Breast Reduction (Gynaecomastia)

Gynaecomastia is swelling of the breast tissue in boys and men, caused by an imbalance of the hormones oestrogen and testosterone. Gynaecomastia can affect one or both breasts, sometimes unevenly.

 Baby boys are often born with gynaecomastia, caused by high levels of their mother’s circulating oestrogen, but it settles in weeks.

The next peak is in teenagers (1in 4) when it is tender and firm and very embarrassing. Fortunately, it usually settles within a couple of years. A minority come to surgery where the tissue is excised via a semicircular incision around the areola (the pink skin around the nipple)

In adult life, there are a variety of causes from medical conditions such as testicular disease and cirrhosis, various medications and street drugs. Bodybuilders taking anabolic steroids are at great risk of developing gynaecomastia.

Middle-aged men (1 in 3), as they put on weight, develop a soft fatty version. This can be of feminine proportions.

These fatty breasts respond well to liposuction. The breast disc below the nipple tends to contain a higher proportion of glandular tissue and may need to be directly excised.

Gynaecomastia may occur unilaterally or bilaterally presenting the sufferer with swollen breast tissue. and often tenderness is sometimes a feature, especially in the teenager There may be an increase in the diameter of the areola or asymmetry of breast tissue. If swelling appears suddenly in adult life, one should suspect breast cancer or malfunction of the testicles.

Signs and Symptoms of Gynaecomastia

The primary symptom of gynaecomastia is simply enlargement of the male breasts. Gynaecomastia is the enlargement of glandular tissue rather than fatty tissue. It is typically symmetrical in location with regard to the nipple and may have a rubbery or firm feel. Gynaecomastia usually occurs on both sides, but is often unilateral. The enlargement may be greater on one side even if both sides are involved. Tenderness and sensitivity may be present, although there is typically no severe pain.

Surgery is undoubtedly the most effective treatment but does need to be done by an experienced surgeon. We have in the past seen very poor results. 

There will be some who wish to avoid surgery at all costs and they might consider the following. Do not expect too much!

Natural gynaecomastia treatment

So if surgery is not an option, what are some of the other remedies or natural gynaecomastia treatment options? There are five different approaches:

+ Exercise and diet
+ Compassion clothing 
+ Medications
+ Herbal Creams
+ Pills and capsules

Let's look at each of these non-surgical options and natural remedies for gynaecomastia in detail to see which of them helps minimize gynaecomastia the most. Each of them works in very different ways. 

Exercise and diet to get rid of gynaecomastia

The first place to start by changing your exercise and diet. It's completely free and might help reverse the body's metabolism. Since gynaecomastia is a least partially due to the buildup of fatty tissue in the breast area, it only makes sense that you would want to minimize the amount of fat in your diet.

When the body is unable to convert fat into energy, it must store it. That leads to fatty deposits and more fatty tissue. Thus, you may want to start thinking about methods to scale back your daily caloric intake or, at the very least, changing what and even how you eat on a daily basis. 

Remember however you are only reducing the fatty element and not the more important glandular tissue. 

In terms of exercise, there are several ways to target the chest area that can help to tighten up the muscle in the area. As the muscle mass becomes more defined, it helps to reduce some of the "flabby" look of the chest area. 

This extra muscle does accentuate the beasts by pushing them outwards. This is a problem for weightlifters even if they are not taking anabolic steroids. 

Medications to eliminate gynaecomastia

If you suspect that your gunaecomastia is due to medical reasons rather than a hormonal imbalance, you can ask your doctor to experiment with different medications. Some men, for example, have experimented with getting testosterone replacement. 

Other popular medications to try include anti-oestrogens, Danazol, Tamoxifen and Clomiphene. 

The problem with this approach, of course, is that these are all prescription medications. They are not approved by the FDA. 

Gynaecomastia creams

There are several very popular, affordable and effective herbal creams on the market today that can help man boobs disappear. One of these Gynexin, which contains all-natural ingredients. By rubbing this cream into your chest, your body will be able to absorb these ingredients. Most men use these creams after a shower. Just as you might use lotions or other creams after a shower to moisturize the skin, you can also use these creams to make your chest area shrink in size. Please be aware, we do not know of any reputable studies to show that any creams help. 

The surgeon will ascertain whether there are particular caused such as loss or malfunction of testicles or ingestion of drugs including anabolic steroids. Most patients are likely to be offered surgery presuming there are no other medical problems.

Your surgeon will discuss exactly how much tissue you want to remove and the risk of any returning after treatment. The exact treatment will be deiced, which may be liposuction alone, breast tissue excision or a combination of both, with the possibility of a second operation to move the nipple height.

The procedure itself will be carried out as a day case, usually under general anaesthetic (at the Cadogan Clinic, this will be Total IntraVenous Anaesthesia (TIVA)), so the patient will not be sick and can go home early.

As you prepare for Gynecomastia Surgery, you will want the process to be as smooth as possible and to avoid unnecessary anxiety and stress.

Smoking - stop smoking at least three weeks prior to your surgery and for three weeks afterwards, as nicotine delays and impairs healing.

Blood thinners - stop taking all aspirin-containing products, medications which contain blood thinners (Ibuprofen, Motrin, Advil, etc.), vitamin E and herbal supplements from ten days prior to your surgery.

Illness - if you get sick or have an active infection, please contact the doctor prior to your gynecomastia surgery.

Caretaker - make sure a responsible adult is confirmed to drive you to and from surgery and that someone is available to stay with you overnight following your procedure.

Schedule time off work - the type of work you do will be a determining factor as to how much time to take off work. Patients with a sedentary job may work from home the next day and travel into work a day or two later. On the other hand, if you have a physical job, you may need to take up to two weeks off.

The preferred surgical treatment for Gynaecomastia is to use Liposuction to remove this stubborn fatty, glandular tissue. We most commonly use Water Assisted Liposuction (BodyJet) or Power Assisted Liposuction using MicroAire or Lipomatic. We have found other techniques such as Ultrasound (VASER) or Laser Assisted less effective. In younger people, or where the tissue is fibrous, it may be necessary to carry out Webster’s procedure, either on its own or in combination with liposuction. This is a direct excision of breast disc through a discrete peri-areolar incision. The skin itself is allowed to retract so that the operation is essentially scar-less.

Infrequently, there are however, patients with very large breasts where there is too much surplus skin and at a second stage, a reduction of skin with repositioning of the nipple is required.

All these treatments are carried out as day cases under TIVA (Total IntraVenous Anaesthesia). You are just lightly asleep and wake up quickly without nausea.

Bruising can persist for several months.

Normally with liposuction, there is no recurrence, but with breasts, we are removing breast tissue, which if the original cause persists, could continue to grow to a certain extent. It would never be as much as without treatment because now there are now fewer breast cells. A few patients need a second treatment.

This is a skilled procedure needing an experienced surgeon to avoid irregularities.

Yes, but only in limited cases.

Perhaps the young man with inflamed tender breasts would be the one most likely to be helped. One can also just wait and see whether time heals. It usually does. Otherwise, surgery is more certain.

Currently, there are no drugs approved by the U.S. Food and Drug Administration (FDA) for the treatment of Gynecomastia. Danazol is a synthetic derivative of testosterone that decreases oestrogen synthesis by the testes. Tamoxifen is an anti-oestrogen drug. It may be prescribed as 10mg pills twice daily.

Scars - It is perfectly possible for the expert surgeon to hide his scars. There should be no liposuction scars acting as a giveaway on the front of the chest and even when in the Webster’s operation it is necessary to carry out a direct excision of tissue. This scar is well disguised around the edge of the areolar. There should be no scars on the chest itself. Some patients make poor scars and Cadogan post-operative scar treatment is important.

Bleeding – bleeding is a risk of a peri-areolar subcutaneous mastectomy (Webster’s operation) but is reduced by including liposuction with the procedure. Occasionally patients will bleed postoperatively and will require an early return to the operating theatre. Your surgeon will discuss any medicines which increase your risk of bleeding and it is important to control high blood pressure.

Recurrence – any hormone imbalance may persist following surgery, so that any remaining breast tissue can also increase in size. The problem would never be as great if a reduction had not been done, but some recurrence is possible.

Swelling, bruising and pain - The bruising after liposuction of the breasts is often greater than in other areas and will persist for longer. Patience is necessary.

Seroma – This is a problem only associated with Ultrasound (Vaser) Liposuction, which we avoid.
Increased and reduced sensation after surgery – most patients will get some alteration in the sensation of their breasts, most commonly numbness around the nipple, but in most cases this is temporary.

Asymmetry – it is sometimes easier to remove tissue from one breast more than the other, in which case there may be some asymmetry, when all has settled down. Lumpiness of the breast is with irregularity of removal of tissue is a complication of surgical excision (Webster’s or other subcutaneous mastectomy) or Vaser liposuction. This is common when there is an inexperienced surgeon, but minor degrees can occur with a good technique.

Unsatisfactory results – Sometimes patients are not satisfied with the result of their gynaecomastia because there expectations and requirements are not in line with technical possibilities. It is important to have a careful discussion with your surgeon to avoid disappointment.

Following traditional breast reduction techniques, you should expect a small degree of scarring.

There are different techniques for breast reduction and the scars created will depend on the technique employed, as well as the patient in question and the size of the breasts being reduced. Most commonly you should expect some scarring around the nipple, across the bottom of the breast fold, and a vertical scar linking the nipple scar to the breast fold scar giving rise to the so-called ‘inverted T’ or anchor pattern. Some surgeons prefer to perform the operation omitting the breast fold scar giving rise to the ‘vertical scar’ reduction. Not everybody is necessarily eligible for this and it tends to be used for not such large breasts.

Due to our specialism in liposuction, it is possible in some cases to perform breast reduction using liposuction techniques only. This technique is often known as ‘scarless breast reduction’ since the incisions required can be made in less prominent positions, such as under the arms, where they cannot be seen.

Regardless of which technique you undergo, Cadogan Clinic is able to provide each and every one of its patients with access to one of London’s most advanced scar minimization programmes, led by our scar prevention team here at the Clinic. Our nurses have decades of experience and will provide you with the tools and techniques to support your healing process as effectively as possible.

All breast reduction techniques require an incision that will result in a scar that will likely be red and slightly raised in the weeks and months after your procedure, before fading completely.

Scar visibility can, however, be greatly impacted by the quality of the surgeon you choose, as well as the level of aftercare you receive. In the hands of a skilled surgeon the scar can be positioned very discreetly, whilst an expert scar minimization team can provide you with the tools and techniques to enhance the healing process. For example, scar the appearance can be reduced by regular moisturisation and massage techniques, all of which our dedicated team will advise our patients in the days following your procedure.

Due to our specialism in liposuction, it is possible in some cases to perform breast reduction using liposuction techniques only. This technique is often known as ‘scarless breast reduction’ since the incisions required can be made in less prominent positions, such as under the arms, where they can not been seen.

Breast reduction recovery time varies from case to case but you should be able to return to your normal day-to-day activities after about two weeks. However, we recommend our patients be sensitive to their body and try not to do too much too soon, ceasing activities after or during which any pain is experienced.

We recommend temporary suspension of activities such as going to the gym, and practicing aerobics and sports that involve using your arms. Any activity that requires lifting your elbows above your shoulders should also be carefully monitored.

All breast reduction techniques require an incision that will result in a scar that will likely be red and slightly raised in the weeks and months after your procedure, before fading completely.

Scar visibility can, however, be greatly impacted by the quality of the surgeon you choose, as well as the level of aftercare you receive. In the hands of a skilled surgeon the scar can be positioned very discreetly, whilst an expert scar minimization team can provide you with the tools and techniques to enhance the healing process. For example, scar the appearance can be reduced by regular moisturisation and massage techniques, all of which our dedicated team will advise our patients in the days following your procedure.

Due to our specialism in liposuction, it is possible in some cases to perform breast reduction using liposuction techniques only. This technique is often known as ‘scarless breast reduction’ since the incisions required can be made in less prominent positions, such as under the arms, where they can not been seen.