Developmental size, shape and symmetry abnormalities of the male breast are common and affected men frequently seek surgical correction. In some instances there is an underlying medical condition that should be investigated and treated appropriately. In addition some medications may lead to the development of gynaecomastia. Gynaecomastia is common during adolescence but the majority resolve spontaneously and sufficient time should be allowed for this to occur except in cases where the deformity is so gross that the individual is liable to suffer psychological harm. In the NHS, surgical treatment for gynaecomastia is considered to be aesthetic although there may also be significant psychological and functional effects. As such, these patients are subject to the Exceptional Aesthetic Referral Pathway (EARP, see Aesthetic Surgery – RefHelp) and any indicated surgical procedures is only approved where the patient meets rigorous physical and psychological criteria and are not contraindicated on any of these measures.
The surgical options for the treatment of gynaecomastia include liposuction alone where the excess tissue is considered to be largely fatty. However, open excision, with or without adjunctive liposuction, may be required where there is significant glandular or fibrous breast tissue that cannot be removed by liposuction alone. The procedure is carried out under general anaesthetic, commonly with an overnight stay in hospital. Patients are likely to require 2-4 weeks off work.
M.A. & E. M-P. 11-12-24
Who to refer:
- Any patient with significant gynaecomastia following appropriate investigations (See Primary Care Management Section) and review of medications.
Who not to refer:
- Early physiological gynaecomastia that is likely to resolve spontaneously, unless severe or associated with major psychological distress.
- Patients who have not had potentially causative medications adjusted.
- Patients who have not had appropriate investigations and treatment of any underlying disorder.
How to refer:
Via SCI gateway to the Plastic Surgery service at St John’s hospital with appropriate details and background information.
Routine blood investigations for gynaecomastia should include TFT, U&Es, LFTs, Prolactin, Testosterone, LH, FSH, oestrodiol, beta-HCG and DHEA and it helps enormously if these investigations are completed prior to referral. The presence of a testicular mass or other abnormality should be excluded.
In some cases medical treatment with Tamoxifen is appropriate and effective but failure to respond is an indication for surgical intervention.
