Gynaecomastia surgery

Gynaecomastia is the enlargement of the breasts in men, caused by the development of glandular breast tissue, sometimes combined with a build-up of fat. It can affect one side (unilateral) or both (bilateral) and can be a significant source of discomfort, especially when wearing fitted clothes or at the beach.

Surgical correction involves removing the excess glandular tissue and, where needed, liposuction of the surrounding fat, for a flatter, more masculine chest contour. At Detalii Med, in Baia Mare, the procedure is performed by Dr Marius Pruna and Dr Valeria Pruna.

The procedure is intended for men who:

• have persistent breast enlargement on one or both sides;
• can feel firm tissue behind the areola or have prominent areolae;
• have not seen improvement after weight loss, exercise or treatment of the cause, where there was one;
• have a fairly stable weight and are in good general health.

In adolescents, gynaecomastia may improve on its own, so the decision to operate is taken with caution and usually after development is complete.

The procedure can reduce the volume of the chest, remove the firm glandular tissue behind the areola and improve the overall contour of the chest. Clothes usually fit better, and the patient feels more comfortable.

The operation does not treat the cause of gynaecomastia if it is hormonal or medication-related, and it does not replace weight loss when excess fat is generalised. It does not create pectoral muscle. When the skin is very loose, for example after significant weight loss, removal of excess skin may also be needed, with longer scars; this is discussed at the consultation.

The consultation plays an important role, because gynaecomastia can have different causes. The doctor examines the chest and assesses how much of the volume is glandular tissue and how much is fat, as well as skin quality and symmetry. The medical history, medication (some medicines can contribute to gynaecomastia), supplements, any use of anabolic steroids, alcohol or other substances, and changes in weight are discussed.

Depending on the case, the doctor may recommend hormone tests, an ultrasound scan or an endocrinological assessment before deciding on surgery. When the breast is enlarged on one side only or a lump with unusual features can be felt, further assessment is all the more important, and the removed tissue may be sent for histopathological examination.

As a guide, the procedure takes about one to two hours, depending on the volume and technique, and the patient usually goes home the same day or after a short hospital stay, as advised by the doctor.

• If there is also excess fat, the doctor first performs liposuction through small incisions.
• The glandular tissue is usually removed through an incision along the lower edge of the areola, where the scar is more easily hidden at the junction between the areola and the surrounding skin.
• The aim is an even contour, without hollows under the areola.

At the end, drains may be placed depending on the case, and the chest is covered with a dressing and a compression vest.

Gynaecomastia surgery is usually performed under general anaesthesia. In limited cases, with little tissue, local anaesthetic combined with sedation may be considered. The type of anaesthesia is agreed at the consultation, and the patient is assessed beforehand by the anaesthetist.

After the procedure, the chest is swollen and tender, and bruising is common, especially if liposuction has also been performed. Discomfort is usually managed with the medication recommended by the doctor.

• The compression vest is usually worn for a few weeks, as instructed.
• Drains, if placed, are removed in the first few days.
• Office work can often be resumed after about a week.
• Strenuous exercise and chest workouts are usually avoided for about four to six weeks.

Follow-up appointments after surgery are scheduled as recommended by the doctor, to monitor healing.

Like any surgical procedure, gynaecomastia surgery carries risks:

• haematoma (a collection of blood) or seroma (a collection of fluid), which may need draining;
• infection;
• asymmetry or contour irregularities;
• a hollow under the areola if too much tissue was removed, or residual tissue if too little was removed;
• changes in sensation of the areola and nipple, usually temporary;
• visible or thickened scars;
• the general risks of anaesthesia.

Gynaecomastia may return if the cause persists, for example certain medicines, anabolic steroids or weight gain.

Part of the change is visible immediately, but at first swelling masks the result. The contour gradually improves as the swelling goes down, and the final appearance is usually assessed after about three to six months. The scars fade over time.

The glandular tissue that has been removed does not usually grow back, but the result also depends on maintaining a stable weight and avoiding the factors that contributed to the gynaecomastia.

Gynaecomastia surgery removes excess glandular tissue and, where needed, fat by liposuction, for a flatter chest. Before surgery, it is important to assess the possible causes, whether hormonal or medication-related. The technique, anaesthesia and recovery are agreed at the consultation, at Detalii Med, in Baia Mare.