Gynaecomastia: causes, symptoms, and treatment

Gynaecomastia is the medical term used to refer to an extremely common hormone disorder that affects the size and growth of male breasts.

In our latest article, highly esteemed Truro and London-based consultant oncoplastic breast surgeon, Professor Philip Drew, explains in more detail what exactly gynaecomastia is, and what the main symptoms and causes of the condition are.

What is gynaecomastia and what are the main causes?

Gynaecomastia is a male-patterned breast growth. There are various reasons for it. In fact, men over 55 are much more likely to have some form of gynaecomastia than not. This is normal age-related change. The condition can occur on one or both sides.

The commonest cause would be medication, which can sometimes stimulate male breast growth. Again, it is it is much more likely that teenage men suffer from some form of gynaecomastia, but less than five per cent of men are left with any kind of gynaecomastia after the age of 18. This is referred to as persistent pubertal gynaecomastia.

What are the symptoms of gynaecomastia?

The main symptom is pain and tenderness beneath the man’s nipple. Gynaecomastia tends to be very tender as it grows in the growth phase.

Another main symptom is the appearance of a lump behind the nipple. This lump is often rubbery and in severe cases, people can suffer from breast growth with skin redundancy.

When should someone consider surgical removal?

Surgery for gynaecomastia is a complex issue because what we don’t want to do is replace a minor cosmetic abnormality (caused by the disease) with a more major cosmetic abnormality caused by the surgery to treat the disease. The vast majority of gynaecomastia we see is just a painful lump behind the nipple with very little excess skin, but nonetheless a prominent nipple with pain.

In the early stages of gynaecomastia, patients may be treated effectively with anti-hormonal medication which can be provided by a specialist to try dampen down oestrogen once the blood tests have been done to make sure there are no other underlying medical causes. However, in some cases, this small lump behind the nipple does not respond to the anti-hormonal medication, and then this is when one should consider surgery.

How do you perform surgery for gynaecomastia?

To avoid the self-confidence-damaging effects of traditional surgery for gynaecomastia, I (20 years ago) developed a procedure which now allows me to remove the lump behind the nipple using a remote probe, which is put in through the axilla.

So, the only scarring visible is a four-metre scar hidden in the hairline of the axilla. There is no visible evidence on the front of the chest that any gynaecomastia surgery has actually taken place, which helps avoid men feeling self-conscious.

How does your surgery differ to surgical treatment for more severe cases of gynaecomastia?

For more serious cases where one has skin redundancy, then one will require a periareolar approach, where a donut of skin around the nipple is removed at the time of the surgery. The nipple is then raised and the underlying breast tissue is then removed.

The next step involves a purse string that is put into the external diameter of the donut and is pulled in to reduce the skin envelope and thus tighten the skin around the nipple. Unfortunately, this surgical procedure does lead to scarring around the nipple.

What happens during minimally invasive excision of gynaecomastia?

With minimally invasive excision, I use a very small incision (about four millimetres) in the armpit and also a probe called a vacuum-assisted biopsy device, which is a large-diameter, cutting probe that is placed in under the skin and behind the lump under the nipple.

This technique removes the glandular tissue with a cutting device which does not need to be constantly placed in and out like a typical biopsy device, as what happens is when it cuts the gland, that cylinder of tissue is sucked back down the probe into a little basket.

So, each time you cut the gland, tissue comes back, and you may have to do between 100 and 150 excisions as only a small piece of tissue is removed each time. It takes about an hour to do and the advantage of a minimally invasive excision of gynaecomastia is that there is no visible scarring on the chest wall.

What is the success rate of minimally invasive excision of gynaecomastia?

85 per cent of my clients say that the outcome is either good or better from the minimally invasive surgery.

How long is recovery time from this minimally invasive excision?

Recovery from minimally invasive surgery generally sees patients leave hospital the day after the surgery has taken place. There will be bruising and this can take a few weeks to settle, but in terms of activity, patients will typically be driving again after ten days or so, and they can return to work after a couple of weeks.

Following surgery, patients do have to wear a compression garment for a couple of weeks at least and then I prefer my patients to wear another one that allows for shaping of the chest. Typically, I would encourage them to wear this (second compression garment) for four to six weeks after they have worn the first one for the appropriate amount of time. Overall, healing is very quick.

Professor Philip Drew is a highly esteemed consultant oncoplastic breast surgeon who specialises in gynaecomastia and many other breast-affecting conditions. Consult directly with him by visiting his Top Doctors profile.