In Australia, with its beautiful weather and outdoor lifestyle, the male chest is often on display. For men who have gynecomastia (male breasts) or a deficiency in the pectoralis muscles it can be embarrassing and often they spend a lifetime hiding their chest. There are now surgical techniques that can help correct these problems and, if desired, can even be used together.

Gynecomastia

Gynecomastia is rarely discussed and kept a dark secret by those who suffer, but according to the American Society of Plastic Surgeons it is quite common, affecting an estimated 40 to 60 percent of men. It may affect only one breast or both and varies in size.

Sydney plastic surgeon Dr. Darryl Hodgkinson explained how it can affect some men: "It is particularly embarrassing for some men and they tend to retreat from social activities. Also their relationship with the opposite sex can be rather inhibited, which can create an inferiority complex."

Who has male breasts? "Obese men will definitely have male breasts, but also ageing men," said Dr Hodgkinson. "By the time men reach 55 years they can develop love handles and a small belly and, with this, usually breasts. These breasts are caused by fat and can often be removed with liposuction alone."

However, younger men can also develop male breasts from adolescence onwards. While some drugs and medical conditions have been linked with male breast overdevelopment, there is no known cause in the vast majority of cases. Dr Hodgkinson explained: "There are things that bring it on such as smoking marijuana and taking steroids. Body builders who take steroids will nearly uniformly develop male breasts."

These male breasts are caused by breast tissue and cannot usually be removed with liposuction alone. Dr. Hodgkinson treats these male breasts with breast reduction surgery. The procedure may remove fat, glandular tissue and in extreme cases excess skin, resulting in a chest that is flatter and better contoured.

"A small incision is made between the junction of the nipple and the skin," explained Dr Hodgkinson. "The nipple is elevated being careful to leave a small amount of tissue on the back of the nipple. The glandular tissue is carefully removed ensuring there is no damage to the muscle."

An association between the muscle and the skin can cause a contraction. Leaving a fine layer of tissue over the muscle prevents this from occurring. Dr. Hodgkinson also uses liposuction so the chest skin contracts in an even way without causing dimples.

"Not every cell should be removed however," stated Dr. Hodgkinson. "The art of male breast reduction surgery is to leave some tissue or then it would look like a thumb print. That’s why most people prefer to come to a plastic or cosmetic surgeon."

A drain is nearly always placed in the area for three or four days to prevent fluid build up and a compression garment is worn for about two weeks. Patients can usually resume normal activity in about three to four weeks. 

Before	After gynecomastia treatment by Dr. Hodgkinson

Pectoralis Muscle Deficiency

The pectoralis muscle is a major structure that when augmented gives a male a much more muscular look. The chest can be augmented with pec implants. These are firm silicone implants that can be trimmed or customised to fit each individual patient’s chest wall. There are two major groups of men who seek pec implant surgery:

Men who are born with chest wall deformities such as pigeon chest or Poland’s Syndrome (lack of one side of the pectoralis muscle). Most of these patients think correcting these problems is a huge operation of breaking the bones of the chest wall and moving them forward, however for these men, the deformity can be camouflaged well with pec implants.

"For these cases you make a customised implant that fits the defect," explained Dr Hodgkinson. "It may not be put under the muscle, it may be put under the skin and can give the chest a more aesthetic, masculine contour."

Before	After pec implants by Dr. Hodgkinson

The other group of men seeking pec implants are men who genetically don’t have very good muscles, or men who would like to have a better chest but don’t have time to get to the gym. "The critical issue for these men is to place the implant underneath the pectoralis muscles not under the skin," explained Dr Hodgkinson. "An incision is made under the armpit and the skin and muscle carefully lifted up and the implant inserted."

The implant comes in four sizes and before surgery the chest wall is measured so the right sized implant is chosen. After pec implant surgery the patient can still build his pec muscles for an even greater result. "Also, sometimes we do pec implants at the same time as gynecomastia because if a patient has been very embarrassed about his chest he might want to optimise the result."

The recovery period requires minimal activity for a week. A compression garment is worn day and night for four weeks and no rigorous activity can be undertaken for six weeks.

For men who have male breasts, or in the other extreme virtually no pec muscles there are various procedures that can help give a better, firmer, more masculine contour to the chest.

Before	After pec implants by Dr. Hodgkinson