Breast reduction in men (gynaecomastia)

Gynaecomastia is the excessive development of the male breast. A distinction is made between so-called pseudogynaecomastia and true gynaecomastia (gynaecomastia vera).

The oversized breast in pseudogynaecomastia is caused by an increased accumulation of fatty tissue, for which reason it is also known as lipomastia. The cause of this is mostly excessive weight and/or a change in the patient’s hormonal balance.

True gynaecomastia, by contrast, is an enlargement of the mammary gland, which is situated directly behind the nipple in men. In cases like this, the abnormal growth of the breast is either genetic or hormonal, or it may be a side effect of  long-term medication.

Often, however, the patient may have a mixture of the two forms. Many patients suffer in their wellbeing, especially when the male breast takes on forms that are more feminine than masculine. This is also often exacerbated by physical complaints such as feelings of tension and oversensitivity of the nipples. If the enlargement is on one side only, it may be necessary, in rare cases, to exclude the possibility of male breast cancer prior to the operation.

If these changes come about during puberty, they recede spontaneously in most cases. However, if they persist, it’s usually a good idea to look for a treatment solution early on, since the psychological strain is often considerable and the social life of the patient (e.g. as regards sport and intimate relationships) is often severely impaired.

As a matter of basic principle, the success rate of treatment by liposuction, if appropriate in combination with surgical removal of the gland, is high for patients who have developed a male breast.

Preliminary examinations required

Prior to the operation, the patient should consult a urologist or endocrinologist. There, the various blood data, in particular the levels of hormones such as oestradiol, testosterone, LH, FSH, prolactin and beta-hCG can be determined and other diseases that might be causing the gynaecomastia excluded. More infrequently, gynaecomastia may be associated with liver or kidney disease, caused by side effects from medication, or be genetic as in the Klinefelter syndrome.

An ultrasound examination (so-called sonography) of the chest region is essential, to determine whether and in what proportions the enlargement of your breast is caused by fatty tissue and/or glandular tissue, so that the operation can be optimally planned. At the same time, an estimate of the amount of excess tissue can be made.

We kindly request you to bring all relevant and recent examination findings to the first consultation. If there is evidence of true gynaecomastia with untreatable causes, you can apply for the costs of gland removal to be met by the health insurance provider responsible.

Procedure for breast reduction in men (gynaecomastia)

In an initial consultation we will discuss your wishes and expectations, take a close look at your previous health history and examine your breast in detail. We also discuss possible causes of the enlargement taking into account the findings from your prior examinations.

According to the findings, various different surgical techniques may be indicated, and these vary in terms of their duration. On average, the net operation time will be about 1 to 2 hours.

If you have pseudogynaecomastia with straightforward proliferation of the fatty issue in the region of your chest, liposuction will be sufficient to reduce it. All that is required for this is a small stab incision on each side of the ribcage, so that the cannulas can be introduced. Before the liposuction, a so-called tumescent solution is injected; the loosened fat cells are then removed by means of a vibration system and, if necessary, the inframammary fold is dispersed. With the aid of liposuction in the chest region, the areas of transition between fatty and glandular tissue can be given a particularly handsome shape.

If you have true gynaecomastia, i.e. an enlargement of the glandular tissue, the tissue has to be removed surgically to reduce your breast. This calls for a semicircular incision to be made at the lower rim of the areola, so that the gland can be excised. As in lipomastia, it is a good idea here to loosen the body of the gland beforehand by means of curettage in tumescence and vibration techniques. As a rule, the scarring is very inconspicuous.

If you have a mixture of the two (⅔ of the cases), the two surgical techniques are combined to reshape the overall appearance of your chest region.

In a case of massive gynaecomastia which is associated with a lot of excess skin, the reduction of the male breast can also be combined with a skin lift (e.g. incision around the nipple with the option of reducing the nipple too). If the skin is already very overstretched and torn, a lift may already make good sense in the first session. But in most cases we recommend waiting until the tissue has retracted after the operation, and then carrying out the lift in a second surgical phase, which may be associated with a smaller incision, if indeed one is necessary at all. We will be happy to advise on this in detail at your initial interview.

We perform the gynaecomastia operation as out-patient surgery and, depending on the findings, either with a local anaesthetic or in semi-conscious sedation (analgosedation). It the patient so wishes, we can also perform it under general anaesthetic.

After male breast reduction

After the operation, while you are still in the operating room, we will fit you with a special compression undergarment for the male upper body, which you can purchase from us beforehand. Then we will take you to our recovery room, where you will be looked after and monitored by a qualified member of our staff. In some cases we insert drainage facilities in the area of the wound to draw off blood and fluid. As a rule, these will be removed 1 – 3 days after the operation. The necessary pain therapy will then be adjusted to suit your requirements. As this is an out-patient operation, mostly performed with semi-conscious sedation (analgosedation), you will be able to go back home the same day. Having said that, for the next 24 hours you should have a trusted adult at your side who can look after you and take action if there is an emergency.

The first check-up with a change of dressing takes place the next day. In the first few days, fluid may continue to emerge from the small punctures made in the liposuction, but that is normal and salubrious, so you should not worry about it. The surface wounds will close quickly in the first week. Normally the skin incisions are simply closed by adhesive methods and not sutured. However, if it was necessary to remove tissue from the mammary gland, we use very fine, thin suture material to close up the wound. This will be removed after approximately 7 to 14 days, at the second check-up. Until that time, you should refrain from showering, just washing your upper body instead. Otherwise, cleansing products may cause irritation, or bacteria may find their way into the fresh wounds.

After that, we will make further appointments for you at regular intervals, at which we will check your progress and change the dressings. Depending on the findings, we will also make recommendations for special scar care, for example in the form of creams or nutritional supplements. We will either have these available for you in our practice or write you a prescription for them.

After removal of breast tissue you must wear a compression undergarment day and night for six weeks to prevent the wound cavities from filling with fluid, speed up the recovery of the skin and stabilise the shape. The undergarment can be covered by clothing and is available in various different colours.

During the first 3 months you should definitely avoid strong sunlight and not go to the solarium, as this could cause the fresh scars to change colour.

A course of antibiotics is not necessary in the normal healing process. Pain-relieving drugs are not usually required for more than 3 days either. To make things easy on the newly formed breast tissue, try to sleep on your back as much as possible in the first few weeks after the operation.

After about 6 weeks most of the swelling will normally have subsided and the first results will be visible. The final result of the treatment will be apparent after about 6 months.

What kind of patient is suitable for the surgical treatment of gynaecomastia?
A breast operation is suitable for men who have not been able to achieve sufficient success in reducing their breast simply by shedding weight and/or doing sport, and in whom other primary illnesses are able to be excluded as causes for their gynaecomastia.

How long does the gynaecomastia operation take?
Depending on the method selected, the net operation time will be between 1 and 2 hours.

What kind of anaesthetic is necessary for a reduction of the male breast?
The out-patient operation is performed under semi-conscious sedation, which means that you can breathe independently and are also responsive. Having said that, you yourself perceive the situation as pleasant and will not, as a rule, have any clear recollections of the surgery. You will be monitored throughout by our anaesthesiological specialist. If you wish, however, the operation can also be performed under a general anaesthetic.

What complications can occur during a gynaecomastia operation?
There are risks involved in any surgical intervention, from the operation itself and from the anaesthetic. However, our many years of experience in surgery and the intensive professional care we take of our patients reduce these risks to a minimum. Complications may also arise after an operation. In rare cases, removal of the glandular tissue leads to unevennesses in the region of the areola or possibly even to scarring and/or hardening of the remaining glandular tissue. Partial or complete necrosis of the nipple tissue has also been described in exceptional cases. You will find a detailed description of the possible complications here.

How long will the result last?
It is extremely rare for a patient’s breast to become enlarged again after a gynaecomastia operation. If this does happen, some undiscovered primary illness or hormonal disorder is usually responsible.

How old do I have to be to have an operation for gynaecomastia?
Particularly in puberty, the level of psychological stress is especially high, but we advise you to wait until you reach the age of majority before opting for a breast reduction, because such an enlargement may often be temporary.

When can I get back to doing sport after a gynaecomastia surgery?
That depends on the scope of the operation. If it was only a case of lipomastia, you can start doing gentle sports as soon as the wounds have healed (10-14 days). But if glandular tissue has had to be removed, you should take it easy for somewhat longer and wait about 4 to 6 weeks. Even then, at the beginning you should avoid sports such as jogging or chest muscle training which put a strain on the scars or cause vibration of your chest.

What does a gynaecomastia operation cost?
Depending on the findings, the costs of the surgery comprise the liposuction itself, if necessary gland resection, and the anaesthesis. If the resection of the gland is being paid for by your health service provider, you will only have to bear the costs of the liposuction or loosening of the glandular body (approx. 3,000 €) and any lifting operations that may become necessary. The latter are assessed as aesthetic operations, at least by the statutory health service providers.

FAQ

DURATION OF OPERATION: 1 – 2 hours

ANAESTHETIC: general anaesthetic / semi-conscious sedation

HOSPITALISATION: out-patient, or in-patient for 1 – 2 days

PAIN LEVEL: low

AFTER-TREATMENT: compression foundation-wear for 6 weeks

PRESENTABILITY, RETURN TO WORK: after approx. 7 days

SPORT: after 4 – 6 weeks

COST: from € 3,000

Ask our advice.

We’ll be glad to provide you with detailed information about this treatment. Simply get in touch with us now and obtain advice at an individual and absolutely personal level.

+49 30 - 94 041 144

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