Enlargement of male breasts 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.

Signs vary from a small amount of extra tissue around the nipples to more prominent breasts. It can affect one or both breasts but usually affects both. The breast tissue may be tender or painful, but this isn’t always the case.

Gynaecomastia can have several causes. As mentioned above, the majority of cases are physiological (hormonal).

Hormone imbalance

Gynaecomastia can be caused by an imbalance between the sex hormones testosterone and oestrogen. Oestrogen is the hormone that causes breast tissue to grow. All men have some degree of oestrogen production, but they usually have much higher levels of testosterone, which counteracts the effects of oestrogen. When the balance of oestrogen and testosterone changes, it can cause a man’s breasts to grow. In most cases, the cause of this imbalance is unknown. Losing weight or doing more exercise will often not improve things as the condition is not caused by excess fat, but rather excess breast tissue.

Puberty

During puberty, boys’ hormone levels vary.  Many teenage boys have some degree of breast enlargement. Gynecomastia at puberty usually clears up as boys get older and their hormone levels become more stable.

Older age

As men get older, they produce less testosterone. Also, older men tend to have more body fat, and this can cause more oestrogen to be produced. These changes in hormone levels can lead to excess breast tissue growth.

Rarer causes

There are some rare causes of male breast enlargement (such as testicular tumours, liver failure or certain medications) and sometimes a medical examination and blood tests may be needed.

Some men may feel that they wish to have moob surgery as they feel embarrassed about their breasts. Name calling and teasing are common among teenagers, and many men feel embarrassed or self-conscious. Men with gynaecomastia may avoid wearing tight tops or going topless while on holiday.

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.

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.

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:

1. liposuction
2. gland excision
3. skin excision

The options above can be combined.

Liposuction works very well when the quality of your skin is good (as it is in most younger men) and your skin has not been stretched significantly from previous weight gain and loss.

Having said this, the main factor influencing whether liposuction will work alone without surgery is related to how firm the breast tissue is underneath the nipple. In some men, the breast tissue is so firm that liposuction may not work and a small cut is required in the lower half of the nipple to remove the breast tissue surgically.

Incision placement for gynaecomastia liposuction

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.

Typical incision placement for gynaecomastia gland 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.

Type of incision after skin excision for severe gynaecomastia

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.