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Today we will look at some of the latest surgical options for the treatment of gynecomastia in men.

Gynecomastia is the enlargement of male breast tissue causing a "female" appearance. It is caused by increase in glandular tissue (glandular type), adipose tissue (also known as pseudo-gynecomastia), or both (mixed type).

Most cases of gynecomastia are idiopathic, that is no particular cause can be found. Obesity, medical drugs and use of anabolic steroids can also all cause gynecomastia. The common pathway being a hormonal imbalance with a shift in the ratio of testosterone to estrogen.

Medical treatment of gynecomastia can be successful and usually involves the use of testosterone injections or anti-estrogen drugs. However when medical treatment fails then surgical treatment is the only remaining option.

There are 3 main surgical options -

1. Classical Resection - this involves literally cutting away the enlarged glandular and fatty tissue through a cut in the skin which is usually made through or around the nipple. It is the most aggressive treatment with the highest potential to leave unsightly scars or an uneven appearance on the chest, but for the glandular type it is also the type of surgery likely to have the highest degree of success.

2. Liposuction - a small tube called a cannula is inserted via a tiny cut in the nipple or in the armpit and fat is sucked out of the chest. This is a less aggressive procedure than classical resection and less likely to leave scars or an uneven appearance. However it is of little use for glandular gynecomastia as it only removes the fat tissue.

3. Laser liposuction - as with normal liposuction this is a minimally invasive technique using a small cannula to suck out fat tissue through a tiny cut. But with this technique a laser is inserted first through the same cut to literally melt the fat before removal. The liquefied fat is then much easier to suck out. This technique is also of use in mild cases of glandular gynecomastia since the laser can also be used to destroy the glandular tissue. Finally the heat of the laser also has a tightening effect on the overlying skin causing it to shrink over the area where tissue was removed. This helps to reduce any appearance of loose skin after the procedure.

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