Gynaecomastia is the medical term for enlarged breasts in boys and men. It describes when patients have more breast tissue than normal.
Most teenage boys experience a degree of breast enlargement but this usually resolves naturally by the time you reach early adulthood. Gynaecomastia can be treated at Great Ormond Street Hospital (GOSH) with surgery.
Causes, symptoms and diagnosis
Breast tissue consists of both fatty tissue, which is soft, and glandular tissue, which is firmer. The amount of both types varies from person to person. Excess breast tissue can affect either both breasts or just one.
In most cases it’s not known what causes gynaecomastia, but there are some rare congenital (present at birth) abnormalities that may be associated with it. If someone has gynaecomastia, they might have blood tests to check that their hormones are within a normal range.
A doctor will diagnose gynaecomastia by examining the chest area.
Gynaecomastia can be treated with surgery – either liposuction, direct excision or a combination of the two:
- Liposuction – the surgeon will insert a thin hollow cannula (tube) into the chest and move it around under the skin to suck out the fat cells. The small puncture wound will then be closed with dissolvable stitches and/or covered with a small dressing.
Direct excision – the surgeon will make a semi-circular incision (cut) around the areola (nipple) edge and remove the excess layer of tissue. The incision is closed with dissolvable stitches and covered with a small dressing.
Both procedures last around one and a half hours, although the patient might be away from the ward for slightly longer. They will be carried out under general anaesthetic so they are asleep when everything’s going on and don’t feel anything.
Complications with this operation are rare, but can occur. The most common complication of direct excision is haematoma – a collection of blood in the space where the fat has been removed.
If the haematoma is small, it will be left for the body to absorb it naturally over few days or weeks. If it is large, a second operation may be required to drain the old blood, but this won’t affect the final outcome of the operation.
As with all surgery, the other main complication is infection, but this can be minimised by careful hygiene after the operation.
Recovery from the anaesthetic happens on he ward. People can start eating and drinking again once they feel like it. Most young people stay overnight after the operation and go home the next day.
The chest area will be quite swollen after the operation, so pain relief is often needed for a few days afterwards. A pressure garment will also be worn for the first six weeks. This will help reduce swelling and make the area more comfortable. If sleeping is uncomfortable, sleeping in a more upright position propped up with pillows can help.
Once the dressings have been reviewed, about a week after the operation, bathing and showering are as usual and people can carry out normal day to day activities. We’d advise avoiding contact sports for a month to reduce the risk of damage to the area. Swimming is possible once the scabs have fallen off and the wounds have fully healed.
When to ask for medical help
We suggest people contact the ward if:
- They are in pain and pain relief doesn’t seem to help.
- They have a temperature of 38C or higher, and pain relief doesn’t bring it down.
- The operation site becomes red, swollen, feels hotter than the surrounding skin or oozes.
It might be hard to tell if the operation has been successful for a few months, because the chest area will be swollen for quite some time. In the majority of cases, the operation is successful and further treatment isn’t needed.