Gynaecomastia (male breast surgery)

Your surgeon will discuss your concerns, review your medical history and assess whether a cause can be identified. A breast examination, clinical measurements and confidential photographs will be taken. Based on the degree of excess fat, gland and skin, treatment options may include liposuction, skin excision or removal of most of the breast tissue (subcutaneous mastectomy).

Surgery typically combines removal of abnormal glandular tissue with liposuction to contour the remaining chest area. There are three main techniques, chosen according to your anatomy and goals. In the simplest, a hemiareolar incision (around the lower half of the nipple) allows discreet access. For moderate skin excess, a peri-areolar approach can tighten the skin and adjust nipple position. In cases with significant skin excess, such as after weight loss, crescent-shaped wedges of skin may be removed from the lower chest fold. All wounds are closed with dissolvable stitches, and scar position and visibility will vary according to the technique and individual healing.

Gynaecomastia surgery usually involves a combination of excising the abnormal glandular tissue from the male breast and using liposuction on the remaining chest to even out the result. There are three styles of gynaecomastia operation. All procedures pay particular attention to limiting scars and preserving the natural appearance of a male chest. In the simplest operation, the hemiareolar incision is located at the lower half of the areola (the pink circle around the nipple). This tends to be a discrete access line for the operation. Patients with a moderate degree of skin excess may also experience a lift and tightening of their skin with a peri-areola breast lift approach. In this operation, the areolar is cut to an proportionate shape and size and the stitched to a larger concentric oval. This tightens the breast skin and changes the position of the areola to a higher location. In men with significant skin excess eg following weight loss, crescentic wedges of skin (wedge lipectomy) are removed from the lower breast/chest fold. These are carefully sutured with three layers of dissolving stitches. These scars are more obvious than the other techniques, but may be necessary in order to remove significant skin excess.

This surgery may be performed as day surgery or with an overnight stay. Many people can return to desk-based work and driving within a few days, but strenuous activities should be avoided for around four weeks. A compression garment or supportive athletic top may be recommended to aid healing and maintain contour.

Dr Amira Sanki and Dr Ilias Kotronakis perform gynaecomastia surgery at accredited Sydney hospitals including St George, Hurstville, Bondi Junction and St Luke’s Private Hospitals. Private health insurance may contribute if the surgery meets specific criteria, such as excess skin following major weight loss.

Gynaecomastia surgery should be performed by a surgeon with appropriate qualifications and experience. In Australia, this includes holding a Fellowship of the Royal Australasian College of Surgeons (FRACS). Dr Sanki and Dr Kotronakis are Australian-trained Specialist Plastic Surgeons, members of the Australian Society of Plastic Surgeons, and have extensive experience in male breast surgery.

A consultation with a qualified plastic surgeon is the best way to receive personalised advice. Further resources are available from the Australian Society of Plastic Surgeons and the Australasian Society of Aesthetic Plastic Surgeons websites.

1. Infection: Any surgical procedure has the risk of infection. Surgeons take precautions to minimise this risk, such as sterile operating environments and proper wound care, but infections can still occur.

2. Scarring: Scarring is an inherent risk of plastic surgery. While surgeons strive to minimise visible scarring, some procedures may result in more noticeable or keloid scars.

3. Pain and discomfort: Plastic surgery involves incisions and tissue manipulation, which can lead to post-operative pain and discomfort. The level of pain varies depending on the procedure and the individual’s pain tolerance.

4. Hematoma and seroma: Hematomas are collections of blood that can form under the skin after surgery, while seromas are collections of fluid. These fluid collections may require drainage.

5. Nerve damage: Nerves can be damaged during surgery, leading to temporary or permanent numbness, tingling, or loss of sensation in the affected area. Nerve damage can also cause muscle weakness or paralysis.

6. Blood clots: Surgical procedures carry a risk of blood clot formation, particularly in the legs. Blood clots can be serious if they travel to other parts of the body, causing complications like pulmonary embolism.

7. Anesthesia risks: Plastic surgery usually requires the use of anesthesia, which carries its own set of risks. These include adverse reactions to anesthesia, breathing difficulties, and, in rare cases, life-threatening complications.

8. Unsatisfactory results: Plastic surgery outcomes may not meet the patient’s expectations or desires. It’s important for individuals to have realistic expectations and to communicate clearly with their surgeon about their goals and desired outcomes.

9. Revision surgery: In some cases, additional surgery may be required to achieve the desired results or to correct any complications or unsatisfactory outcomes. This can increase the financial and emotional burden on the patient.

10. Psychological and emotional effects: Plastic surgery can have psychological and emotional impacts, both positive and negative. While many people experience improved self-esteem and body image after surgery, others may struggle with unrealistic expectations, body dysmorphia, or dissatisfaction with the results.

It’s crucial for individuals considering plastic surgery to consult with a qualified and experienced plastic surgeon who can thoroughly explain the risks and benefits specific to their desired procedure. Understanding and carefully weighing these risks against the potential benefits can help individuals make informed decisions about whether to proceed with plastic surgery.