Treatment for gynaecomastia involves establishing and treating any underlying cause, if appropriate, and then planning surgery to improve any ongoing problems with the contour of the chest. Surgery for gynaecomastia consists of liposuction together with Ultrasound Assisted Liposuction and Open Excision as necessary.
Liposuction is the removal of tissue, most commonly fat, by passing a suction probe backwards and forwards under the skin. In general, the area is injected with fluid to reduce the amount of blood loss and to reduce injury to the tissues that will be left behind. One or more small cuts are made and the suction probe is inserted into the layer of fat to be removed. The suction, combined with the motion of the probe, removes fat cells. This is very effective for gynaecomastia that is mainly fat but the dense, glandular tissue is not typically removed by liposuction alone. In mixed gynaecomastia, often liposuction is used at the start of the operation to remove the fat part, and so the breast tissue left behind is smaller and easier to remove.
Ultrasound Assisted Liposuction is a combination of liposuction as above connected to an ultrasound machine. Ultrasound is the use of sound waves that are higher than we can hear. When they are used together with the suction probe, they tend to break down certain types of cells and tissues, so they can often remove both the fat part and the glandular part.
Occasionally, the glandular part of the breast is so thick that even Ultrasound Assisted Liposuction cannot remove it. Then it can be removed by making a semi-circular cut under nipple areolar complex, the nipple and darker colored skin around the nipple. Using this cut, the thick glandular tissue can be removed and the chest can be reshaped.
These techniques are effective for mild to moderate gynaecomastia. In the more severe cases, there is extra skin as a result of the breast development and that will need to be removed. This can often be removed as a ring around the nipple areolar complex or, in the most severe cases, techniques that are usually used for female breast reduction can be used.
Most young men who choose to have surgery for gynaecomastia have good outcomes but there is the always the risk of complications. Infection and bleeding can occur after any surgery, and a collection of fluid under the skin may require further surgery to resolve. There is the possibility of undercorrection, in which too much of the gynaecomastia is left behind, creating a difference between the two sides, and overcorrection , where there can be hollowing behind the nipple or the nipple can scar down to the ‘pec’ muscle and move unnaturally. More severe complications, such as loss of the nipple or blood clots in the legs or chest are possible but rare.
Aftercare is important as gynaecomastia can occasionally re-grow and further treatment is sometimes required. The chest, is an area that changes dramatically during adolescence and early adulthood, and it is important that any treatment is planned to give the best long-term result.