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Chesty Issue

Dr Sawjin Tew

The literal translation of ‘gynaecomastia’ is woman breast, and describes the increase in glandular breast tissue in the male breast. 

If gynaecomastia occurs in puberty due to hormonal changes, it is usually reversible and resolves by late teens. Gynaecomastia of puberty does not need treatment as it is self-limiting. 

If gynaecomastia persists, one needs to exclude medical causes such as liver disease, lung cancer, adrenal tumours, pituitary tumours, colon or prostate cancers, thyroid disease, testosterone imbalance, or drug use.  The underlying medical causes will need treatment first, as the patient may be unwell due to the medical condition and also to prevent further development of gynaecomastia. After medical treatment, gynaecomastia may resolve but if it does not, surgery may be an option for residual gynaecomastia.

However, if an underlying cause is not found, gynaecomastia is considered idiopathic which means ‘of unknown cause, and arising spontaneously’. This category which accounts for the majority of cases of gynaecomastia.

An embarrassing condition

Gynaecomastia can be an embarrassing condition for young men. In our society, young men do not want to be different from their peers, and with the beach and swimming and gym culture, men often expose their chest or wearing tight fitting clothing. Patients who have the surgery want good chest shape and minimal scarring. 

What can be done about it?

Once a patient makes the decision to seek treatment, the most suitable procedure to treat it depends on whether it is mostly fatty or glandular tissue in the male breast, and whether there is skin excess. An ultrasound would help to define the proportion of fatty or glandular tissue.

Where the skin excess is minimal and there is good elasticity in the skin, and if the gynaecomastia comprises mainly fatty tissue, then liposuction would be the most suitable option. Liposuction uses tiny access incisions that leave scars that are hardly visible. 

Where the gynaecomastia consists of glandular tissue, then excision of the gland, usually via an incision at the inferior edge of the areola would be a suitable procedure. This scar heals very well and is easy to hide.

If there is severe skin excess, then the excess skin will not shrink adequately after the gland is excised. Excising the excess skin will leave a scar on the chest wall. 

Sometimes, the procedure is staged over two sessions. In the first session, liposuction can be used to remove the fatty gynaecomastia. If the skin that is left behind does not shrink adequately especially in the older male patient, then it may be excised at a later stage.

Recovery from surgery

After liposuction or surgery to remove the gland, it is essential that a compression garment is worn for several weeks to encourage the swelling to decrease and the skin to shrink, so that the chest gains a firmer and tighter appearance. For the first week after the operation, drains are sometimes used to carry away any excess blood or fluid produced by the body in response to surgery. The upper arm muscles are connected to the muscle of the chest wall, so patients are advised to avoid upper body exercise for about three weeks so that the skin of the chest wall has a chance to adhere to its new position on the muscle of the chest wall.

What happens if nothing is done about it?

Patients can live with the condition as it is not dangerous. However, some patients are embarrassed and therefore seek surgical correction.  
As with most plastic surgery procedures, the procedure is tailored to the individual patient, realistic outcomes, sequelae of surgery and risks are discussed during the consultation. Every effort is made to minimise complications of surgery such as asymmetry, bleeding, seroma and infection. 

Fast facts
Cost: $2500 to $6000
Time off work: approximately  one to three weeks
Hospital stay time: day surgery or overnight
Time for surgery to take full effect: about four months

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