Gynaecomastia is excessive enlargement of the male breast Gynaecomastia is the development of significant breast tissue in a male. It is uncommon before puberty and 40% occur in adolescent males. The overall incidence is up to 1/3 of healthy males. There is also another peak in incidence with advancing age (60% at age 70). It occurs on both sides in 25 – 75% of cases and can be asymmetric. Pseudogynaecomastia is an accumulation of excess fat in the male breast and 35% of males have palpable breast tissue above 2cm on one or both sides. Physiology of a male Male breast development is part of normal adolescence and normally reverses and diminishes within one to two years. It develops in response to oestrogen levels and then as testosterone levels rise it causes the breast glandular tissue to involute or decrease in volume. This means if it has been present for only a few months in adolescence, reassurance may be all you need. If, however, it persists or is significant it is unlikely to resolve and may need treatment. Pain can often be a feature necessitating treatment. Though most gynaecomastia cases don’t have an underlying cause, there is a myriad of health problems that can cause it. It’s important to have a specialist endocrinologist who specialises in hormonal and other problems to see you before seeking plastic surgical advice for treatment. They will perform appropriate blood tests and any other investigations appropriate to your setting. Even if you have an underlying cause, treating it may not resolve the gynecomastia, especially if it has been longstanding. Nevertheless, it is better to treat the cause first to reduce the chance of it recurring after treatment by Dr Sawhney. We can recommend a specialist endocrinologist in your area if you contact our team. Alternatively, see your general practitioner for a referral to one. How does gynaecomastia surgery work? There are different degrees of gynaecomastia that require different procedures or combinations of treatment. Essentially, it depends on whether the tissue is mainly fat or more fibrous glandular tissue and how much excess skin is present. If you have mild and mainly fatty tissue liposuction may be all you need. You may even need more than one sitting to achieve a desired result. If you have mainly fatty tissue with a thick breast bud behind the areola you may require liposuction with an incision under the areola to remove that breast bud. If you have more fibrous glandular tissue you may need a formal removal of that breast tissue with scars under the areola extending horizontally beyond the areola on both sides for access. This is called a subcutaneous mastectomy. Excess skin if mild, may shrink with liposuction alone. Significant skin excess may be addressed by excising skin at the time of a subcutaneous mastectomy. If, however, skin excess is extensive, especially if the nipples have descended, you may need to excise the skin above and below the areola in separate procedures to maintain blood supply to the nipple and areola. At your first consultation, Dr Raja Sawhney will assess your needs and form a tailored approach to achieve your goals. Before and after images Magnifying Glass Patient 1 Don’t forget to share this via Twitter, Google+, Pinterest and LinkedIn.