How do your manboobs interfere with your life?

Even though gynaecomastia (manboobs) is a relatively common condition in men, its impact on the lives of sufferers is grossly underestimated. Nearly all of my patients describe some of the following symptoms:

Dreading going on beach holidays with friends

This is an extremely common complaint my single patients describe during our medical consultation. Often, young, single young men dread going on holiday with their pals because they fear endless teasing about the size of their chests. Usually they try and cover up the area with t-shirts or in the most extreme cases avoid the holiday completely. There really is no need for this as the condition can be successfully treated. Leave about 12 weeks before a holiday as the absolute latest to have the surgery.



Avoid taking their top off in front of their partners

This is a really unfortunate situation and I generally advise my patients that their partners are highly unlikely to be concerned by their chest size. However, as part of the psychological impact of gynaecomastia, these reassurances fall on deaf ears, so low is the confidence of these young men. Often their partner will try to reassure them but after several years they will finally realise that their loved one is really suffering and then supports their desire to seek medical advice.



Frustrated at not being able to wear fitted shirts / T-shirts

Current fashion is slim-fit and this is often not compatible with over sized chests especially if the men are over sensitive with the size of their chest. Usually guys will cover up with loose clothing and several layers of clothing even in the summer. Quite often I see guys sweating in the consultation because they have so many layers on despite it being the middle of summer. Its not just T-Shirts, it is also regular work shirts which can be too tight particularly around the sides of the chest. If this affects you, do mention it during your consultation.



Dread taking their young kids swimming

For any young father, being able to take your kids swimming should be an absolute pleasure. For many gynaecomastia sufferers the absolute opposite can be true and these young dads have these priceless moments dominated by embarrassment. In only a few men do their children comment on their father's chest size. But if your condition does inhibit you participating in this family time, you should speak to a doctor.


Male Breast Reduction Surgery can fix all of the above concerns
Thats why I just love performing this surgery as it really does change the lives of my patients for the better. There is no reason why these men should not be able to lead a normal life. For sure, if the problem is 100% psychological and not physical, surgery will NOT help. But that is why the consultation is necessary to make sure that surgery is the best option. I have helped 100's of men lead normal lives and bury their demons.

For an appointment in London or Harpenden please call 01582762877 or email my secretary.

What causes gynaecomastia?

History of gynaecomastia

As early as the seventh century when Paulis of Aegina first described surgical excision, men have presented requesting reduction of their gynaecomastia. Various excision techniques have been described over the decades, and more recently liposuction has gained popularity. The optimal form of surgery depends on the classification of gynaecomastia, with the outcome of surgical intervention to restore a normal adult male chest appearance. However, it is the author’s experience that often affected men prefer an adolescent appearance, such is their stigma attached to any form of breast swelling.

What is gynaecomastia?

Gynaecomastia is best described as abnormal breast tissue enlargement in men. It is caused by an imbalance of the oestrogen / androgen ratio either during normal physiological changes such as at birth, puberty or in the seventh decade of life, or due to pathological conditions (See Table 1). However, the most common cause is unknown, accounting for 25% of all cases.

Table 1: Common causes of gynaecomastia

Social Impact of Gynaecomastia

There have been relatively few publications on the psychological aspects of gynaecomastia in men, compared to the variety of surgical techniques. It is the psychological factors that cause men to request surgical treatment for a relatively benign condition. Therefore, it is important to understand these factors to help manage the patients and their expectations.

Nuzzi et al. compared the physical and psychological differences between affected adolescents and healthy adult males, and identified that there was no difference in the severity of gynaecomastia and the psychological scores [5]. Moreover, they confirmed that there was a significant negative impact on psychological scores in adolescents with gynaecomastia.

Wassersug et al. suggested that due to the embarrassment from their breast size, sufferers would refrain from otherwise beneficial exercise [6]. The associated loss of masculinity was the biggest contributing factor to their embarrassment. Recently, media attention has started to focus on male beauty and not just female perfection. This may have had a significant impact on men’s perception of their own bodies and may have led to a rise in fitness trainings. Certainly, male fashion uses slimmer fitting shirts and tops and for those that suffer with gynaecomastia, these items of clothing are impossible to wear, causing further social embarrassment.

We identified that only 6% of men who had corrective surgery scheduled, had the confidence to go topless in front of their friends, clearly demonstrating social inhibition. A common driving factor in men requesting surgery was that their embarrassment was inhibiting their swimming habits, and in particular when taking their own children swimming. Indeed 16% of patients would not go swimming without covering up with a T-shirt, when with their children. Oversized clothing was worn in 45% of patients in an attempt to hide their breasts. Social embarrassment in front of their partners was present in large numbers with 48% of men not able to go topless with their loved ones.

Clearly these statistics demonstrate the severe impact gynaecomastia has on these men’s social lives. Routine dismissal in primary care compounds their lack of self-esteem and this practice must be discouraged with further advice on best management.

Want to get rid of Moobs like Jabba?

Its not long now until the most awaited film for years, episode 7 of the Star Wars saga, The Force Awakens. Now how is this related to treating gynaecomastia I hear you ask - well, its not. Its just a
very weak attempt at connecting this topic to Star Wars - and the Moobs like Jabba connection!

However, seriously speaking, I have seen several men this week who have decided that they are going to make a change for the better in 2016 and they are going to get their chest reduced to a more acceptable size. When a patient comes to see me for a consultation I typically hear the following key points in their history:

• They have suffered from gynaecomastia since puberty
• It affects their choice of clothing - they want to wear slim fit shirts
• A successful procedure will boost their self esteem
• They want to be able to go swimming without feeing self conscious
• Diets don't help

Some of my patients will have used some medicines in the past which without their knowledge could have contributed to the development of gynaecomastia.

Common drugs which can cause gynaecomastia include:

• Cimetidine and Ranitidine ( antacids)
• Finasteride ( for hair regrowth)
• Anabolic steroids ( for body building)
• Ketoconazole (anti-fungal shampoo)
• Digoxin, Amiodarone, Nifedipine & Verapmil (Heart & Blood pressure)

If you would like an appointment to discuss treating gynaecomastia, then please call 01582762877 now or complete this enquiry form.

Want a chest like Chris Eubank or Anthony Joshua?

Many of my patients are slim, heathy and enjoy gym and sport. Indeed I have treated many young men aspiring to be boxers just like Chris Eubank & Anthony Joshua.

These patients are extremely fit yet still have some degree of breast swelling - gynaecomastia. In most of these cases, the condition is true gynaecomastia which is some resistant breast gland which needs surgical removal. In others there is mixed gynaecomastia which consists of fatty breast tissue as well as glandular tissue. Again this needs surgical removal but it can be removed via my VASER Lipo technique or traditional excision.



So if you are bothered by the appearance of your chest let me explain how I treat my patients with gynaecomastia:

1. After you contact the clinic you will be offered a full consultation with me. There is a fee for this consultation.
2. During the consultation I will obtain a full medical history from you and you will also get the opportunity to explain in detail why you would like to be considered for surgery and what are your options. You will also be shown some intraoperative video if you are interested. Many patients also want to find out what the recovery involves, how much time off work they need and what are the side effects and risks following gynaecomastia surgery in the UK. All of this will be explained to you.
3. During your examination I will assess the type of gynaecomastia you have - true, mixed or pseudo. I will also explain where your scars would be and what sort of result you should expect.
4. If after your consultation I feel you are not suitable for VASER lipo I will explain why. It is important to me that you understand how VASER can help and what its limitations are. Only 5% of patients who attend need to be referred to a colleague for formal gland excision through a  bigger scar.
5. If we feel that VASER is a suitable option for you, then my secretary will sit with you and explain the pre-operative procedure and also your quote.
6. We respect the GMC's guidelines and allow a 14 day cooling off period between consultation and surgery, however in most cases we have a 4 week wait.
7. Before surgery you will have an appointment with my nurse to check your fitness for surgery - this is a standard pre-op assessment. Blood tests are taken as are measurements and it is also another opportunity to ask questions.
8. On surgery day you will meet the anaesthetist and the nurse again and myself. The procedure takes place shortly after you arrive and you will be out of the operating theatre after about 90 mins. 
9. In the recovery room, your companion can sit with you until you are ready to go home (about 60-90 mins after the surgery is finished).
10. We see you the next day for a wound check and to go through any instructions on how to look after yourself in the forthcoming days.
11. We review you at 1 week post op and 8-12 weeks post op.
12. :-)

If you would like to schedule an appointment please call 01582762877 for a consultation in London or Harpenden.

Gynaecomastia treatment - don't forget the side walls

For many sufferers of gynaecomastia, getting T-Shirts and Work Shirts to fit comfortably is an issue. Often they describe the shirts being too tight around the sides of the chest as well as at the front. If this is a major problem for my patients I recommend not only just reducing the front of the chest but also extending towards the sides of the chests to reduce the density of the breast tail.

treating the lateral chest walls only

In the above case, the gentleman received just a single 5mm incision at the bottom of the nipple area. I then treated the side of the chest wall giving him a more streamline silhouette and looser fitting shirts.

Daily stretches and massage are advisable when treating this area to reduce contracture of the skin and delayed healing. But otherwise, this heals very simply and very quickly. The photos above are taken 2 weeks apart.

Treating gynaecomastia has become an areas of special interest for me in my VASER practice. We are starting to offer suitable patients with pure fatty gynaecomastia a non-surgical option called fat-freezing. Less than 1% of patients so far are suitable. So for the other 99% - VASER is an excellent choice for treating gynaecomastia.

Side chest wall reduction for increased definition

Most patients who present to me with gynaecomastia are mainly focussed on the front of their chests as this is what tends to stick out under clothing. However, I always examine the sides of the chest walls as if there is excess tissue in this area, often called the breast tail. The lateral chest wall (sides of chest) contribute to the overall chest measurement size and so by reducing the size of these fat pads, your shirts will fit better and be looser. This will mean more comfortable days at work and also more confidence when wearing T-shirts or Slim-Fit shirts.

If you are considering cosmetic surgery for chest reduction and you live in the UK then please contact my PA to book a consultation. 

Psychological Impact of Male Breast Reduction in London & Hertfordshire

I have been performing gynecomastia surgery using VASER since 2008 and have improved the lives of many men which has been extremely rewarding.

Many men report the many positive changes to their lives after having had Male Breast Reduction at Riverbanks and I published these recently.

How Male Breast Reduction Improves Mens' Lives:

• They can now take their kids swimming without feeling self-conscious about the size of their chests
• They don't mind undressing in front of their partners
• They are happy to go on beach holidays with friends
• They stop wearing oversized clothes and enjoy the current fashion of slim fit shirts.

I hear these stories time and time again from my patients and it motivates me to do the best job I can in order to stop their silent suffering and let them lead normal lives.

These findings were also presented in September 2015 to the British College of Aesthetic Medicine in London.

There are many more clips of mine for you to watch on my YouTube Channel which features gynecomastia videos including patient testimonials and surgery clips.