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Gynaecomastia, commonly termed and “Man/Male Boobs” or “Male Breasts”, is a common and distressing condition in male patients and is defined as the presence of abnormal enlargement of breast tissue in the male chest. This excessive male breast tissue development can have an incidence of up to 32 to 65 percent in the male population. (1) It can sometimes be part of normal physiology in the newborn, pubescent, and elderly populations. Sixty percent of boys develop this transiently, and it can be present in 30% to 70% of adults.
Gynecomastia is a condition characterized by enlargement of the male breast that affects up to 60% of the male population. The most common reason for gynecomastia is idiopathic (unknown), but it can also be related to certain drugs or secondary to conditions such as liver cirrhosis, hormonal imbalances, or testicular cancer.
There are usually 3 age groups in idiopathic gynecomastia which correspond to times of physiologic hormonal change. These are the neonatal, pubertal, and older (> 50years old) age groups.
Work-up of gynecomastia first involves a thorough history and examination to uncover any sinister underlying causes. These may be followed by ultrasound scans of the breasts or testes as well as blood tests. Once any treatable medical conditions have been excluded, gynecomastia surgery for breast reduction can be considered.
Why do I suffer from gynecomastia? What are the common causes?
There are numerous identifiable causes of gynaecomastia, though most cases are often idiopathic (no identifiable cause). Some of the identifiable causes include developmental and drug-induced causes, endocrine, metabolic or hormonal imbalances, tumors, systemic illnesses, congenital disorders, and familial, idiopathic, and miscellaneous causes.
In addition, patients with high BMI or high body fat percentage may also find an increased accumulation of fatty deposits around the chest area, which may accentuate the appearance of gynaecomastia. This condition is also commonly termed as pseudogynaecomastia.
A comprehensive clinical evaluation consisting of detailed history taking and physical examination would be recommended to exclude identifiable cause(s) of gynaecomastia.
This table provides some of the identifiable causes of gynaecomastia. (REF 3)
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Causes |
Examples |
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Medications |
Сertain medications used to treat conditions such as prostate enlargement, anxiety, depression, heart failure, gastritis, male infertility and HIV, illicit drug or alcohol use |
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Hormonal changes |
Infants, puberty, age-related hormonal changes |
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Health conditions |
Hypogonadism, endocrine tumors (pituitary/adrenal tumors), liver failure/cirrhosis, kidney failure, thyroid disease, increased BMI (with high peripheral estrogen production) |
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Herbal/ supplement products |
Certain products containing ingredients with estrogenic activity have been associated with the condition |
Can Gynecomastia be prevented?
By controlling certain risk factors for gynaecomastia, such as avoiding alcohol and drugs which may cause it, one may reduce the risk of gynaecomastia. On top of that, losing weight and exercising helps reduce subcutaneous fat and build up better musculature in the male chest, improving the overall appearance.
Is it possible to improve the contour of my chest (Pectoralis Major) muscle to look more masculine?
Yes absolutely! On top of liposuction removal of unwanted breast tissue, enhancements can be made by grafting fat into/onto areas of the chest muscle which require more volume. This procedure is not suitable for everyone, and it has to be tailored to each individual’s aesthetic goals of surgery.
How is gynecomastia surgery performed?
Gynecomastia surgery can be performed under general anaesthesia, or local anaesthesia with sedation.
There are many different grading systems for gynecomastia, most involving the assessment of skin versus excess breast tissue. Treatment modalities are then aimed at removing these two aspects.
Excess breast tissue can be removed through a combination of liposuction and excision of the fibrous breast disc behind the nipple by using a small incision around the areola. If there is excess skin, there may be a need to remove skin in a mastopexy-style approach using a periareolar or vertical scar, depending on the amount. More recently, ultrasound-assisted liposuction (VASERTM) has been used to good effect in both removing breast tissue, and thermal tightening of skin without having to make large incisions. This is suitable for patients with mild to moderate excess skin and smaller fibrous breast discs.
The aim of gynecomastia surgery should be to give the patient a shapely, athletic male chest suitable for their body type. It goes beyond just pure removal of tissue. At Polaris Plastic & Reconstructive Surgery, our doctors utilize both VASERTM and other techniques to give you an outcome tailor-made to your goals and desires.
