Gynaecomastia Surgery in Kuching

Overview

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What gynaecomastia is

Gynaecomastia is enlargement of glandular breast tissue in men. It is genuinely common: it affects a large proportion of adolescent boys, most of whom resolve without treatment, and it appears again in a significant number of men in middle and later life.

It is worth distinguishing true gynaecomastia, where firm glandular tissue sits behind the nipple, from pseudogynaecomastia, where the fullness is fat alone. Most patients have a mixture of both, which is why the operation usually combines two techniques.

Why it happens

Common contributors include normal hormonal changes at puberty and with age, being overweight, certain medications (including some used for prostate conditions, blood pressure, depression and reflux), anabolic steroid use, and alcohol or recreational drug use. Less commonly it is caused by liver, kidney, thyroid or testicular disease.

This matters clinically. Before offering surgery, Dr Kueh will take a history and, where indicated, arrange investigation to rule out an underlying cause. Some cases resolve when a contributing medication is changed. Sudden, one-sided or painful enlargement always warrants assessment, since male breast cancer, though uncommon, does occur.

How surgery is done

The approach depends on what your chest is actually made of.

Liposuction alone

Where the fullness is predominantly fat with little glandular tissue, liposuction through two or three tiny incisions may be enough.

Gland excision with liposuction

The most common approach. Firm glandular tissue is removed through a small incision along the lower border of the areola, where the scar blends into the colour change. Liposuction then blends the surrounding contour so there is no crater or step.

With skin excision

Where there is substantial excess skin — typically after major weight loss or in longstanding severe cases — skin must be removed as well. This gives a flatter chest but leaves longer scars, and the trade-off is discussed carefully beforehand.

Who it may suit

• Men whose gynaecomastia has been stable for at least a year
• Men in whom an underlying medical or drug cause has been excluded or addressed
• Men at a stable weight, since weight change alters the result
• Non-smokers in good general health

Who it may not suit

• Adolescents whose gynaecomastia is recent — many resolve on their own, and surgery is usually deferred
• Men currently using anabolic steroids, unless they stop
• Men with a treatable underlying cause that has not yet been managed
• Men still actively losing weight

What recovery involves

Recovery is generally quicker than patients expect. A compression vest is worn for four to six weeks to control swelling and help the skin settle onto the new contour. Most men return to desk work within three to seven days.

Chest and upper-body exercise is avoided for around four to six weeks. Bruising and swelling are normal for the first few weeks; the chest often feels firm and numb initially, and sensation returns gradually. The final contour is usually clear at three to six months.

Risks and limitations

Risks include bleeding, haematoma (the most common early complication after gland excision), infection, altered or reduced nipple sensation, and visible or thickened scars.

Contour problems are the most relevant aesthetic risk: removing too much tissue directly under the nipple can leave a saucer-shaped depression, while removing too little leaves residual fullness. Some asymmetry between the two sides is common, because the two sides usually differ to begin with. Loose skin may remain if skin elasticity is poor. Occasionally a second, smaller procedure is needed to refine the result.

Gynaecomastia can recur if the underlying cause returns — resuming steroids, significant weight gain, or restarting a contributing medication.