Gynaecomastia (Male Chest Reduction)

Guys – do you feel that your chest is not the shape that it should be? Tight T shirts not giving the look that you want? You may have gynaecomastia (or gynecomastia in American spelling), or abnormally enlarged male breast glands. Gynaecomastia is also commonly known as “man boobs” amongst other less flattering names that you may have heard.

All men have some residual breast gland with overlying fat. The gland, and occasionally the overlying fat in isolation, can enlarge to a volume that can make you embarrassed or self aware. This can occur to both sides of the chest or one side more than the other.

What causes gynaecomastia?

The cause of the majority of cases of gynaecomastia has never been discovered. In adolescent males, the rate can be as high as 65% depending on the definition used. Hormone imbalances, through a variety of pathways, can be a cause. The most important of these is testicular cancer or male breast cancer. Many drugs can cause gynaecomastia as a side effect. Cannabis and anabolic steroids are an identifiable and treatable cause. Men who are overweight may occasionally carry more fat on their chests than elsewhere, much in the same way that others may carry their excess on their abdomen or love handles.

A fully trained Plastic Surgeon will examine you thoroughly and order some tests to exclude treatable reasons for your gynaecomastia.

What is involved in gynaecomastia surgery?

Not all male breast enlargement is due to enlargement of the same chest components (gland and/or fat). Your skin will respond differently to stretching and relaxation compared to other people. So we use different surgical techniques to accommodate your particular needs.

There are two common techniques of gynaecomastia surgery, although some of the less common techniques have a role in unusual cases.

1.    Hemi-areolar – An incision is made between 3 and 9 o’clock (around the lower half) of the nipple. This is used to perform liposuction on the overlying fat and remove the excessive male breast breast tissue. The scars usually heal to be invisible

2.    Inverted T gynaecomastia surgery – This is appropriate for men with excessive skin and soft tissue that has begun to droop so that the nipple is below the normal position. The scars are similar to an inverted T breast reduction technique.

Can liposuction alone achieve a good male breast reduction?

Consider the cross section of the breast. Liposuction can only remove fat. Even a male chest that has normal breast gland volume with extra fat (called pseudo-gynaecomastia) will have the overlying skin stretched to some extent. A liposuction only gynaecomastia surgery is relying on the overlying skin to reduce in area after the fat has been removed, something that does not occur in all cases, especially if the skin has stretch marks. It may be necessary to have a second procedure with an incision all the way around the nipple to take up the slack in the chest skin, much like a purse string (or Bennelli breast reduction procedure scar).

Another consideration is the requirement for pre-approval from Medicare. Medicare will cover liposuction of the chest wall in certain circumstances, as specified under item number 45585. This requires your surgeon to write to Medicare (and provide photographic evidence) requesting approval to use this item number. Most health funds will not reimburse patients for this item number unless it has been approved by Medicare prior to your operation.

A consultation with Sydney Plastic Surgeon Dr Gavin Sandercoe will inform you of your options, risk and expected results.