Understanding different gynaecomastia types and treatment options for banishing man boobs

Increasing prevalence of gynaecomastia in young males due to misuse of unprescirbed testosterone supplements.

The medical term for male breast enlargement is gynaecomastia, commonly called as 'Man Boobs' or 'Moobs'. This type of male breast enlargement usually causes embarrassment and may affect self-esteem. I have found a recent increase in gynaecomastia amongst male young population in my practice and I give my perspective regarding this below.

 

Why is there an increase in prevalence of gynaecomastia in young males?
Based on my observations I have noted that some young males take testosterone based supplements to increase their muscle mass. Once they stop these hormone supplements, the estrogen: testosterone ratio in their body gets disturbed, which is often followed by a rise in estrogen levels, which leads to such enlarged breast tissue. This is due to their testes becoming 'lazy' at producing testosterone as it was artificially supplemented.

On the other hand, there is no known cause of gynaecomastia, for the majority of men. Very rarely, gynaecomastia may develop due to the intake of medicines for high blood pressure, heart disease and prostate cancer; certain drugs such as marijuana and anabolic steroids. It can also develop following diseases causing liver failure or testicular cancer, and can be a component of rare congenital abnormalities. However, the good news is male breast enlargement is treatable by cosmetic surgery.

What does a gynaecomastia procedure involve?
This procedure involves removal of tissues from the breasts and liposuction. Excess skin needs removal particularly following massive weight loss.

 

What is the cost of gynaecomastia procedure?
The cost of undergoing a gynaecomastia usually is from around £3000.

 

What are the different grades of gynaecomastia?
The different grades of gynaecomastia are as follows:
Grade 1: Tight skin that does not require reduction
Grade 2: Some saggy skin that may or may not require reduction
Grade 3: Large amount of saggy skin where the removal of excess redundant skin and adjustment is required
Grade 4: Large breast(s) with sagging.

What are the different types of gynaecomastia?
The different types of gynaecomastia are as follows:

  1. Fatty Gynaecomastia (pseudo-gynaecomastia)
    Fatty gynaecomastia in common in young patients with good quality skin, but can affect all ages. These patients are normally suitable for correction with liposuction only. Liposuction involves minimal scarring and can be performed under local or general anaesthetic and is suitable as a day case procedure. The downtime following liposuction is minimal and a patient can resume day-to-day activities within 48 hours.
  2. Glandular (fibrous) Gynaecomastia 
    If a patient has got localised gynaecomastia without much fat, then an open excision technique (removal by cutting) is used and there is no need for liposuction. This is common with muscular patients, with a well-defined chest and normal body mass index. 
    Liposuction is sometimes needed to improve the overall contour after the removal of the glandular component (fibrous tissue).
  3. Mixed Gynaecomastia
    Patients with mixed gynaecomastia, where there is existence of glandular tissue/fibrous tissue associated with the localised deposition of fat, are suitable for liposuction-assisted open excision (open approach) surgery. In this technique, the fatty component is removed by liposuction; the glandular component, which is normally underneath the nipple area, is excised (removed) through a small cut within the areola (the area around the nipple).
    This operation is relatively invasive. I prefer to insert a plastic tube (suction drain) underneath the skin following such a procedure for a period of 12 to 24 hours. 
    This type of procedure requires extended time in the hospital, with a view to removing the drain either on the later part of the same day, or the next day. As a result, an overnight stay is often required (with the associated additional costs).
  4. Massive weight loss reduction
    Morbid obesity is a major challenge in western culture. There is increasing awareness about obesity-related diseases and issues, for example diabetes, hypertension, reduced mobility, as well as isolation in social and professional environments.
  5. Gender reassignment (sex change)
    There is increasing awareness of and demand for gender reassignment. The removal of female breasts remains an essential procedure for body contouring transformation in patients undergoing gender reassignment from female to male. We perform this breast removal procedure which is also called subcutaneous mastectomy. 
    This type of breast removal procedure is the equivalent to the correction of grade 4 gynaecomastia in patients following massive weight loss. This operation leaves behind more scarring. The level, as well as size, of the nipple is optimised. The patient may require one to two nights stay in the hospital. The operation consists of removal of breast tissue, adjustment of loose, excess and redundant skin as well as re-positioning of the reduced sized nipples.

 

What does a liposuction procedure involve?
This process usually consists of sucking out the fat through a small tube which is inserted via a 3-4mm incision. If an excess of glandular tissue is the prime cause of breast enlargement then it may be removed making an additional cut at the junction of the nipple and surrounding skin. This will normally create a scar, usually around the nipple edge. This type excision can be carried out alone or may be combined with liposuction. Gynaecomastia operation usually takes about 90 minutes to complete and this can be carried out under general anaesthesia, or in some cases under local anaesthesia with or without sedation.

 

What care should be taken post-operatively?
After the surgery, the chest is slightly swollen and bruised for some time and very difficult to assess the outcome of the operation in early postoperative period. It is normally recommended that the patients should wear an elastic pressure garment continuously for a period of one to two weeks to reduce the swelling. The patients should not carry out any exercise for a period of about three weeks, particularly following 'open' excision of the glandular tissue. Normal activities can be carried out by patients after about six weeks.

 

What are the complications involved in gynaecomastia procedures?
The complications involved in this surgery are relatively rare. This normally includes an uneven contour to the chest, reduced nipple sensation and inadequate removal of the breast tissue and asymmetry. If an excision is performed rather than liposuction then a blood clot may form in less than 5 % of cases which may require an additional operation.

Before and 4 months after treatment for gynaecomastia.

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