BILATERAL GYNECOMASTIA TREATMENT, SURGERY

Gynecomastia is the medical term used to describe the abnormal enlargement of breast tissue in men. Many men may not realise that they have breast tissue – found just under the nipple on the chest wall. This is because the hormonal balance in men means the tissue stays so small that it cannot be seen or often even felt.

If anything alters this balance – either there is an increase in the ‘female’ hormone estrogen, or a fall in the ‘male’ hormone testosterone – the breast tissue will respond by growing. As these changes are happening throughout the body, they will act on all breast tissue, causing roughly equal changes on both sides.

The man may experience a ‘fullness’ or jutting out of the nipples, followed by the development of man boobs or gyno.

Bilateral gynecomastia

In most cases growth of the breast tissue happens on both sides of the chest in roughly equal amounts, resulting in bilateral gynecomastia. Just as in women, however, it is common for one side to be slightly bigger than the other. In rarer cases, the growth is only one-sided, or unilateral.

Unilateral breast swelling should always be checked out by a doctor as it can be caused by things other than true gynecomastia (including breast cancer) which may need treatment. Therefore, bilateral man-boobs may actually be less worrying than swelling on one side only.

Bilateral gynecomastia is much more common in men who are overweight or obese.

This is both because some of the breast swelling can be caused by simple build-up of fatty tissue, and also because fatty tissue encourages the body to produce more estrogen which alters the hormonal balance.
normal breast and gynecomastia

Causes of gynecomastia

At times, bilateral gynecomastia is so common as to be almost normal – for instance up to 70% of teenagers will experience gynecomastia at some point during puberty. Gyno is also very common in male babies and in ageing men.

For these men the cause is altered hormone levels, and often time alone will cause the swelling to go away. However, there are other causes, and thinking about them may give some clues as to how to solve the problem.

The following list gives some of the more common reasons for developing gyno:

  • Medications including some used to treat ulcers and heart conditions
  • Recreational drugs including bodybuilding steroids and marijuana
  • Liver and kidney disease
  • Rare genetic conditions
  • Tumours which produce hormones

It is often a good idea to get gynecomastia assessed by a doctor, both to make sure there is no simple cause which can be easily fixed, and to rule out any serious underlying causes. As above, this is especially true if the swelling is not bilateral.

Treatment options:

  • Time
  • Diet and exercise
  • Topical creams
  • Tablets – prescribed or from the internet
  • Surgery

For many men there may be no need to treat gynecomastia. Time may cure gyno in puberty, while diet and exercise are most effective in many other cases.

Changing medication can help in some cases, and stopping recreational drug use is always advised.

Hormone altering medications – to either block the action of estrogen or increase the testosterone level – are available, as are many creams and pills from the internet. All should be just as effective in bilateral gynecomastia, but their use is often not advised as there can be significant unwanted side-effects, and none are licensed for use in gynecomastia.

For many men intent on obtaining treatment for their gynecomastia, the best option is surgery. Surgery provides immediate results which should be long-lasting and effective. However, surgery is a big decision which should only be made after discussion with a qualified and experienced surgeon.

Bilateral mastectomy for gynecomastia

Surgery to remove breast tissue is called a mastectomy. In bilateral gynecomastia this will be done on both sides during the same procedure.

In some cases, a mastectomy will be combined with liposuction to remove any additional fatty tissue – again this can be done on both sides at the same time.

In most cases, a mastectomy for gynecomastia is not covered by health insurance and will need to be self-funded. Bilateral surgery will inevitably be more expensive than a one-sided operation – however having both sides done at the same time is likely to be more cost-effective in the long run.

A bilateral mastectomy is a common procedure, as most men with the condition have bilateral gynecomastia. The surgery will involve scars on both sides of the chest, with a potential for greater discomfort.

The surgeon will do their best to ensure the scars are placed in a similar position on each side, and that similar amounts of tissue are removed / remain to make the appearance as symmetrical as possible. As the gynecomastia may be slightly different sizes on each side, this can be challenging.

However, choosing a surgeon who is experienced in male gynecomastia surgery and perhaps asking to see some ‘before and after’ photos should help ensure the final appearance is as good as possible.

Obtaining a satisfactory aesthetic appearance may be most challenging for patients with severe bilateral gynecomastia; surgery for these men may involve removing some of the ‘sagging’ skin on the chest.

Ensuring the final appearance is as equal as possible on each side is difficult, but again the best results will be obtained by experienced surgeons.

Following a bilateral mastectomy there will usually be some discomfort and restrictions to movement and lifting. These may last for several days or even weeks. It is important to discuss what to expect after the procedure with the surgeon and make sure there is sufficient help at home in the early days after the operation.

Although an immediate benefit will be seen after surgery for bilateral gynecomastia, it will take some time for the wounds to heal fully and the scars to settle down. Most men are happy with the final appearance following bilateral surgery for gyno.

Summary

Bilateral gynecomastia is the most common form of gynecomastia, and may in fact be less worrying than swelling on one side only. If diet and exercise fail, treatments such as creams and pills for bilateral gyno are available, but often their effects are unproven.

For most men intent on treatment, a bilateral mastectomy to remove the breast tissue on both sides through surgery is the best option. Bilateral surgery is very common (as most men with the condition have bilateral gyno) but is more expensive, and the post-operative discomfort and restrictions on activity will increase accordingly.

Most men are happy with the final results of surgery for bilateral gynecomastia, although achieving absolute symmetry can be challenging.

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