The Truth about Gynaecomastia

By: Mr Philip Turton
Created on 14th February 2012

Specialist breast surgeon Mr Philip Turton explains why men no longer have to suffer in silence with this common male problem

The explosion in the number of men who develop excessive breast tissue has become a huge problem in the UK. This is generally referred to as gynaecomastia or pseudo-gynaecomastia depending on the type of tissue excess. It is also commonly referred to as ‘moobs' or ‘man boobs'.

Although all men have some breast tissue, in most it is completely unnoticeable. But in others an embarrassing excess either of the thicker glandular type, or of the softer fatty type develops. When this becomes noticeable to a man, it is usually also noticeable by others. This unflattering appearance may cause unkind teasing, especially during the teenage years, or make the individual so self conscious that they go to quite extreme lengths to hide it. This may include wearing baggy tops and avoiding situations where you may have to get undressed in front of others.

Many patients I have seen share similar stories: if the problem started in teenage years, the individuals often report that they avoided sport at school, others avoid swimming, or beach holidays to keep the problem hidden. Most report wearing T-shirts under shirts, or loose jumpers (even in summer!) to keep the problem hidden. The psychological aspects even prevent some people from forming relationships or affect the relationships they are in.

The good news is that men no longer have to put up with this unwanted and usually embarrassing appearance. Specialist breast surgeons have a variety of techniques that can deal effectively with this problem.

Are there different types of gynaecomastia?
The commonest type these days is called pseudo-gynaecomastia. This is the fatty variety. The other type is true-gynaecomastia. This variety can vary from a very small but very firm area of tissue directly behind the nipple (like a bud) that is dense and glandular, to a broader area or glandularity in other men. In some men the glandular type is mixed with a more fatty component as well.

What causes this problem?
The fatty tissue excess is called pseudo-gynaecomastia. It is uncommon for it to form because of other health problems and many men who request a male breast reduction are over-weight.

Some have lost their excess weight but the problem fat has failed to shift. The excess body fat has been deposited on the pectoral area of the chest. In some men, the fatty excess also stretches the overlying skin in the nipple area giving a pendulous breast appearance because the skin is more fixed at the bottom of the muscle than it is at the top. It is likely that some men are unfortunately more prone than others to deposit fat in the chest area. I often perform pure liposuction to treat this type.

The glandular variety is sometimes caused by important underlying medical problems. For example, testicular tumours can cause this condition, and the gynaecomastia may appear first. There are numerous other causes such as pubertal development, drugs used to treat prostate cancer, male menopause, alcohol (particularly beer), cannabis, anabolic steroids and numerous others. Patients who are concerned should see their GP or a specialist like myself urgently.

More frequently (in over 90 per cent of cases) gynaecomastia occurs without any cause, and is due to an over sensitivity of the small amount of normal breast gland in a man to normal hormone levels. This enables the tissue to grow. There are also a huge number of medications that may cause glandular gynaecomastia as an unwanted side effect.

These factors should be discussed at a consultation. As a breast specialist I am trained to investigate other causes where it is appropriate. This can include a detailed medical history being taken, clinical examination, screening blood tests and on rare occasions specific imaging tests of the testicles, or abdominal adrenal glands.

Treatment
I commonly use liposuction to perform a male breast reduction where there is a fatty component. This is generally an excellent treatment where there is not a lot of loose skin. I use different types of liposuction to treat this condition, but have found the Body Jet liposuction system to be very effective. Although it is possible to have this procedure done while awake, most patients prefer a quick general anaesthetic.

The procedure takes approximately 30 minutes per side, depending on the volume to remove. I will usually carry out the procedure as a day case, enabling same day discharge home. This surgery is however always carried out in a dedicated main operating theatre, treating every case with the professionalism that is required for excellent results without complications. Usually the only sign of surgery are two little scars measuring 2mm in a skin crease so that they heal inconspicuously. The use of local anaesthetic during the procedure seems to completely eliminate pain when patients wake up.

The thick glandular component is usually too difficult to remove without excising it directly. However, it is important that a cosmetic approach is used in men, minimizing scar visibility whenever possible. I will usually hide the scar in the lower half of the areola as this produces a great cosmetic result. The surgery through such a small keyhole opening requires expertise and experience. The skill of perfecting results come from years of specialist training and an ability to think in three dimensions as you operate. Tissue depth has to be constantly monitored to get the best results.

Sometimes the glandular excision needs to be combined with liposuction either at the same operation or after a period of time after the first. With very severe gynaecomastia with a full breast formation I may have to use special skin pattern incisions and oncoplastic surgery techniques or even mastectomy.

Occasionally I will advise a period of medical treatment with an anti-estrogen medication, where there has been a rapid development of glandular excess, particularly if it is tender and has recently formed. This approach can be used if the excess has formed due to essential medication.

In conclusion
Traditionally, men have been quite shy about dealing with moobs, but in the modern era of specialist cosmetic breast surgery this is changing. I have noticed a real cultural shift over the last five years. Men are much more likely to request surgery to correct this problem now.
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