GYNECOMASTIA SURGERY SIDE EFFECTS, PROCEDURE AND RESULTS
Gynecomastia is the enlargement of breast tissue or boobs in boys or men. All males have breast tissue, and just as in women, it is under the control of hormones in our bodies. Both men and women produce the ‘male’ hormone testosterone and the ‘female’ hormone estrogen. Breast tissue responds to high levels of estrogen by growing. Normally in males the level of testosterone is much higher than the level of estrogen, so boobs do not grow. If something upsets this balance, breast tissue can get bigger, causing gynecomastia. It can be caused by either an increase in the level of estrogen or a decrease in the level of testosterone. This change in the balance of hormones in males causes the breast tissue to grow and the man develops boobs or breasts – gynecomastia.
Causes of gynecomastia
Breast enlargement is very common in some groups – many newborn babies, around 1/3 of teenagers and a large number of ageing men will experience some enlargement of their breasts. In these groups the changes in hormone levels can be normal and often need no treatment. In babies and teenagers the breast swelling usually goes away on its own.
Men who are significantly overweight are very likely to feel some enlargement of their breast tissue – sometimes called ‘man boobs’. This is partly caused by fat tissue under the skin on the chest wall, and partly by true breast glandular tissue. Fat tissue anywhere in the body encourages the formation of estrogen, and thus can lead to gynecomastia.
The most common cause of gynecomastia in other men is medication. Boob swelling can be caused by a wide range of medicines including those used to treat:
- Prostate cancer – such as flutamide
- Stomach ulcers – including cimetidine
- Anxiety – such as Valium
- Depression (tricyclic antidepressants)
- Cancer – chemotherapy drugs
- HIV – HAART medication
- Some heart problems – including digoxin
Other substances taken for non-medical reasons are also the cause of gynecomastia in some men. These include:
- Anabolic steroids taken for bodybuilding
If a man is taking a drug – either prescribed medication or recreational drugs – they should visit a doctor to discuss whether this might be the cause of the gynecomastia. Medication should not be stopped before speaking with a doctor as this can be dangerous. There are often different medications which can be tried and can continue to treat the problem without causing breast swelling.
If none of these are being taken, other causes need to be considered. Other causes of changes in hormone levels in the body include:
- Tumors which secrete hormones
- Low levels of hormones caused by problems in the pituitary gland (the part of the brain which controls hormone production)
- Rare genetic disorders such as Kleinfelter’s syndrome
- An overactive thyroid gland (hyperthyroidism)
- Liver disease
- Kidney disease
Therefore a man who goes to the doctor worried about developing boobs should get a full check-up. The doctor will ask what drugs the man is taking, and any other medical problems they have. They will also examine the man, including the chest area and boobs as well as a more general examination (including the testicles), to rule out any worrying causes of breast enlargement. Dangerous causes of gynecomastia are rare, but medical help should be sought particularly if the swelling is different on each side, the swelling is painful or lumpy or if there is any fluid discharge from the nipples. Any swelling which persists for a long time or is very distressing for the man should also be discussed with a doctor.
In many men gynecomastia may not need to be treated. Particularly in babies and teenagers, the problem can simply be observed as most cases will go away on their own. For some men investigations might be needed to work out the cause of the problem. These might include:
- Full physical examination by a doctor
- Blood tests
- Ultrasound scan of the breast tissue
- Other scans such as an MRI of the area
These tests will be used to look for a cause of the breast swelling. They will also be used to rule out other conditions which might mimic gynecomastia – such as an infection of the breast tissue or breast cancer, which although rare does happen in men.
Early treatment may simply be advice about weight loss or stopping a medication which may be causing the problem. If these do not work, then medication to reduce the swelling might be tried. Medicines to reduce the amount of estrogen (such as the drug used in breast cancer, tamoxifen) can reduce the gynecomastia in some men.
If medication does not work or cannot be tried, surgery might be suggested. This should be discussed with a surgeon – usually a plastic surgeon– who is experienced in undertaking a gynecomastia surgery procedure in males. In general gynecomastia surgery is very safe, with few side effects and significant good outcomes. The most common procedure is called a mastectomy, and involves removing all of the glandular tissue of the boobs. There are very few risks involved with this procedure, although it is an operation and should be approached carefully. How the procedure is done, any risks, outcomes and expectations of the procedure should be discussed with the surgeon before agreeing to any surgery to remove man boobs.
If breast swelling in males is particularly large or distressing the possibility of surgery might be discussed. Man boobs can be very distressing for the individual and modern surgery methods are usually extremely safe and effective. Some men may therefore feel that it is worth considering surgery to remove the breast tissue and improve the look of their chest. The surgery is often carried out by a plastic surgeon who should discuss the operation, expectations, safety, risks and any gynecomastia surgery side effects before proceeding.
In a man with gynecomastia, there are two types of surgery that may be offered. The first is fat removal surgery or liposuction. In this technique fatty tissue is removed, not the true breast glandular tissue. In some men, particularly those who are overweight, this may be sufficient to improve the chest’s appearance to an acceptable level. However in men with a large amount of ‘true’ breast tissue enlargement, liposuction will simply not work. Liposuction is carried out using a probe which is passed under the skin to the area. This probe breaks down the fatty tissue and simply sucks it out. It is carried out under general anesthetic – meaning the man is asleep during the procedure. Scars are usually very small and should be almost invisible once healed. Liposuction can provide dramatic improvements; however, it does not stop fatty tissue from re-forming over time. In addition, occasionally the appearance can be lumpy or uneven. However this is a relatively minor procedure which is generally safe with few risks and only minor post-procedure pain.
Mastectomy for gynecomastia
If liposuction is not thought to be suitable or likely to be effective, the surgeon may suggest doing a mastectomy. A mastectomy is surgery to remove breast tissue, and is the more major form of man boobs surgery. A mastectomy that is done for gynecomastia can be done as ‘open’ surgery or using keyhole instruments. Where keyhole surgery is carried out this can result in smaller scars and less pain after the procedure, meaning the recovery time for the man after surgery is shorter. The procedure will be done under general anesthetic. During the procedure most of the glandular tissue of the breast is removed, to try and keep it from growing back in the future.
In some cases, where the gynecomastia has been particularly large or present for a long time, a plastic surgeon may consider removing excess skin tissue along with the glandular tissue of the breast itself. This is done to make the final appearances as good as possible. Although this plastic surgery procedure results in larger scars and the recovery is more painful, it may be worth considering to provide better results for significant gynecomastia. However, skin removal and refashioning should always be undertaken by an experienced plastic surgeon as the risks of the procedure are larger.
Most men are happy with the results of their surgery for gynecomastia. There will usually be some pain after the procedure, which should be controlled with pain medication. Depending on how much tissue needed to be removed, a small plastic drainage tube may be left in place for a short time to allow swelling fluid to drain away. There may be some stitches which need to be removed post-surgery.
Gynecomastia surgery side effects
The two main side effects after gynecomastia surgery are pain and the presence of scars. Pain should be adequately controlled with simple pain killers. The surgeon will arrange to see the man sometime after the surgery to review the post-surgery results. The final appearance of the scars depends on the type of surgery and the technique used. Mastectomy for gynecomastia is usually done through a small curved scar just underneath the nipple area. If keyhole surgery is used, there will be several scars which may be spread across the chest, each only a few millimetres in length. All mastectomy scars should heal well and become barely visible with time.
Gynecomastia surgery risks
Gynecomastia surgery is very safe with few serious risks. Serious problems following surgery are rare, although as with any surgery complications are possible. Possible post-gynecomastia surgery problems include:
- Pain after gynecomastia surgery
- Infection of the wounds
- Collection of swelling fluid under the skin
- Regrowth of the breast tissue over time
- Poor appearance of the chest
- Poor appearance of the scars
Gynecomastia surgery is often carried out by a plastic surgeon, who will be highly experienced in making sure the final appearance is as good as possible. However scars can sometimes be lumpy, meaning the man is unhappy with the outcome. While this is a recognised side effect of gynecomastia surgery, in some cases a second plastic surgery procedure might be needed to improve the post-surgery appearance. Once the scars have healed they should be barely visible. Care needs to be taken by the surgeon during the procedure, because if too much breast tissue is taken away under the skin the nipple can ‘stick’ to the chest wall, creating an unsightly result. Whilst the results should be permanent, in some cases the long-term appearance deteriorates as gynecomastia can recur over time, particularly if the man gains weight and fatty tissue regrows.
Gynecomastia is a common problem, particularly in male babies, teenagers and older men. Many cases need no treatment; however if the man finds the problem distressing he may seek help to remove the breast tissue. If drug treatment fails or is not possible, surgery may be carried out. It is important that the man’s expectations and understanding of the procedure are fully discussed before the procedure. The most common surgery for gynecomastia is a mastectomy, most commonly carried out by a plastic surgeon. This procedure aims to remove most of the breast glandular tissue to try and keep the problem from coming back. Although the procedure is usually straightforward and safe with good long-term outcomes, there can be some side effects such as pain after gynecomastia surgery. After a full discussion with the surgeon, the man may or may not feel surgery is worth undertaking. Following the procedure, most men are happy with the results of the surgery and the appearance of their chest.