06 June 2018
Summer holidays are approaching, but how many of us men are looking forward to days on the beach as much as we did in our youth?
Could it be that we don’t look as good in swimming trunks as we did 20 years ago?
According to Consultant Cosmetic Plastic Surgeon JJ Staiano, who runs a private clinic at Spire Parkway Hospital in Solihull, Birmingham, our biggest hang ups when it comes to stripping off our tee shirts is the fact that we seem to have suddenly developed ‘man boobs’!
Here Mr Staiano looks at what causes gynaecomastia (man boobs) and how they can be treated.
What causes the fat to gather in the breast region?
There is a long list of causes for gynaecomastia and they usually revolve around a hormonal imbalance with an excess of the female hormones encouraging excess breast growth. This hormonal imbalance can either be due to an intrinsic cause such as a hormone producing disease (eg liver or kidney disease or a tumour in the adrenal or pituitary gland) or an extrinsic cause from taking certain drugs, for instance steroids or drugs to treat prostate cancer or AIDS or even marijuana! It can also be caused by certain periods when hormones are out of balance such as puberty and senility (old age).
However, having said all that, by far the most common cause, is what we call ‘idiopathic’ - which means there is no cause and the vast majority of people with gynaecomastia have no reason for it!
Why do men who are not particularly overweight still develop fatty breasts?
In most cases, we don’t know why some men develop gynaecomastia. While the gynaecomastia is made up of fatty tissue (as well as glandular tissue), it may not respond to weight loss once you have reached your ideal weight.
Can they be prevented by diet and exercise?
Gynaecomastia is usually a combination of an excess of the dense glandular tissue and the fatty tissue that makes up the breast. An excess in the fatty tissue can be caused by being overweight and so it is always important to make sure that you are at your ideal weight before considering surgery and in these cases diet and exercise can help.
While it is no guarantee that diet and exercise will improve the condition it is important to lose weight before having surgery because weight fluctuations after surgery can have an unpredictable effect.
If a patient chooses surgery what will this entail – what does the surgeon do?
Surgery usually involves liposuction to remove the fatty tissue. This is done through small incisions which usually heal well and can be difficult to see. If there is hard glandular tissue beneath the nipple this will need to be removed. This is done through a u-shaped incision at the base of the areola (the brown area around the nipple). This also tends to heal well so that you can take your shirt off in public without having visible scars on your chest.
In cases where the gynaecomastia is more extensive and there is an excess of skin once the fat is removed then you may need to have the skin removed. This will create scarring either all the way around the areola or across the chest and can be more visible.
How long is an ‘average’ operation?
Surgery takes around two hours depending on the extent of the condition.
How long will the patient be in hospital?
Surgery is normally done under a general anaesthetic (you get put to sleep) and usually involves an overnight stay; however, it can be done as a day case.
Will there be much scarring?
The aim is to hide the scarring so that you can take your top off in pubic without anyone noticing. Only in cases of more severe gynaecomastia with skin excess does the scarring become more obvious.
What about excess skin, is that taken away during the operation?
There may be excess skin, but when this is removed, the scarring is more obvious and so, if you have good quality skin (particularly for young patients who are non-smokers), we tend to avoid removing the skin in the hope that it will re-tighten once the breast tissue is removed.
Has the demand for gynaecomastia surgery increased in the last ten years?
The demand has always been high but one of the problems is that men tend not to talk about it so every patient thinks that they are the only one with the problem.
Is there a typical age group?
We see patients of all ages but the most common age group is 25-35 when patients want to take their children swimming but feel uncomfortable with their shirts off.
What sort of feedback have you had from patients in the past?
Gynaecomastia surgery is life changing, mainly because men tend to live with the problem for many years before plucking up the courage to do something about it.
However, men are also understated and less vocal than women when it comes to talking about it and so they talk less about it in public. That's why we have an army of satisfied patients who are happy to talk to prospective patients in our ‘buddy scheme’
Q: How quickly could I have a consultation, and how much would it cost?
A: It depends on the availability of the consultant you wanted to see, but we pride ourselves on getting you fast access to diagnosis and you can often get a consultation within 24/48 hours. Initial consultation fees vary by consultant, but between £175-£250 is a reasonable guide.
Q: If I need surgery, how quickly could I have it?
A: We have no waiting lists at Spire Parkway, but again it depends on the availability of the consultant you wanted, but as a guide, and subject to your pre-operation assessment, between one and two weeks.
Q: I don’t have health insurance, can I self-pay?