Man boobs (pseudogynaecomastia, gynaecomastia)

 

Standard undergraduate teaching regarding the management of gynaecomastia or “man boobs” in adolescent males is to leave them alone as the great majority of young men will grow out of this phenomenon. Nonetheless, one still regularly sees men of all ages who have undertaken surgery, or have had surgery undertaken on them more to the point, and who have been left with unsightly scars around their nipples. Generally unnecessarily.

 

 

Older men, particularly those who are overweight or those who drink too much alcohol, may develop these “man boobs” but will find the man boobs will not go with time unless the men lose weight and/or stop drinking in time for their livers to repair and hormonal status to return to something close to normal.

Indeed, some get so despondent about their man boobs that they feel too embarrassed to go to the gym and go to the pub instead: perfectly maladaptive.

 

Most cases of apparent “man boobs” are not true gynaecomastia but instead “pseudogynaecomastia” which denotes a breast appearance in a male due not to true breast gland tissue but due merely to fat deposits. These patients do very well with liposuction to their chest wall.

 

True gynaecomastia, due to excessive genuine breast breast tissue in a male, can be treated with liposuction as well but is a little more difficult: the male breast tissue has to be broken up with a Mangubat disrupter prior to suctioning. Good results still ensue.

 

How is it done?

 

• Treatment areas are carefully photographed and the treatment plan is marked on the skin as agreed to by the patient.
• As with all our liposuction treatments, patients receive some light sedation to the point of comfort and relaxation without compromising verbal communication. Patients can speak and respond to questions.
• Antiseptic applied, patient draped, doctor scrubbed gloved and gowned.
• Under local anaesthetic, tiny incisions are made, one lateral and one inferior to each breast. They are sited to be as inconspicuous as possible (and, once healed, look about equivalent to an acne scar). The sternum and centre of the chest is avoided, naturally.
• Dilute local anaesthetic is then infused under the unwanted fat or breast tissue on each side. Patients may be aware of the anaesthetic fluid slowly spreading under each “man-boob”.
• Once anaesthetised, time is taken to pre-tunnel the breast/fat tissue to ensure even spread of the anaesthetic and an even result ensues.
• With careful planning and preparation, the actual suctioning is straightforward, but performed systematically for best results, typically with a 3mm triport cannula.  Two access points each side allows for criss-crossing. Axillary tail, if present, is not neglected.
• Aspirate from each side is measured to ensure symmetry of result.
• Patient showers, dressings applied, and patient is allowed home once fully recovered
• Review in rooms next day.

 

Liposuction to male gynaecomastia is rewarding work, as patients are so grateful with high % satisfaction levels. So high, that one is left wondering why more men don’t just get it done.