Breast Reduction (Gynaecomastia)

Gynaecomastia is a condition in which there is increased tissue in the male breast to create a less masculine shape. It is a bodily reaction to an imbalance of circulating hormones and can become a source of great aesthetic concern amongst suffers. Gynaecomastia first appears at puberty and can affect one or both breasts, often unevenly. It tends to become more prominent with weight gain and age. Gynaecomastia has colloquially become known as male breasts, or ‘moobs’.

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

 Anti-oestrogen medication also be effective in some patients, but there are no other surgical alternatives.

Patients who meet their surgeon have usually failed to have regression of their problems spontaneously or with drugs. The surgeon will ascertain whether there are particular causes such as loss of testicles or ingestion of steroids. Bodybuilders beware! The majority of patients are likely to be offered surgery presuming there are no other medical problems.

The preferred 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.

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.