What treatments are there for gynecomastia?

What is Gynaecomastia or Gynaecomastia Surgery?

Gynaecomastia is a condition of excess breast glandular tissue in males, likely caused by a hormonal imbalance. Some patients have underlying medical conditions or are taking medication that can cause this but most of the time, it is idiopathic (no known cause).

Gynaecomastia surgery, also known as man boob or male breast reduction surgery is an outpatient surgical procedure where the enlarged male breast tissue is removed. During the surgery, the glandular breast tissue and excess fat is removed. There are several techniques employed for treatment of Gynaecomastia.

In my practice, I use the MELT(1,2) (Microdebrider excision with liposuction technique) which allows excision of glandular tissue (microdebrider) and sculpting of the chest (liposuction) through a small incision that is well hidden in the shadows of the areolar. The procedure is usually completed between 1 to 2 hours. Once completed, your pecs are sculpted into a new shape in proportion to the rest of your physique.

What are the alternatives to gynecomastia surgery?

Psuedogynecomastia, which is not true gynecomastia, is a condition where there is excess fat without excess glandular tissue. If you have this condition, exercise and diet regimes leading to weight loss will be more effective.

In certain patients, there is an underlying medical condition or medications that can lead to Gynaecomastia. Treatment of the underlying condition or cessation of the medication should be done first before seeking treatment for Gynaecomastia.

There are no medications that have been shown to be able to treat Gynaecomastia or reduce breast tissue. In fact, even liposuction would not adequately remove the glandular tissue, leaving remnant breast tissue which requires a second operation or excision. Similarly, non-invasive procedures like CoolSculpting are not recommended for the treatment of Gynaecomastia.

True Gynaecomastia can only be treated by surgical excision.

Hope this answers your question. Have a great weekend ahead!

Dr. Terence Goh

AZATACA Plastic Surgery

References:

1. Use of the microdebrider for treatment of fibrous gynaecomastia. J Plast Reconstr Aesthet Surg. 2010 Mar;63(3):506-10. Goh Terence1, Tan BK, Song C.
2. Review of the microdebrider excision and liposuction technique (MELT) for the treatment of gynecomastia. J Plast Reconstr Aesthet Surg. 2020 Feb;73(2):303-312. Sim N, Tan G, Tan BK, Goh Terence1.

Gynecomastia, or enlarged breasts in men, is a fairly common condition usually caused by an imbalance of hormones. Although there are many possible causes for gynecomastia (e.g. certain types of medication, obesity, some medical conditions, excess alcohol consumption), in many cases no specific cause can be identified.

In adolescents/teenagers with gynecomastia, treatment should consist of observation and regular reviews, as this condition often resolves after several years. Surgical treatment can
be considered if the gynecomastia has not resolved by the early to mid-twenties.

When gynecomastia is persistent, or significant enough to trouble you, surgical treatment should be considered and can be done either by excision or by liposuction.

Surgical excision is preferred if the enlargement is due to hard, glandular tissue that cannot be otherwise removed by liposuction. The incision is usually placed at the edge of the areola.

If the enlargement is predominantly due to soft, fatty tissue, a reduction can be done by liposuction or Vaser liposelection. Small incisions are placed inconspicuously near the armpits or at the side of the chest.

Gynecomastia reduction is usually done under general anaesthesia and takes 1.5 to 2 hours. No hospital stay is required. Recovery time is 1-2 weeks. Following the procedure, the patient is required to wear a pressure garment (a tight-fitting shirt to help control swelling and maintain the contour of the chest) for approximately one month.