Gynaecomastia Surgery (Male Breast Reduction, Man Boob Correction, or Male Chest Reduction)
Gynaecomastia is the condition where excess tissue in the male chest creates the appearance of a feminine breast.
The condition is normal at 3 stages of life:
- In newborn babies
- In puberty – up to 30 to 40% of boys undergoing puberty but resolves in most cases
- In the elderly
Most abnormal cases have no causes
Some cases have an underling cause which can include
- Hormonal disturbances
- Genetic conditions
- Systemic disease such as kidney or liver failure
- Tumours that secrete certain hormones
- Drugs which can interfere with normal hormonal balance – this includes many cardiac medications, some antibiotics, tricyclic antidepressants. Withdrawal of causative drugs can result in resolution of gynaecomastia in 60% of cases.
Gynaecomastia Surgery (also known as Male Breast, Man Boob or Chest Reduction Surgery) involves the removal of fat and glandular tissue from the male chest. Sometimes this is combined with excision of skin and repositioning of the nipple. This is performed to restore a masculine shape to the chest.
Men seek Gynaecomastia Surgery to
- Correct the feminine appearance to the chest they find embarrassing
- Wear swimwear they want to wear
- Wear tight fitting shirts
- Feel confident and masculine
- Remove skin and fat after massive weight loss
The best candidates for gynaecomastia surgery are men who:
- Are physically and mentally healthy
- Have realistic expectations
- Are willing to accept the scars associated with surgery
- Have already lost the weight they want to lose (if this applies)
- Have been a stable weight for at least 6 months (ideally 12 months)
Gynaecomastia surgery may not be suitable for men who:
- Have not lost the weight they want to lose
- Have fluctuations in their weight
- Are very overweight or obese (BMI >35) – ideally your BMI should be less than 30 for best results
- Have multiple medical problems
- Are on blood thinning medication
- Are actively smoking
Men who have gynaecomastia surgery often wish they had surgery sooner, as the results from surgery can be life-changing.
At MODE, Dr Aggarwal will guide you through the planning of surgery and help decide which procedure is best suited to achieve your goals.
Procedure Snapshot
- Anaesthetic: GA by accredited anaesthetist
- Time: 3 hours
- Duration of stay: Overnight night stay in hospital
- Hospital: Any of the hospitals where Dr Aggarwal works. This is usually Sydney Adventist or Hunters Hill Private Hospitals.
- Medicare/Health fund rebate: Gynaecomastia surgery is covered by a Medicare item number which means with appropriate health fund cover, some rebates may be claimable from Medicare and the Health Fund, therefore reducing out of pocket costs.
- Recovery: Most people stay in hospital for 1 night and this can be slightly longer in the event that a drain needs to stay for longer. In most cases drains are removed the following day with patients going home without a drain. Heavy lifting or upper body exercise is disallowed for 8 weeks and for this period you are required to wear a chest compression garment. You can shower after 48 hours, but avoid swimming in a pool or beach for 2-3 weeks until all wounds have healed, and all drains are out.
- Results: One of the most satisfying procedures for patients but it is important to note that results vary from patient to patient.
Cosmetic Concerns
- In most cases scars from surgery involve:
- Small stab incisions for liposuction cannulas to remove the fat. These are barely perceptible long term
- Scars are placed around the areola of the nipple. This means they are well hidden. This incision is to remove the glandular tissue behind the nipple.
- This means that excellent are achievable with minimal scars on the chest.
- In a small minority of patients, skin must also be excised in addition to fat and gland removal. These are patients with severe gynaecomastia or have lost a lot of weight.
- Dr Aggarwal will discuss with you if skin needs to be excised – in general our approach at Mode in such cases is to stage the procedure: we will aim to achieve as much as possible with minimal scars and see how much the skin shrinks over time. If skin excision (and therefore additional scars) are required by delaying this, the scar length is often shorter than it would have been had skin been excised in the first procedure.
- Most cases of gynaecomastia have no known cause.
- It is very common in boys undergoing puberty and in most cases it spontaneously resolves.
- In some boys and men it can be due to endocrine (hormonal) causes, renal (kidney) or liver disease, obesity or due to some tumours. There are also many medications, and some illicit drugs that can cause the condition.
- Dr Aggarwal will always examine you thoroughly to rule out these other causes, and sometimes additional tests, and a visit to an endocrinologist (hormone specialist) may be necessary prior to embarking on surgery. It may also be necessary to rule out or cease drugs that may be contributory. If surgery is embarked upon without correcting an underlying cause it is possible for the condition to recur.
- In most cases where boys have passed puberty, stopped growing, have stable weight and there are no underlying causes – the results of surgery are permanent. However in a very small minority of these patients glandular tissue can regrow.
- Man boobs are not cancerous
- However every medical examination of the male chest area should exclude breast cancer as males (those with man boobs or not) can develop breast cancer. Dr Aggarwal will examine you at the time of consultation to exclude any suspicious lumps or masses.
- Furthermore surgery performed for gynaecomastia often includes excision of glandular tissue behind the nipple. This is sent for testing (histopathology) to ensure there are no causes for concern.
- In a genetic condition called Klinefelter’s syndrome where there are extra chromosomes in the body, there are a constellation of features associated with the condition include gynaecomastia. These patients are at increased risk of male breast cancer.
Procedure Information
The procedure is always performed under general anaesthesia given by an accredited anaesthetist in a fully accredited and licensed facility (usually one of the North Shore’s premier private hospitals). The procedure takes three hours and most patients will spend 1 night in hospital.
- A small incision is placed in the fold under the male breast and another on the edge of the nipple.
- This is used to infiltrate solution into the chest to reduce bleeding as well as the site for liposuction.
- Later in the procedure a scar is placed around the areola to excise glandular tissue behind the nipple that cannot be removed from liposuction alone.
- A solution containing adrenaline and local anaesthetic is infiltrated at the start of the procedure in both sides of the chest.
- Liposuction is then carried out to remove as much of the fat from the chest to restore a normal masculine chest contour.
- If required, glandular tissue is removed through an incision around the areola. This tissue is located directly behind the nipple and care is taken to maintain some tissue behind the nipple in order to prevent a sunken nipple after surgery.
- The wounds are then closed and a drain is placed.
- In general 1 drain is placed on each side of the chest.
- Whilst in hospital the drain outputs are recorded, and the drains removed once fluid drainage is minimal. In most patients the drain comes out the next day
- In a small number of cases, if the drain is not ready to come it is possible to either stay in hospital till drain removal, or go home with the drain and see Dr Aggarwal or his staff in rooms to have the drain removed after discharge from hospital.
- Dr Aggarwal will place waterproof dressings over the incisions.
- You will be able to get all areas wet after 48 hours. However you will not be allowed to swim in a pool or beach for at least 2 weeks after surgery or until all drains are removed (whichever is later).
- You will be given a script for antibiotics by Dr Aggarwal which you must continue for 1 week or until all drains are removed. You will also be given appropriate pain relief medications.
- When you go home it is best to have someone look after you as you recover.
- While most sedentary activities can be resumed when you go home, you must lay low and not exert yourself. You will also not be allowed to do any heavy lifting or upper body exercises for the first 8 weeks. During this period you will also be required to wear a chest compression garment (a tight vest).
- Dr Aggarwal will see regularly after your discharge from hospital.
Risks & Complications
Every surgery carries risks, and therefore one must consider if risks outweigh the benefits for your own personal situation. If they do then the surgery may be well worth it. Dr Aggarwal will discuss the pros and cons of surgery with you during your consultation.
- Risks of anaesthetic – there are general risks of going under an anaesthetic such as a mild stress on the heart and lungs, risk of reaction to anaesthetic drugs and risk of blotting in the legs. These risks are generally low in patients who are otherwise fit and healthy.
- Bleeding (1-2%) – any bleeding is controlled during surgery however unexpected bleeding can occur in the immediate postoperative period. If this occurs it will necessitate a return to theatre to control the bleeding.
- Infection (<1%) – this is very rare. However you are given antibiotics during induction (when you are going to sleep), as well as a course of oral antibiotics after your surgery to keep this risk to a minimum.
- Seroma (2-5%) – Gland excision behind the nipple as well as liposuction leaves an empty space where the body can collect fluid after surgery. This space is emptied by a drain placed there overnight but occasionally may need to stay in for longer. Keeping a chest compression garment on after surgery, as well as reducing movement is also essential to avoiding the risk of a fluid collection. If a fluid collection develops after removal of drains it may need to be removed via a needle through the skin. The fluid is removed as if it accumulates there is a risk of it getting infected
- Nipple compromise – this is a very rare complication. By cutting around the nipple, its blood supply is reduced and it gains it nourishment through small blood vessels from underneath. However glandular excision behind the nipple can reduce the blood supply further. To maintain good blood supply the incision only goes half way around the nipple. The risk of nipple compromise increases with diabetes, and smoking. Usually this settles with dressings.
- Change in nipple sensation – due to surgery around and behind the nipple the sensation of the nipple can be altered. If the nipple sensation decreases it gradually returns over a few weeks after surgery.
- Chest asymmetry – asymmetry before surgery is very common. Therefore often asymmetrical amounts need to be removed from each side of the chest to restore symmetry. While due care is taken to achieve as symmetrical result as possible, small degrees of asymmetries may still persist. Sometimes asymmetries of the ribs or bony skeleton can create the perception of asymmetry not related to the soft tissues.
- Hypertrophic or poor scars – How one’s body behaves to scarring is individual and largely genetic. Some types of skin are more prone to hypertrophic or keloid scarring, and some individuals and families are more prone to this. We will routinely advise you on how to improve the quality of scars over time. You should also discuss any history of abnormal scarring with Dr Aggarwal preoperatively.
Procedure FAQs
- We advise patients to get a referral for gynaecomastia surgery.
- It is possible to claim a Medicare rebate of approximately $73 for the consultation if you have a referral
- Furthermore, gynaecomastia surgery is associated with a Medicare Item Number which means with appropriate health insurance, rebates may be possible through Medicare and the health fund, reducing out of pocket costs for surgery.
- You can see us at our main practice at Gordon, or at our other locations at Hornsby, Hunters Hill or Camperdown.
- Please scroll to the bottom of the page to find out more information about these locations.
- Any of the hospitals where Dr Aggarwal works – but more commonly at Hunters Hill Private or Sydney Adventist Hospitals.
- Cease fish oil, and other supplements such as Ginkgo, Ginseng.
- Please discuss with Dr Aggarwal if you are on blood thinning medications as to when you should stop and recommence those.
- Stop smoking well in advance of surgery – Dr Aggarwal does not offer gynaecomastia surgery to patients who are actively smoking.
- You will be required to wear a chest compression garment for 8 weeks.
- Heavy lifting and upper body exercise will need to be avoided for 8 weeks to allow the chest tissues to heal.
- Heavy gym exercise may need to be discontinued for 3 months.
- Dr Aggarwal will provide you with the necessary scripts for antibiotics and pain relief. The antibiotics need to be continued for a week or until when the drains are out.
- No.
- Yes
- However we always encourage patients not to be away overseas shortly after having a procedure, so that we can closely follow your recovery and address any concerns that may arise.
- You may do gentle swimming in a pool or beach after 2-3 weeks once all wounds have healed and all the drains are out.
- It is best to not drive for the first 1-2 days after an anaesthetic. To reduce upper arm movements it may be best to avoid driving for the first week after surgery.
- No, patients will require a general anaesthetic in an accredited private hospital.
- Patients also need to stay in hospital for 1 night to allow drain monitoring, pain control.
- Not usually.
- However it is possible that surgery can temporarily change the sensation of the nipple.
- If affected, this gradually recovers over the weeks following surgery and can take up to 12 months.
- Diet and exercise is best to try to lose as much weight as possible.
- However in patients affected by gynaecomastia it may not reduce the chest despite weight loss.
- However results can be unpredictable and require multiple treatments with non-surgical means. Non-surgical techniques cannot reduce the glandular tissue that often accompanies gynaecomastia. Patients, especially those with moderate to severe excess fat and glandular tissue, will achieve the best results with surgery
Procedure Pricing
- The price for gynaecomastia surgery is approximately $5000-7000 out of pocket costs assuming an appropriate level of health insurance cover.
- This includes
- Surgical fees
- Hospital and theatre fees
- Anaesthetist fees
- Chest Compression Garment
- Follow up
- Please note that the above prices do not include
- Preoperative consultation fees – which are $280 for the initial consult and $140 for additional preoperative consultations
Meet Dr Aggarwal
Dr Aggarwal is a well regarded, respected, highly skilled and experienced Specialist Plastic Surgeon. Graduating at the top of his class throughout his training, Dr Aggarwal has completed fellowship training at some of the world’s most prestigious reconstructive and cosmetic plastic surgery institutions. He continues to publish research is prestigious plastic surgery journals, and is actively involved in the training of future plastic surgeons.
What sets Dr Aggarwal apart from others is his personal, affable and warm nature. Not only does he pay attention to detail, to producing natural, beautiful results but he ensures that the patient’s journey is just as special as their outcome. Dr Aggarwal looks after patients at two of Sydney’s most prestigious public hospital campuses (RPA and POWH/RHW), and operates privately on the North Shore.
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New Consulting Locations
In addition to our Hornsby and Camperdown locations, in 2018 we bring you:
- Hunters Hill (Lower North Shore) – conventiently located near one of Dr Aggarwal’s operative locations at Hunters Hill Private Hospital, Hunters Hill offers the convenience of accessing Dr Aggarwal in the lower north shore.
- Gordon (North Shore) – set to be our primary practice, our flagship rooms will be open for trading in August 2018. Follow our blog to see an update on progress.
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info@modeplasticsurgery.com.au
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Gordon NSW 2072, Australia
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