Breast reduction for men

Breast reduction for men is surgery to correct overdeveloped or enlarged breasts (gynaecomastia). Excess breast tissue may cause a man’s breasts to sag and stretch the areola (the dark skin surrounding the nipple). Gynaecomastia may be present in one breast (unilaterally) or in both breasts (bilaterally).

Gynaecomastia is common in men of any age. Enlarged breasts in men can be the result of hormonal changes, weight gain, hereditary conditions, disease or the use of certain drugs, including anabolic steroids and marijuana.

Breast reduction surgery can be performed at any age, but is best done when the breasts are fully developed. Adolescents may benefit from surgery, although secondary procedures may be needed in the future if breast development continues.

Gynaecomastia can cause emotional discomfort and may affect a man’s self-confidence. Some men may avoid certain physical activities or intimacy with others to hide their condition.

Things to consider before breast reduction surgery

Some important issues to keep in mind include:

• Any surgical treatment to correct gynaecomastia will require incisions (cuts). While most incisions are hidden in natural contours or in the areolae of the breasts, some scars may be visible and these are an unavoidable result of any breast reduction surgery.
• If gynaecomastia has resulted from the use of certain prescription medications or drugs, including steroids or from weight gain, you must be fully free of these substances and remain at a stable weight in order to maintain the results of your surgery.
• Think about the financial cost. Breast reduction surgery to treat gynaecomastia may be partially covered by Medicare and private health insurance. Ask your medical practitioner for further information about out-of-pocket costs.
• Smokers are at increased risk of complications. If you are serious about undergoing cosmetic surgery, you should try to quit smoking.

Finding a medical practitioner

You may want to ask your doctor for advice about a suitable and reputable medical practitioner or hospital where breast reductions are performed. At your first consultation, you should ask the medical practitioner about their training and experience.

It is preferable to have this procedure done by a specialist who is specially trained to perform breast reductions in men and has a lot of experience in carrying out this type of surgery.

Breast reduction surgery

Various techniques may be used for breast reduction. The technique most appropriate to your situation will be discussed with you before your surgery.

Gynaecomastia may be treated with liposuction, surgical excision (removal of tissue) or sometimes both. In cases where gynaecomastia is primarily the result of excess fatty tissue, liposuction techniques alone may be used.

Liposuction involves infiltrating fluid into the tissue and then inserting a cannula (a thin hollow tube) through a small incision. The cannula is moved back and forth in a controlled motion to loosen the excess fat, which is then removed from the body by vacuum suction. Factors such as the person’s age and skin elasticity are important considerations when deciding whether liposuction alone will give good results.

Excision (surgical removal) is recommended where glandular breast tissue or excess skin must be removed to correct gynaecomastia. Excision is necessary if the areola is to be reduced or if the nipple needs to be repositioned on the chest. Incision (cutting) patterns vary depending on the specific conditions and the medical practitioner’s preference.

Whenever possible, the medical practitioner will try to hide the incisions within skin creases or at the edges of the areola. Usually, some tissue is left behind the nipple to prevent a postoperative hollowing or ‘donut’ deformity. This residual tissue may regrow in the future – for example, if substances that cause gynaecomastia are used again after the operation.

Immediately after the breast reduction operation

After the surgery, you may expect:

• a drainage tube in the wound to help prevent fluid build-up
• bruising and swelling
• possible numbness
• pain and discomfort
• dressings or bandages. If liposuction is used, expect to wear a compression garment
• the results of the breast reduction surgery to be immediately visible.

Complications of breast reduction surgery

All surgery carries some degree of risk. Some of the possible complications of breast reduction include:

• risks of anaesthesia, including allergic reaction, which (rarely) may be fatal
• surgical risks, such as bleeding or infection
• blood clots, such as deep vein thrombosis, leading to pulmonary embolus or stroke, which can be fatal
• fatal cardiovascular complications, such as a heart attack
• changes in breast and nipple sensation
• temporary or permanent areas of numbness
• rippled or baggy skin where the liposuction was performed
• inflamed, itchy scars
• asymmetry (unevenness) of the breasts
• indentations of the nipple or areolar regions
• skin death (necrosis) along the wound
• death of nipple tissue
• death of deeper tissues, such as fat (fat necrosis)
• further surgery to treat complications.

This is not a complete list. For example, your medical history or lifestyle may put you at increased risk of certain complications. You need to speak to your medical practitioner for more information.

Self-care after breast reduction surgery

Be guided by your medical practitioner, but general self-care suggestions after breast reduction surgery include:

• Follow all instructions about looking after your wounds.
• Expect recovery from liposuction alone to take only a few days. Recovery from excision surgery may take a few weeks.
• Avoid lifting and physical exercise for a month if you have had excision surgery. You will probably have some soreness and swelling for a few weeks.
• Wear an elastic garment for one to four weeks to achieve the best results and minimise scarring.
• Report any bleeding, severe pain or unusual symptoms to your medical practitioner.

Long-term outlook after breast reduction surgery

All scars are permanent. However, scarring should fade to your natural skin colour over time. The results of breast reduction surgery may help to improve your self-image and confidence. The final results are permanent in many cases, but weight gain, hormonal imbalances or the use of certain drugs (including anabolic steroids) may cause the breasts to re-enlarge.

Other options to breast reduction surgery

Alternatives to breast reduction for men depend on the cause of the condition. You will need to consult with your doctor, but options include:

• Stop the use of any drug that caused the condition – this option may be successful to reverse drug-induced gynaecomastia.
• Healthy dieting or regular exercise – this may help men whose breast area is enlarged due to obesity, excessive alcohol intake or poor health.
• Accepting yourself – talking to a counsellor or psychologist may help you overcome your concerns and you may decide that you like yourself the way you are.

Where to get help

• Your GP (doctor)
• A medical practitioner specially trained and experienced in performing cosmetic surgery
• Cosmetic surgery hub and hotline, Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 361 041
• Cosmetic surgery, Department of Health and Aged Care, Australian Government
• Australian Society of Plastic Surgeons Tel. (02) 9437 9200
• Royal Australasian College of SurgeonsTel. (03) 9249 1200
• Australian Health Practitioner Regulation Agency (AHPRA) Tel. 1300 419 495