Breast reduction for men

Gynaecomastia refers to the abnormal growth of breast tissue in men, resulting in visible breast enlargement. This condition can have both physical and psychological effects on affected patients. It is important to understand the different forms of gynaecomastia in order to offer an accurate diagnosis and the appropriate treatment method.

Types of gynaecomastia

There are various types of gynaecomastia, which differ in their causes, the tissue affected and the symptoms:

Physiological gynaecomastia

Physiological gynaecomastia occurs at different stages of life and is usually harmless. It can occur in childhood, puberty and old age:

• Pubertal gynaecomastia: Around 60-70% of male adolescents experience temporary breast enlargement during puberty, which is caused by hormonal fluctuations, particularly an imbalance between the concentrations of testosterone and oestrogen. This problem usually disappears on its own within 12 to 24 months.
• Senile gynaecomastia: In old age, a decrease in testosterone levels and a relative increase in oestrogen lead to a more frequent development of gynaecomastia. This is also generally a benign but permanent change.

Pathological gynaecomastia

This form of gynaecomastia is caused by diseases or external influences that cause hormonal imbalances in the body:

• Drug-induced gynaecomastia: Certain medications, such as antiandrogens, steroids, antipsychotics or antidepressants, can cause gynaecomastia as a side effect. These drugs affect the hormonal balance and promote the growth of breast tissue.
• Endocrine disorders: Diseases such as hypogonadism, hyperthyroidism or liver cirrhosis can also shift the hormonal balance and lead to the development of gynaecomastia. Tumours that produce hormones, such as testosterone-producing tumours, can also cause gynaecomastia.
• Systemic diseases: In particular, renal insufficiency, liver disease or the use of drugs (e.g. marijuana) can also lead to gynaecomastia.

Unilateral and bilateral gynaecomastia

• Unilateral gynaecomastia: One mammary gland is affected, the other remains unchanged. This form can indicate an underlying disease such as a tumour and should always be thoroughly investigated.
• Bilateral gynaecomastia: Both breasts are affected, which is often due to physiological causes or drug-induced gynaecomastia.

Pseudogynaecomastia

It is important to distinguish gynaecomastia from pseudogynaecomastia, as the latter has a different cause and requires a different treatment. Pseudogynaecomastia is not an increase in mammary gland tissue, but an accumulation of fat in the breast region. This often occurs in overweight or obese men and can be particularly visible in the lower chest area.

Pseudogynaecomastia is therefore a phenomenon caused by an excess of fatty tissue and not by increased glandular activity. The diagnosis can be made using imaging techniques such as ultrasound or a mammogram.

Diagnosis of gynaecomastia

The diagnosis begins with a thorough medical history and a clinical examination. The extent of the breast tissue, the ratio of fatty to glandular tissue and any asymmetries are assessed.

• Ultrasound examination: Is often used to differentiate between fatty tissue and true glandular tissue.
• Mammography: Mammography can be used for clarification, particularly in older patients or in the case of unilateral gynaecomastia.
• Blood tests: Determination of hormone levels (e.g. testosterone, oestrogen, prolactin) to identify hormonal imbalances or underlying diseases.

Treatment options for gynaecomastia

Treatment depends on the type and cause of gynaecomastia. In general, a distinction is made between conservative measures and surgical interventions.

Conservative treatments

• Drug therapy: In certain cases, treatment with aromatase inhibitors or anti-oestrogens (such as tamoxifen) can be tried, especially in younger patients or in cases of drug-induced gynaecomastia.
• Hormone therapy: If the cause of gynaecomastia is a hormonal imbalance, targeted hormone treatment can be considered to normalise levels.

Surgical treatment

If gynaecomastia persists or is symptomatic, surgical removal of the excess tissue is the most effective treatment. There are various surgical procedures that are used depending on the extent of the gynaecomastia:

• Liposuction: In liposuctional gynaecomastia, which mainly involves fatty tissue, excess fatty tissue is removed by liposuction. This procedure is minimally invasive and leads to a quick recovery.
• Combined liposuction and gland resection: If excess glandular tissue needs to be removed in addition to fatty tissue, a combination of liposuction and a small incision is used to remove the glandular tissue. This technique offers an aesthetically pleasing result by optimising the shape and contour of the breast.

- Combination with skin tightening: In cases where gynaecomastia is associated with significant excess skin - particularly after dramatic weight loss or at an advanced age - removal of glandular and fatty tissue alone may not be sufficient to achieve an aesthetically pleasing breast shape. In such cases, a simultaneous skin tightening is an important part of the surgical therapy to achieve a natural and smooth breast shape.

The operation can be performed on an outpatient or inpatient basis and is preferably performed under a short anaesthetic.

Postoperative aftercare

Postoperative care is required after the surgical treatment. This includes wearing a compression garment to tighten the skin and support healing, as well as regular check-ups to recognise any complications at an early stage.

Risks of surgery for gynaecomastia

As with any surgical intervention, there are certain risks and possible complications that should be considered when treating gynaecomastia with a surgical method. These risks depend on various factors, including the patient's individual health status and the type of surgery (e.g. liposuction, mastectomy or skin tightening). It is important that patients are aware of the possible risks and receive a thorough explanation from the attending physician before the operation.

- Infections: Although infections are relatively rare during gynaecomastia surgery, they can occur if bacteria enter the wound. To minimise the risk, antibiotics are usually prescribed and strict hygiene measures are observed during and after the operation.

- Bleeding and haematomas: Post-operative bleeding is also a possible complication. It can occur either during the operation or in the first few days afterwards and can lead to haematomas, i.e. accumulations of blood under the skin. This can lead to swelling and pain. Haematomas are usually treated with drainage or controlled pressure dressings. However, serious haemorrhages are rare.

- Scarring: Scars are an unavoidable risk with any surgical treatment. In particular, gynaecomastia surgery that requires skin tightening and/or incisions around the areola can result in visible scars. Although surgeons try to make the incisions as inconspicuous as possible, scarring is individual and depends on factors such as skin type, wound healing and surgical technique. In some cases, scars can become hypertrophic, i.e. lead to excess, widened scars.

- Asymmetry: There may be some asymmetry of the breast after the operation, as the result depends on the individual anatomy. This can be the case in particular if glandular or fatty tissue is removed unevenly. In some cases, a follow-up operation is required to further optimise the symmetry.

- Altered nipple sensitivity: A common side effect after gynaecomastia surgery is a temporary or, in rare cases, permanent change in the sensitivity of the breast or nipples. The nerves that supply the nipples can be injured or irritated during the procedure. This can lead to reduced sensitivity or, in rare cases, to numbness or hypersensitivity.

- Seroma formation: A seroma is an accumulation of fluid under the skin that can form after surgery. This is a natural reaction of the body to the surgical procedure. Seromas can usually be drained through drains, but sometimes re-draining may be necessary.

- Wound healing disorders: In some cases, delayed wound healing or wound infections may occur, especially in patients with diabetes or nicotine abuse. These problems can prolong healing and affect the aesthetic result.

Prognosis

The prognosis after surgical treatment of gynaecomastia is very good in most cases. The results are permanent unless hormonal or other underlying conditions cause the gynaecomastia to recur. For many patients, the psychological improvement is just as important as the physical improvement.

Conclusion

Gynaecomastia is a common but often treatable condition that can have both physiological and pathological causes. It is crucial to recognise the different types of gynaecomastia and to develop an individual treatment strategy. Early diagnosis and targeted treatment can not only improve the physical appearance, but also significantly improve the quality of life of affected patients.