Gyneconomastia is a condition where men develop breast tissue. It can be true gynecomastia
which is the development of the breast gland or it can be a development of fatty breast
tissue which is actually called pseudogynecomastia. Frequently, it’s a combination of both.
The causes of gynecomastia are varied. The development of the breast gland in men can
be normal and there are three age groups in which this can occur—usually at birth, puberty,
or in old age. In addition to this, gynaecomastia can be caused by medications, kidney disease,
liver disease, as well as some elicit over the counter drugs. However, it’s important
to remember that in about 50% of cases, no cause for the gynaecomastia is found.
The treatment of gynaecomastia depends on the type of gynaecomastia it is and the underlying
cause. If it’s true gynaecomastia, then the treatment depends on addressing the underlying
cause. For example, it was medication causing that, then switching to alternative medication.
If that fails or is not possible, then it may be worth to consider the off-license use
of certain medications like tamoxifen. However, I would say the most effective way of treating
true gynaecomastia is through surgery. If it is pseudogynaecomastia, that is fatty breast
tissue without a gland, then the treatment may simply be diet and exercise or frequently
surgery which commonly is liposuction.
The surgery for gynaecomastia depends largely
on what the underlying issue is. If it is true gynaecomastia and there is a breast gland
or breast lump, then surgery involves simply excising this. This involves a scar just either
around the nipple or on the side of the chest wall. If the gynaecomastia is actually made
of of fatty tissue and more correctly called pseudogynaecomastia, then the surgery involves
liposuction. In this case, I favour the use of VASER liposuction because that causes less
bruising and also produces skin tightening some months down the line. Frequently, it’s
a combination of both gland and fatty tissue, so both techniques need to be used.
In a small proportion of cases, there is also an excess amount of skin which needs to be
excised. In my practice, I’ve developed a technique called the VAGS procedure (VASER,
gland, and skin). It helps us to think about the three steps
that are needed in addressing gynaecomastia. Firstly, patients undergo VASER liposuction
which allows removal of the fat. Then, in the same operation, I make a cut either around
the nipple or the side of the chest wall to remove the gland. Thereafter, the patients
are allowed to recover and if necessary, after a period of 10-12 months, they may undergo
a skin excision to remove loose skin though in my experience, most patients don’t need
this. The chances of recurrence from gynaecomastia
are low unless the precipitating factor is still present. For example, if the gynaecomastia
is as a result of a patient taking a particular medication and they are still taking it, then
the chances of it coming back is a little bit higher.
The recovery from gynaecomastia surgery is fairly quick. Gynaecomastia surgery is done
as a day case procedure under either a general anesthetic or even under sedation. Once the
procedure is over, the patient wears a compression garment for three weeks. All the sutures are
dissolvable and there are no drains. Patients go home with some simple painkillers like
paracetamol and ibuprofen. Our advice is to avoid undertaking any heavy lifting or going
to the gym for a couple of weeks. Most patients are back at work in about three or four days
and can drive after about five to seven days as long as they can do an emergency stop safely.
The dressings are removed at two weeks and thereafter, the patient builds up their activity
returning back to full range of normal activity between four to six weeks. Results take a
little bit longer as the swelling can take a few months to settle down.