Base-line information you need to know about
breasts in order to make the informed choices
if you are considering surgery to your breasts
It is important to
realise several facts:
- Both men and women
have breasts - but under the influence
of female hormones, they develop to be
larger in women.
- Breasts are composed
of a mixture of fat and glandular tissue.
The glandular tissue (the part which secretes
breast milk in women) weighs more than
the fat, so the larger the proportion
of glandular tissue your breasts have,
the heavier and more fibrous they are
- Breast fat increases
and decreases in tandem with variations
in body fat generally.
- Breast glandular
tissue increases and decreases in tandem
with variations in the ratios of your
or drugs which affect your body's fat
distribution, or your hormone balance
will cause male breast enlargement
Armed with these pieces
of information, you will understand why
your breasts may have grown larger and therefore,
find it much easier to decide whether surgery
on your breast mounds is for you.
Male breast growth
(gynaecomastia) is a common problem, especially
as obesity becomes more prevalent - estimates
of the prevalence of this condition vary
from 30% - 50% of the population. It is
an embarrassing condition for men of all
ages and is often resistant to weight loss
and exercise. Male breast reduction involves
removal fat and glandular tissue from the
breasts either using liposuction
or surgery. In very large breasts, surgery
rather than liposuction is the only sensible
treatment course to follow because it is
also often necessary to excise excess skin
and re-drape it on the chest wall.
Commonly asked questions
about gynaecomastia and male breast reduction
There are a variety
of causes for this condition, some of which
are treatable medically rather than surgically,
with resolution of the gynaecomastia thereafter.
Most gynaecomastia is idiopathic - it has
no treatable cause, but this is a diagnosis
we reach by excluding all the others which
can be classified as follows:
changes in hormone ratios just after birth,
at puberty and late in life
- Various drugs:
- digoxin, spironolactone
and other drugs that mimic oestrogens
phenothiazines and other drugs that
raise prolactin levels
cyproterone acetate and drugs that
- Liver disease
- Primary testicular
failure: Anorchia; Klinefelter's Syndrome;
- aquired testicular
failure: mumps; irradiation
- secondary testicular
failure: Hypopituitarism; isolated
- pituitary failure
- thyroid disease
- Growths in
- adrenal glands
- and vanishingly
rarely, in the lungs; liver or kidneys
Usually you will have
been referred for treatment by your GP who
knows what drugs you take and after doing
the relevant physical examination and special
investigations to exclude the above conditions
- meaning an idiopathic cause for your gynaecomastia
is all that remains and so surgery is indicated
to rid you of your problem.
It is best, therefore, to have seen your
GP before seeking a surgical referral, otherwise
I shall have to order these tests myself
which will delay your treatment and incur
you in potentially needless expense.
I a good candidate for male breast reduction?
This is best decided
during a consultation, but generally speaking
if you are a healthy, emotionally stable
man, with firm, elastic skin that will contract
to your chest’s new contours after
breast reduction, you will benefit from
either liposuction or surgery to decrease
your breast mounds. Obese men will gain
some benefit, especially if they realise
that this may help them overcome mechanical
problems if their breasts get in the way
during exercise, or manual work, or make
it difficult to get clothing that fits.
However, it must be understood that this
is not an operation to correct obesity and
that it will almost certainly need to be
repeated if it is performed before you have
reached and maintained your goal weight
for 6 months.
Patients who continue to use cannabis, or
take any of the drugs listed above will
have poor results from surgery and risk
their gynaecomastia reforming with time.
Back to top
should I expect from my consultation?
During your consultation,
I will take a full medical history. I will
ask you specifically about any conditions
and drugs listed above. I will examine you
completely, and then focus on your breasts
to assess their size, composition and the
quality of their skin envelope. During the
consultation I will take standardised photographic
views for your medical records. Depending
on my findings, I may ask your GP to perform
further tests, or if you prefer, order them
myself at your expense.
the surgery performed?
The aim of either
liposuction, or surgery for this condition
is to produce as predictable, stable and
aesthetic a breast shape for you as possible.
Liposuction is best suited to small breast
mounds composed mostly of fatty tissue in
men with good elastic skin tone. It involves
making 2 - 3 small incisions through which
the excess tissue is sucked out.
Surgical technique depends on the size of
your breast mounds and the elastic tone
of your skin. At the least, incisions are
made around half the circumference of the
areolar skin, but may stretch all the way
around the areolar, then vertically down
the chest wall and then in a symmetrical
curve below - to leave an anchor-shaped
does my operation involve?
Before surgery, you
will meet and be assessed by your anaesthetist
who will prescribe medications for your
comfort and to lessen anxiety if need be.
On the evening before, or the morning of
your operation I will review what we have
discussed and planned previously and we
will both sign your operative consent forms.
Then I will measure and draw guidance marks
for surgery on your chest and breasts with
you sitting upright.
The operation is performed under General
Anaesthesia - you will be asleep. The operation
usually takes an hour or so, depending on
the technique used. After surgery, you will
awake in a recovery area and soon afterwards
you will be returned to your room. A drain
is placed under the incision in each breast
to remove the normal healing fluid that
the body produces and stop it accumulating
within your reduced breasts. These drains
will be removed when the drainage is minimal
- usually after a day or two and once they
have been removed you can shower normally.
Most patients go home a day or two after
surgery on simple pain relieving medications
and a short course of antibiotics.
about my recovery and return to normal activities?
You will feel tired
and somewhat sore for a week or two following
your surgery, but you will be able to move
around and function relatively normally.
You will be swollen and bruised after surgery
or liposuction, and this can have an effect
on your healing and final result, so to
counter this you will need to wear an elastic
pressure garment 24 hours a day, 7 days
a week, for 4 weeks after surgery - except
when your are washing you or it! Thereafter,
you should wear it at night for a further
4 weeks. Your final result will mature over
3 - 6 months.
I encourage you to start gentle exercise
immediately. You can return to work as soon
as you feel able, but if your work involves
heavy, manual work, you should have at least
a week off, or on lighter duties.
New scars benefit from friction-free massage
(using vaseline, for instance, to lubricate
the massaging process). Beginning to massage
scars two to three weeks after surgery,
will help them mature, soften and flatten
faster than if left to their own devices.
New scars should be protected from sunlight
for 2 years to avoid them pigmenting differently
from the surrounding skin and becoming a
different colour permanently. Factor 15
sun block should be applied whenever they
are exposed - even to a British winter sun.
In the longer term, final size, shape, symmetry
and aesthetic result of breasts after reduction
surgery will vary according to individual
factors. If asymmetry is significant, a
second procedure may be performed to remove
You may find you lose nipple sensation,
which although usually a temporary loss,
may take up to a year to return, and may
remain permanently diminished or absent.
You may also experience altered pigmentation
in the nipple-areolar skin, which may be