment option.

Surgery for gynaecomastia is a highly individualised procedure and may not be suitable for everyone. Always talk to your Specialist Plastic Surgeon before making a decision. Your Specialist Plastic Surgeon will assess your condition and general health, and plan the treatment that is best suited to you.

Before you decide on breast reduction surgery, there are some important issues to keep in mind:

• Any surgical treatment to correct gynaecomastia will require incisions. While most incisions are hidden in natural contours or in the areolae of the breasts, some scars may be visible and an unavoidable result of any breast reduction surgery
• Surgeons generally recommend waiting until breasts are fully developed. Younger men or adolescent boys may be advised to wait a number of years after the onset of gynaecomastia before surgery
• Breast reduction surgery is not recommended for overweight men who have not tried proven weight-loss techniques such as diet and exercise
• If gynaecomastia has resulted from the use of alcohol, certain prescription medications or drugs including steroids, you must be fully free of these substances before undergoing surgery
• You must remain at a stable weight in order to maintain the results of your surgery

Breast reduction may be a good option for you if:

• Alternative medical treatments are ineffective in treating the condition
• You are self conscious about the appearance of your breasts
• You experience discomfort as the breast tissue is tender and sore
• You are physically healthy
• You have realistic expectations
• Your breasts are fully developed
• You are not a smoker or a drug user

If the condition is minimal, surgery for gynaecomastia can sometimes be performed with a local anaesthetic and sedative. A general anaesthetic is usually necessary if more extensive surgery is required.

Modern anaesthesia is safe and effective, but does have some risks. Ask your Specialist Plastic Surgeon and anaesthetist for more information. Your surgeon and/or anaesthetist will ask you about all the medications you are taking or have taken, and any allergies you may have. Make sure you have an up to date list before the surgery.

Modern surgery is generally safe but does have the potential for risks and complications to occur.

Some general complications and risks associated with surgery may include:

• Risks of anaesthesia including allergic reaction or potentially fatal cardiovascular complications such as heart attack
• A blood clot in the deep veins of the legs (deep vein thrombosis), which can move to the lungs (pulmonary embolus) or to the brain and may be life threatening
• Allergic reaction to suture materials, tape adhesive or other medical materials and lotions
• Excessive bleeding

Some potential complications and risks associated with surgery for gynaecomastia may include:

• Slightly mismatched breasts or nipples
• Temporary numbness or loss of breast sensation
• Recurrence of breast growth after surgery can occur if breasts are not fully developed
• Another procedure may be needed to remove excess skin
• Permanent pigment changes in the breast area
• Keloids and hypertrophic scars that are raised, red and thickened scars. These may form over the healed incisions. They may be itchy, annoying and unsightly but are not a threat to health.

Depending upon your general health and the extent of the procedure, surgery for gynaecomastia can be performed either as a day case or alternatively with a short hospital stay. Your Specialist Plastic Surgeon will advise on the best option for you.

Before undergoing surgery, it is important that you:

• Be as fit as possible to help the recovery process
• Reach your optimal weight
• Check with your surgeon about your medications as some may need to be stopped
• Stop smoking

You will also be asked to provide a complete medical history for your Specialist Plastic Surgeon including any health problems you have had, any medication you are taking or have taken, and any allergies you may have.

You may be advised to stop taking certain medicines such as non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, and medicines that contain aspirin. You may also be asked to stop taking naturopathic substances such as garlic, ginkgo, ginseng and St John’s Wort as they may affect clotting and anaesthesia. Always tell your surgeon EVERYTHING you are taking.

You may be given medicines to take before the surgery, such as antibiotics.

Your surgeon will also advise you if any other tests are required, such as blood tests, X-ray examinations or an Electrocardiograph (ECG) to assess your heart

Prepare a “recovery area” in your home. This may include pillows, ice packs, a thermometer and a telephone within easy reach. Make sure you arrange for a relative or friend to drive you to and from the hospital or clinic. Someone should also stay with you for at least 24 hours after you return home.

Your surgeon should give detailed preoperative instructions. Follow them carefully.

While you are healing, you may experience some pain, bruising, swelling and numbness around the operated site. This is normal. Your Specialist Plastic Surgeon will prescribe pain relief as needed. If you have any problems or concerns, be sure to tell your surgeon.

After surgery, you will wear an elastic dressing or surgical bra to provide support for your breast. A plastic tube may be inserted into each breast to drain excess fluid. Other dressings may be changed or removed at this time.

Depending on the extent of your procedure, you may need to take a few days off work to rest. Avoid heavy lifting, strenuous exercise, swimming and strenuous sports until advised by your surgeon.

If you experience any of the following symptoms, notify your surgeon immediately:

• Temperature higher than 38ºC or chills
• Nausea, vomiting, shortness of breath or diarrhea
• Heavy bleeding from the incisions
• Leakage of blood or fluid beyond the first day after surgery
• Worsening and/or spreading redness around the incision sites
• Increasing pain or tenderness in either breast
• Any other concerns or problems regarding your surgery, particularly if it appears to be worsening

Your surgeon will give you specific instructions on post-operative care. These instructions may include:

• How to care for your surgical site(s) following surgery
• Medications to apply or take orally to aid healing and reduce the risk of infection
• Specific concerns to look for at the surgical site(s) or in your general health
• When to follow-up with your surgeon

Be sure to ask your surgeon specific questions about what you can expect during your individual recovery period, such as:

• Where will I be taken after my surgery is complete?
• What medication will I be given or prescribed after surgery?
• Will I have dressings/bandages after surgery? If so, when will they be removed?
• Are stitches removed? When have they/will they be removed?
• When can I resume normal activity and exercise?
• When do I return for follow-up care?

Scars are an inevitable part of any invasive surgery. Your Specialist Plastic Surgeon will endeavour to minimise scarring and to keep your scars as inconspicuous as possible by locating the incisions in easily hidden sites. That way, scars will be along natural skin lines and creases. Scars may fade with time and become barely noticeable. If you are prone to scarring, you should advise your surgeon.

Revisional surgery may be required to remove excess skin. Other procedures may also be necessary to correct minor irregularities.

Cost is always a consideration in elective surgery. Prices for individual procedures can vary widely between Specialist Plastic Surgeons. Some factors that may influence the cost include the surgeon’s experience, the type of procedure used and the geographic location of the office.

Costs associated with the procedure may include:

• Surgeon’s fee
• Hospital or surgical facility costs
• Anaesthesia fees
• Prescriptions for medication
• Post-surgery garments
• Medical tests

Your surgeon should welcome any questions you may have regarding fees.

• Areola: Pigmented skin surrounding the nipple
• Bilateral gynaecomastia: A condition of over-developed or enlarged breasts in men affecting both breasts
• Endocrine system: A group of glands that make hormones which help to control activities in your body such as reproduction, metabolism, growth and development. Testing of your endocrine system may be done to look for signs of diabetes, thyroid disorders, growth hormone deficiency, osteoporosis, hypertension and obesity
• Excision: To remove the skin
• General anaesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness
• Haematoma: Blood pooling beneath the skin
• Intravenous sedation: Sedatives administered by injection into a vein to help you relax
• Liposuction: Also called lipoplasty or suction lipectomy, this procedure vacuums out fat from beneath the skin’s surface to reduce fullness
• Local anaesthesia: A drug injected directly to the site of an incision during an operation to relieve pain
• Mammogram: An x-ray image of the breast
• Mastopexy: Surgery to lift the breasts
• MRI: Magnetic Resonance Imaging; a painless test to view tissue in a similar fashion to an x-ray
• Reduction mammoplasty: breast reduction, a surgical procedure that removes excess breast tissue to reshape the breast
• Sutures: Stitches used by surgeons to hold skin and tissue together
• Unilateral gynaecomastia: A condition of over-developed or enlarged breasts in men affecting just one breast

Visit the Plastic Surgery Glossary for more medical terms.