Recently I have been studying the outcomes of my patients undergoing surgery to correct their gynaecomastia conditions, while identifying representative cases to upload on our clinical gallery for the assistance of future patients, who may be considering undergoing this procedure.

In undertaking this review I have been interested in the many different presentations of this condition in the patients I have seen, which have required different surgical approaches to attain a satisfactory outcome and correct the deformity.

As a result I have developed some guidelines to assist me in determining the best surgical procedure in each particular case, which may be helpful in deciding whether you want to proceed with surgery.

There is no doubt with our modern lifestyle, increased body weight and body mass index as well as self-esteem and body image concerns that gynaecomastia is becoming more common and treatment requested more often.

The types of patients I am commonly seeing with gynaecomastia are-

1. Teenage and young adult males with unilateral or bilateral gynaecomastia with breast gland overgrowth only = subcutaneous mastectomy of gland only via periareolar incision. (also seen in body builders taking anabolic steroids)

Example left periareolar mastectomy only for symmetry 50g removed

2. Males of all ages with body mass index and weight marginally above average, who have developed gynaecomastia with development of breast tissue and surrounding fat amounting to 100g or less on each side = liposuction alone or combination of liposuction and subcutaneous mastectomy via periareolar incision.

Example periareolar mastectomy and liposuction 100g removed each side

3. Males of all ages who are substantially overweight with body mass indexes in the obese category and extensive breast development-

If breast weight estimated to be less than 400g (C cup bra in a woman) = liposuction and subcutaneous mastectomy, without skin excision may be adequate if no associated skin laxity.

Example periareolar mastectomy and liposuction about 400g removed each side

If breast weight estimated to be more than 400g (C cup bra in a woman) = will require associated skin resection in combination with direct gland excision to achieve satisfactory outcome and avoid anterior chest skin laxity and recurrent seroma formation.

Example periareolar mastectomy and liposuction about 600g removed each side with poor result should have had skin resection as well

If minor skin laxity I would recommend elliptical excision of skin above the areola to correctly reposition the nipple on completion.

Example subcutaneous mastectomy and superior elliptical skin excision to lift nipple position 350g removed each side

If major skin laxity would suggest resection as per female breast reduction using an inferior pedicle to maintain vascularity of the nipple and resecting all other glandular tissue and redundant skin. The nipple can then be placed in the correct position following resection.

Example inferior pedicle breast reduction technique with skin and gland excision 480g removed from each side

4. Males following extensive weight loss with redundant sacs of pendulous skin hanging from their anterior chest and little breast glandular tissue = require skin resection using superior areolar ellipse of skin or in more severe cases will require inferior pedicle skin reduction mastectomy technique.

Example 70kg weight loss patient with inferior pedicle breast reduction technique 450g removed from each side (also underwent body lift)

If you have gynaecomastia and fit into one of these categories and would like to discuss your optimal treatment option please contact our Brighton office at Bayside Plastic Surgery on 03 9596 8888 to arrange an appointment with Dr David Ross, who will work out a suitable treatment plan for you.

David A. Ross
Bayside Plastic Surgery
January 2015