Men’s Breast Reduction (Gynaecomastia)

What Happens during Surgery?

Male breast reduction surgery is usually a one- to one-and-a-half-hour operation carried out under general anesthesia.   It can be performed also with the patient under local anesthetic and sedation.  Your surgeon will advise you which anesthesia is best for you. It may require a one-night stay in hospital though it is possible to be discharged later on the same day.  

The type of surgery you need depends on the structure of the underlying breast tissue to be removed. 

• fatty tissue only - you may require only liposuction. 
• Both glandular and fatty – excision (tissue cut away) and possibly liposuction as well. 

Liposuction

See our section on Liposuction for details of various liposuction techniques, risks, complications, recovery and after care. 

Excision

If the underlying tissue to be removed is glandular, it will need to be cut out (or excised). This procedure can be performed in conjunction with liposuction. 

You will require larger incisions than for liposuction alone.  This will result in more scarring, but this is kept to a minimum.  Surgeons endeavour to hide incisions around the areola, along natural contour lines of your chest and under the arm. The surgeon will work through the incisions to cut away excess tissue, and also use liposuction on fatty deposits. 

It is possible in major reductions that you will have excess skin as a result of the tissue removal.  In this case, the surgeon will remove also the excess skin and suture the skin taut to create a flat, firm chest following surgery.  This will result in greater scarring, so ensure you take advice at consultation stage on the likelihood of this occurring.

Sometimes, a small drain is inserted through a separate incision to draw off excess fluids. Once closed, the incisions are usually covered with a dressing. The chest may be wrapped to keep the skin firmly in place.

Recovery / Convalescence

What to expect immediately
After the surgery, you will have bandages and possibly drains in your chest.  These are usually removed after 48 hours.

You will experience some swelling and discomfort when the anesthetic wears off.  You will be prescribed pain killers and can take at home later on the usual over-the-counter medication such as Ibuprufen or Paracetamol.  Any pain, swelling or bruising is usually temporary though it may last up to two to three weeks.  You may be prescribed antibiotics in the first weeks to prevent risk of infection. 

If you leave hospital with a special support dressing this will be removed at around one week following your operation.  Stitches may be dissolvable or permanent; if the latter, you will have them removed around a week after surgery. 

You should refrain from any strenuous activities especially lifting for six weeks. Also, do not do any sport or activity which carries the risk of injury to your chest.  You will be advised of when you can take up exercise again, but do allow plenty of time for rest and recuperation.  It is advisable also to take sufficient time off work to convalesce; you might feel able to return to work within days, but allow for a week off work.   

You can aid your recovery by: 

• Applying ice packs (or packets of frozen vegetables wrapped in towels) to your chest immediately after surgery.
• Rest and sleep with your upper torso elevated.
• Keep breast skin supple by applying moisturizer, though carefully avoid the wounds
• Do not do any exercise or take up activities that can strain you – avoid bending and lifting for instance
• Do not get your chest wet in the shower or bath until the drains are removed
• Wear loose, light clothing preferably in natural fibres

Longer term care

You need to be patient to see the full results of your breast reduction as it will take time - up to three months - for them to adjust to their new shape.  Scarring may take between six months and a year to fade, but you should feel confident about your body and be able to expose you new torso well before that date.  Occasionally, you may find that the ends of the scars heal as raised red bumps (keloids), which may need minor corrective surgery.

Ensure you keep in touch with your outpatients’ unit so you are informed about when you can take up exercise, swim and perform other activities. 

Avoid exposing your chest to excess or direct sunlight for around six months. If this is unavoidable, use high protection factor sunscreens. 

Safety

Male breast reduction to correct gynaecomastia is a highly successful procedure, but as with all cosmetic surgery, there are risks from the surgery itself and from any complication which might arise.  You may also feel that the outcome is not what you intended.  There are no guarantees in cosmetic surgery, but rest assured that the majority of people find the benefits of breast reduction are long term and they feel physically and psychologically better having opted for it.   Most complications are temporary and relate to infection or are due to pain and swelling. 

There are some long-term and permanent complications you need to be aware of and discuss at consultation stage. 

All cosmetic surgery carries the risk of:

• Infection
• Allergic reaction to anesthetics, analgesics or sutures/bandages
• Lack of wound healing (excessive bleeding – hematoma)
• Blood clot (possibly deep vein thrombosis, or cardiac or pulmonary risk)
• Fluid accumulation
• Ongoing, excessive pain
• The need for further, possibly corrective, surgeryAbsorbable sutures causing skin ruptures and uneven healing of the scar tissue

What are the risks in Breast Reduction surgery?

Scarring

Scars occur around the areola and, possibly also from the breast to armpit.  They should fade to be barely noticeable within around six months to a year.  At first, scars will be pink and slightly raised.  If you notice they heal over the longer term in ridges (keloids), consult your surgeon as you may need minor corrective surgery.  You may also find that your breasts are red and hot and some leakage occurs from the scars.  Consult your surgeon should you see this sign as you may need antibiotics.

Uneven or lop-sided breasts

You may find that you have asymmetric breasts after the operation or that the areolas are not be aligned.  This can be caused by uneven removal of tissue (more permanent) or as a result of your skin adjusting to its new shape (usually temporary).  This may require further surgery to correct.  However, it does take time to see the results of your surgery and you will need to ensure swelling, pain and bruising has subsided before you form an opinion.  If in any doubt, ask your surgeon.

Nerve damage

If you experience any loss of breast sensation, varying degrees of sensation or numbness, these can be both temporary and permanent.  Fat tissue and nerve endings may have been severed during surgery.  In rare cases, part of the breast’s underlying fat or nerve tissue may die (necrosis), and you will lose sensation.  This is more likely to happen if you are a heavy smoker, have diabetes or have poor circulation, as the blood supply will not be sufficient to ‘feed’ the nipple area.

Skin discolouration

You may have temporary or permanent skin discoloration caused by swelling and bruising.