Definition & Overview
A mastectomy for gynaecomastia is a medical procedure used to treat male patients with abnormally enlarged breasts. The condition usually begins during the early stages of male development, such as puberty or adolescence. It is believed to be caused by hormonal changes that occur during this time. However, it can also be due to medications that disrupt the balance between the hormones androgen and oestrogen. In some patients, the condition resolves without treatment. In some, however, the condition causes severe and prolonged enlargement that causes embarrassment and low self-esteem. Thus, some patients choose to undergo a mastectomy.
Who Should Undergo and Expected Results
A mastectomy is for males who suffer from gynaecomastia, which is considered as the most common benign (noncancerous) disorder that affects the male breast. It most commonly affects newborns, adolescents, and older men. However, most newborn and adolescent cases are temporary and resolve without treatment.
Gynaecomastia is characterised by excess glandular tissue in the chest area. It can affect one breast or both. Its symptoms include:
- Dimpling of the skin
- Nipple retraction
- Milky discharge from the nipple
- Enlarged areola
- Asymmetric breasts
Although it is benign, gynaecomastia can cause psychosocial problems for those affected.
Gynaecomastia can be caused by several factors, such as:
- Hormonal imbalances
- Ageing, which causes a natural decline in testosterone production
- Underlying medical conditions, such as:
- Klinefelter syndrome
- Cancer, such as testicular cancer
- Testicular tumours, such as Leydig cell tumours or Sertoli cell tumours
- Endocrine disorders
- Chronic liver disease
- Aromatase excess syndrome
- Peutz-Jeghers syndrome
- Human growth hormone
Human chorionic gonadotropin
Excess fatty tissue
Individual cases of gynaecomastia are categorised based on severity:
- Grade I – There is minor breast enlargement with no excess skin
- Grade II – There is moderate breast enlargement with no excess skin
- Grade III – There is moderate breast enlargement with excess skin
- Grade IV – There is a highly noticeable enlargement of the breast with excess skin
Mild cases of gynaecomastia can usually be managed with medical treatment, lifestyle changes, proper diet, and exercise. Unfortunately, cases persisting beyond two years are often unresponsive to non-surgical medical treatment, making surgery the only available option.
Hormonal imbalances and existing medical conditions are considered as valid medical reasons for undergoing surgical treatment for gynaecomastia. On the other hand, mastectomies used to treat gynaecomastia caused by obesity, medications (that can be discontinued), and excess fatty tissue are considered as a cosmetic treatment.
Furthermore, since some cases of gynaecomastia are temporary and do not require treatment, patients need to meet certain criteria before they are considered as a good candidate for a mastectomy. These include the following:
- The condition has persisted longer than three years after the initial evaluation.
- The enlargement is severe, or greater than 4 cm in diameter.
- The condition causes the patient emotional disturbance.
- The tissue that needs to be removed is glandular and not fatty tissue.
The goals of a mastectomy include the following:
- To restore the normal size of the patient's breast
- To correct breast deformities
How is the Procedure Performed?
A mastectomy for gynaecomastia works by surgically removing glandular breast tissue. If only fatty tissue has to be removed, surgeons may perform liposuction-assisted mastectomy. However, if the breast gland itself has to be removed, a subcutaneous mastectomy is required.
The following steps are taken to perform a mastectomy:
- The patient is placed under general anaesthesia.
- The surgeon cuts into the patient’s skin. He may use:
- an inferior periareolar incision
- a periareolar circular incision
- an inferior periareolar incision with lateral, superior, and medial extensions
- a periareolar circular incision with transverse lateral extension
a circular incision with inferior, medial, lateral, and superior extensions
The surgeon accesses the glandular tissue underneath the areola. For massive enlargements, the surgeon may need to remove more skin and make a deeper excision.
- The tissue is then excised.
- The surgeon may place a surgical drain if necessary. This helps remove the blood and liquefied fat that may leak from the incision during the first 24 hours after the procedure.
- The surgeon puts all subcutaneous tissues back and closes the skin incision with sutures.
Since the surgery removes the tissue causing the enlargement, its effects are visible right after. Patients have to wear compression garments for at least four weeks. The appearance of the breasts will continue to improve until the final results become visible after a year.
The recovery period is not that long. Most patients can go back to work after two days, and resume their normal activities within a few days. They are typically scheduled for a follow-up visit one week after the procedure, then once a month for the next six months.
Undergoing a mastectomy for gynaecomastia can reduce the chances of a recurrence, but this is not 100% guaranteed.
Possible Risks and Complications
Patients who undergo a mastectomy for gynaecomastia are at risk of:
- Surgical wound infection
- Breast asymmetry
- Changes in breast sensation
- Necrosis of the areola and/or the nipple
- Deformed breasts
Song YN, Wang YB, Huang R, He XG, Zhang JF, Zhang GQ, Ren YL, Pang JH, Pang D. “Surgical treatment of gynecomastia: mastectomy compared to liposuction technique.” Ann Plast Surg. 2014 Sep;73(3): 275-8. http://www.ncbi.nlm.nih.gov/pubmed/23644441
Mario Mucio Maia de Medeiros. “Surgical approach to the treatment of gynecomastia according to its classification.” Rev Bras Cir Plast. vol. 27 no. 2 Sao Paulo Apr/June 2012. http://www.scielo.br/scielo.php?pid=S1983-51752012000200018&script=sci_arttext&tlng=en