Gynaecomastia

Gynaecomastia, or excessive breast growth in males (also known as man boobs or moobs), can be due to a number of causes. Hormonal imbalance is a major cause commonly due to the onset of puberty or rarely, a hormone-secreting tumour (eg. pituitary or testicular tumour).  Some men are treated for conditions such as prostate cancer or some of the complications associated with sickle-cell disease, with hormonal therapy and one of the side-effects of these treatments may be gynaecomastia.  Certain drugs may cause gynaecomastia such as marijuana or steroids, but the most common cause is idiopathic.  This means that no cause is found.

Gynaecomastia causes severe psychological and emotional distress as young men feel unable to take their shirt off in public and often feel uncomfortable wearing T-shirts or any tight top that may show the contour of the chest.

Gynaecomastia is certainly more obvious in obese patients and losing weight is the first line of treatment in this group.  For those patients that are not overweight, surgery is the only effective means of tackling the problem.  The surgical option used depends on the degree of gynaecomastia and whether or not there is skin excess.

    Mild gynaecomastia with no skin excess - liposuction is an effective treatment for this group of patients.  It leaves minimal scarring with only small stab incisions and will effectively remove the excess breast tissue as long as it is predominantly fatty.  Sometimes there is a dense nubbins of breast tissue behind the nipple that cannot be removed with liposuction.  In these cases, the tissue needs to be removed through an infra-areolar incision.  This is a half-moon shape incision below the nipple.  The scar is planned at the junction between the pigmented areolar skin and the paler skin of the chest wall.  By leaving the scar here, it is well hidden and is often difficult to see once the initial redness has faded.

    Moderate gynaecomastia with some skin excess - again liposuction forms the mainstay of treatment for these cases, but the possibility of an infra-areolar incision to remove the more dense tissue beneath the nipple is increased.  A modest amount of skin excess in a young healthy patient with good skin quality (non-smoker) would be expected to shrink and recoil once the underlying tissue was removed.  Alternatively, skin can be removed and the breast envelope tightened, but this involves more scars.  The scars involved in a modest skin reduction would be all the way around the nipple (circumareolar, as opposed to infra-areolar when only the breast tissue is removed, see above).  Again, this scar is relatively well hidden as it sits at the junction between the areolar and chest skin, but it is often puckered initially.  This is because as the skin envelope is tightened the excess slack skin is gathered up resulting in a puckered or 'pie crust' appearance to the circumareolar scar.  This puckered appearance will settle and flatten after some months.

    Severe gynaecomastia with skin excess - can be equivalent to a female breast reduction.  In these situations, there is a significant excess of both breast tissue and skin and it is difficult to address this without causing more extensive scarring.  The pattern of scars may vary, but the techniques all involve scars that extend on to the chest wall and so will be more visible than the infra-areolar or circumareolar scars.