Author: Omar Quaba MA FRCS(Plast)
Consultant Plastic Surgeon
Ninewells Hospital Dundee
Spire Murrayfield Hospital Edinburgh
Some men have concerns about enlarged breasts. This article will explore options for male breast reduction in Scotland and potential outcomes.
What is male breast enlargement?
Enlargement of male breasts (man boobs) is a condition medically known as gynecomastia. It occurs as a result of enlargement of the glandular tissue and excess fatty tissue in the male breast.
How common is gynecomastia?
Gynecomastia is very common. It can affect more than 50% of boys during puberty but will usually reduce with time. Up to one-third of men will develop gynecomastia.
What are the causes?
Most men with gynecomastia have no serious underlying problem. The condition is usually caused by hormone imbalance due to a change of hormone levels in competed and testosterone. Another common cause is being overweight. Some drugs such as anabolic steroids and cannabis can cause gynecomastia as well as conditions such as liver failure and kidney failure.
Why do some men consider cosmetic surgery for gynecomastia?
Some men may feel that they wish to have moob surgery as they feel embarrassed about their breasts. Name calling and teasing are common amongst teenagers, and many men feel embarrassed or self-conscious. Men with gynaecomastia may avoid wearing tight tops or going topless while on holiday.
What are my options for treatment of gynecomastia?
If you are going through puberty, then you can be reassured that with time, your gynaecomastia will usually improve. This can feel like a long time to wait, but plastic surgery is not an option until you are at least 18 years old.
If you are overweight, then it is essential to try to lose weight. Weight loss may help resolve your gynecomastia.
Men who are at a healthy weight should ensure that they are not using any medications or substances that may be contributing to their breast enlargement.
Gynaecomastia surgery may be an option if reversible causes have been ruled out and you remain self-conscious.
Male breast reduction in NHS in Scotland?
Cosmetic surgery is not routinely available under the NHS in Scotland. Referral is governed by the Adult Exceptional Aesthetic Referral Protocol (AEARP).
You might be a candidate for male breast reduction surgery if you have severe gynaecomastia or breast asymmetry that is impacting on your life. You should see your GP in the first instance to make sure that there are no reversible causes for your gynecomastia. Your GP will carry out a physical examination and may request blood tests to check things such as your levels of testosterone. If your GP feels that your gynaecomastia is severe and will not respond to diet or exercise, they may refer you to a plastic surgeon or breast surgeon for gynecomastia treatment.
Exclusions to referral include being overweight (Body Mass Index higher than 27) and mild enlargement. Before consideration, photos will usually be requested. If you are judged to have severe gynaecomastia, then you may be asked to attend to see a psychologist for assessment.
What is the surgical management of gynecomastia?
You might be suitable for surgical treatment of gynecomastia (gyno surgery) when other options (weight loss/ exercise) and any reversible causes have been excluded. Broadly speaking there are three options:
- gland excision
- skin excision
The options above can be combined.
Liposuction for gynaecomastia
Liposuction works by sucking out pockets of fat using a small cannula passed through the skin. It works well for fatty tissue, but not so well for firmer glandular tissue. All men have a combination of fatty tissue and glandular tissue in varying proportions. If your breasts are mostly fatty, then liposuction alone may be a sufficient treatment.
Liposuction works well when there is not too much loose skin, and the skin is of good elasticity. Good elasticity allows the skin to shrink back once the fatty tissue has been removed.
What if my breasts are firm?
If you have firm tissue just under your nipples, it is unlikely that liposuction alone will work. Liposuction can still be used to deal with the fatty tissue and to help tighten the skin. Once the liposuction has been completed, a small semi-circular incision is made around the areolar. The incision allows your surgeon to remove any remaining firm glandular tissue. The wounds closed with either dissolvable or non-dissolvable stitches.
When would I need a skin excision?
If you have very severe breast enlargement with a lot of loose skin, you might need skin removal. If the skin is not removed in these instances, it will not stretch back and potentially leave you with loose folds of skin that look unsightly.
The main disadvantage of skin removal, is that it leaves quite noticeable scars across your chest.
What outcomes can I expect?
Male breast reduction can carry a high satisfaction rate when performed properly. You should have realistic expectations. Minor asymmetry and irregularities are not uncommon. You should, however, expect to see a significant improvement in the appearance of your chest.
How do I choose a surgeon?
Several good private clinics are offering Gynaecomastia surgery in Scotland. The General Medical Council (GMC) provide useful information for patients considering cosmetic surgery. You should make sure that you choose a plastic surgeon who is on the GMC Specialist Register for Plastic Surgery and who is a member of BAPRAS or BAAPS.
Ask your potential surgeon to show you examples of their work.