Gynaecomastia is the medical term for enlarged breasts in boys and men, relating to an abnormal amount of breast tissue. 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 breasts or just one.
What causes gynaecomastia?
In the majority of cases, there is no known cause. However, there are some rare congenital abnormalities that may be associated with it. Every so often, a blood test to measure the hormones that influence breast size may be suggested to check that they are within the normal range.
What are the signs and symptoms of gynaecomastia?
During teenage years, it is common for most boys to experience a degree of breast enlargement, but by early adulthood this has resolved naturally.
How is gynaecomastia diagnosed?
Gynaecomastia is diagnosed by clinical examination, that is, the doctor will check your son’s chest. The decision whether surgery will be helpful or not, is based on your child’s overall chest size and shape, general health and any previous chest surgery.
How is gynaecomastia treated?
Gynaecomastia is treated by surgery, either liposuction to suck out the fatty tissue, or by direct excision to cut out the firmer layer of tissue, or a combination of two methods. Both procedures last around one and a half hours, although they may be away from the ward for slightly longer.
What happens before the operation?
You and your child will need to come to a pre-admission appointment shortly before the operation is scheduled. The purpose of this is to check that your child is well enough for the operation and also to give you an opportunity to ask any questions. We suggest making a note of these before you come to the appointment.
The doctors will have explained the operation in more detail. You can discuss any worries you may have and they will ask you to sign a consent form, giving permission for your child to have the procedure. If your child has any medical problems, please inform the doctors.
What does the operation involve?
Both procedures are always carried out while your child is asleep, as they are delicate procedures causing some discomfort.
Liposuction – The surgeon will insert a thin hollow cannula (tube) into the chest area. The surgeon moves the cannula 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.
Are there any risks?
Complications with this operation are rare, but can occur. The most common complication of direct excision is a 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 a period of days or weeks.
If it is large, this may require a second operation to drain the old blood, but this will not affect the final outcome of the operation. The other main complication is infection, which is true of all surgery, but this can be minimised by careful hygiene after the operation.
What happens after the operation?
Your child will return to the ward after the operation to allow them to recover from the anaesthetic. Your child can start eating and drinking as normal once they feel like it. Most children stay overnight after the operation and go home the following day.
The chest area will be quite swollen after the operation – and for a while afterwards – so it is important not to judge the results of the surgery for several months. Your child will need to wear a pressure garment for the first six weeks after the operation. This will help reduce swelling and make the area more comfortable.
Your child will probably need pain relief for a few days after the operation as the area will be quite sore. The nurses will explain how much medication to give and how often. Your child may find moving about uncomfortable, but it is important to move normally to reduce the swelling.
Sleeping may be uncomfortable to begin with, but sleeping in a more upright position propped up with pillows will help.
Your child’s dressings will be reviewed either back at Great Ormond Street Hospital, or at your family doctor’s (GP) surgery about a week after the operation. After this appointment, your child will be able to bath and shower as usual and carry out normal day to day activities.
However, we advise avoiding contact sports for at least one month to reduce the risk of damage to the area. Swimming will be possible once the scabs have fallen off and the wounds have healed fully.
You should contact the ward if:
your child is in pain and pain relief does not seem to help
your child has a temperature of 38°C or higher and pain relief does not bring it down
the operation site becomes red, swollen, feels hotter than the surrounding skin or oozes.
What happens next?
The successful outcome of the operation may not be visible for several months after the operation. The area will be swollen for quite some time, which will mask the results. In the majority of cases, the operation is a success and further treatment is not required.