Gynecomastia

Is Gynecomastia common?

Gynecomastia is common in three stages of a male’s life:

• Enlarged breasts in baby boys after birth;
• Irregular sex hormone levels in puberty can cause breast enlargement;
• Decrease in testosterone production and higher estrogen levels in middle age to older men.

The most significant cause of this condition is the accumulation of glandular tissue in the breasts due to being overweight, leading to the appearance of gynecomastia.

What are the causes of gynecomastia?

The most common cause of gynecomastia today is obesity. Another common cause is a hormonal imbalance that changes the free estrogen and free testosterone levels and causes breast tissue to grow. Other causes include genetic disorders (Klinefelter Syndrome) and illegal drug use, including anabolic steroids. Side effects from antidepressants, Cimetidine, Prolactin, Diazepam, proton-pump inhibitors, Tamoxifen, Spironolactone and anti-androgens can be a cause.

Some medical conditions can cause gynaecomastia, including:

• Testicular cancer (Leydig Cell Tumours of the testicles)
• Sexual dysfunction
• Tumours of the adrenal and pituitary gland
• Hypogonadism
• And liver disease such as cirrhosis, kidney disease and kidney failure (renal failure).

Elevated levels of Human Chorionic Gonadotropin (hCG) can also cause this condition.

Who is at risk for gynecomastia?

Individuals with specific chromosomal diseases are at particular risk for gynecomastia. Apart from these diseases, every man who has an unhealthy diet and adopts a sedentary lifestyle is at risk for gynecomastia. Patients with hyperthyroidism (overproduction of the thyroid gland) are more susceptible to hormone imbalances or hormonal changes which can lead to the clinical presentation of this condition. Specific hormonal treatments can also put you at a higher risk, such as the treatments taken by prostate cancer patients.

What are the symptoms of gynecomastia?

The main symptom of gynecomastia is palpable swelling under the nipple and enlargement of breast size accompanied by fat deposition which makes the breast feel rubbery or firm. This growth will have usually been there for more than 1 year. In male teenagers, swelling may occur under the nipple, but usually softens and disappears over time. Gynecomastia can be accompanied by proliferation of the brown area around the nipple, which we call the areola. Along with enlargement of the breast, enlargement of the areola is possible. Nipple discharge in one or both breasts may occur as can breast pain or tenderness.

How is gynecomastia diagnosed?

Most patients with gynecomastia who come to see us complain of visible breast enlargement. A lot of these patients also have increased fat deposition in their abdomen and waist. A breast ultrasound may be used to diagnose gynecomastia as it can easily visualise the tissue content of the breast. Breast ultrasounds usually show an increase in both male breast tissue and adipose tissue. Although this condition is not related to breast cancer, blood tests and biopsies of the tissue may also be taken for further results.

What are the treatment options for gynecomastia?

We have found vaser techniques to be our preferred option in the treatment of gynecomastia. It’s helpful for both adipose tissue and breast tissue in gynecomastia patients. While Vaser melts and liquefies fat tissue, it also breaks down the breast tissue and allows it to be more readily removed by liposuction. We prefer power-assisted liposuction (Microaire) to remove breast and adipose tissue liquefied with Vaser. The combined use of Vaser and Microaire have become our preferred option in our gynecomastia procedures.

What is the price for a gynecomastia procedure?

For gynecomastia surgery using liposuction, prices will vary, and it’s important to understand this liposuction procedure option for male breast reduction surgery, is not currently covered by Medicare in Australia. The total cost of a male breast reduction with liposuction starts from a minimum base price of $5,500 for the first area, with any additional areas of liposuction charged from a minimum fee of $2,000 per area.

These prices are just a guide and are not an exact quote. An exact quote for your individual needs will always be provided to you during your initial consultations at Cosmos Aesthetics. Your personalised pricing will be calculated for your individual needs, incorporating all potential costs including liposuction to your areas of concern, anaesthetic fees, compression garments, and any applicable surgical fees. Two mandatory consultations with our doctors, a minimum seven day cooling off period following your second consultation, and a referral from your GP are also required if you are considering having gynecomastia surgery using liposuction.

How is the gynecomastia procedure done?

This breast reduction surgery takes around 1.5 hours and is performed under twilight sedation or general anaesthesia. Anaesthetic fluid is inserted into the area to reduce bleeding and pain. This liquid facilitates the melting of fat in the breast area. Melted fat and breast tissue are then removed by power-assisted liposuction. Any remaining palpable breast tissue under the nipple is removed through a half-moon incision around the nipple line, usually around 1cm, which will leave a scar only under the breast. This procedure can be combined with other body shaping procedures. Shapewear is worn for 6 weeks post-op. Patients can return to their usual activities within 1 week.

What should patients pay attention to after the gynecomastia procedure?

Patients can usually go home or to their hotel the day of the procedure. We advise patients not to use their arms too much for the first few days after the procedure. Heavy use of the arms shortly after the procedure can both increase pain and cause bleeding in the breast area. We recommend you wear the garment for 6 weeks post-op, at which time we will schedule the 6 week follow up.

Can gynecomastia heal without a procedure?

If caused only by hormonal factors, drug intake or any other evident underlying cause, gynecomastia can subside or even fade away completely if that cause is eliminated. Pubertal gynecomastia typically fades away between 6 months to 2 years.

Likewise, if being overweight is the only cause of gynecomastia, it may subside or even completely fade away in some patients after weight loss. In other cases, this procedure is usually required to treat gynecomastia.

Can gynecomastia progress?

If the underlying cause of gynecomastia is being overweight, the breasts will continue to grow as the patient continues to gain weight. Stretch marks may occur, especially in rapidly occurring gynecomastia. This causes droopy skin after weight loss. Even though the breast shrinks, drooping is inevitable due to excess skin and patients will still need a procedure to correct it. In cases like this, patients must be careful from the moment they start gaining weight and reduce their weight gain as much as possible. If no stretch marks have occurred and the quality of skin has not deteriorated, gynecomastia can be eliminated through liposuction with minimal scarring.

Is there an age limit for the gynecomastia procedure?

In gynecomastia procedures performed for aesthetic purposes, patients must be over the age of 18. Gynecomastia would have been present for a minimum of one year.

Why is Vaser Liposuction preferred in gynecomastia procedures?

Older liposuction methods can be used in gynaecomastia procedures as well, however, we have found Vaser liposuction to be more helpful for gynecomastia. The first procedure for which Vaser was approved was the gynecomastia procedure.

What are the most common procedures combined with the gynecomastia procedure?

Gynecomastia occurs usually due to adiposity and is in most cases accompanied by increased fat deposition in other areas of the male body. These are typically around the abdomen. Therefore, gynecomastia procedures are often performed in combination with the Vaser liposuction procedure on the abdomen and waist region. Nowadays, there is an increasing number of patients who want body shaping with high-def (high definition) liposuction to be performed together with gynecomastia treatment. In these patients, the liposuction procedure can be performed on gynecomastia, the waist and abdomen. A defined appearance can be given to the abdominal region with this procedure.

Can the gynecomastia procedure be performed under local anesthesia?

If the patient’s breast enlargement is rather minor and if the area to be treated is not too large, the procedure can be performed under local anesthesia. General anesthesia or twilight sedation is preferred in all other cases or in combined procedures involving other body parts.

Do patients need to wear shapewear after the gynecomastia procedure?

Patients are advised to wear shapewear (compression garments) for 6 weeks after this procedure. Shapewear not only prevents the accumulation of blood and body fluids in the site of the procedure, but also facilitates the skin’s adaptation to underlying tissues. Shapewear should be worn as continuously as possible, especially during the first 2-3 weeks, while in the following 3 weeks, shapewear can be worn only while sleeping.

How long after the gynecomastia procedure can patients take a bath?

Patients can take a bath/shower 2 days after the procedure. They need to take off their shapewear before taking a bath or shower and put it back on afterwards with minimal delay.

Can the gynecomastia procedure be performed in all seasons of the year?

The procedure can be done in any season. What patients might consider there is the requirement to wear shapewear after the procedure, which can be uncomfortable for patients if the weather is very hot.

How long after the gynecomastia procedure can patients do sports?

Patients can start exercises that don’t involve their arms 2 weeks after the procedure. They need to wait about 6 weeks before they can start doing sports without restriction.

How long after the gynecomastia procedure can patients return to normal life?

Patients are advised to take things slow for about a week, which means that they can usually return to normal life 1 week after the procedure. Patients may experience pain in the chest area if they use their arms too much in the first 2 or 3 weeks after they return to normal life. The gynecomastia procedure does not cause much restriction in the lives of patients apart from this.

Can breasts grow back after the gynecomastia procedure?

Breasts will not grow back as long as patients can maintain their current weight. However, if the patient gains weight, there may be an increase in adipose tissue and the breasts may grow back, in which case patients may need to be operated on again. It should be noted that procedures done for a second or third time may be more challenging and painful than the first one, which is why we explain to our patients in as much detail as possible everything they should pay attention to after their first procedure.

Is the gynecomastia procedure covered by insurance?

Since the gynecomastia procedure is a type of cosmetic procedure, it is not covered by insurance in most cases.