Today, most people want to look their best, whether that’s appearing youthful and dynamic in the workplace, being able to wear fitted clothes socially or wanting to sport a toned physique. As a result, cosmetic surgery for men is on the rise and the fastest growing cosmetic procedure is male breast reduction, commonly referred to as gyno surgery. As a leading expert in this area, Mr Maisam Fazel has developed his own male breast reduction technique called the VAGS (VAser, gland, skin) procedure, which he discusses with us here.
Why do some men develop breasts?
The ageing process, weight gain or occasionally previous steroid use can leave many men with prominent male breasts or ‘moobs’. This can significantly affect one’s confidence by limiting the type of clothing one chooses, and even stops some men from taking their t-shirt off at the beach or pool.
What is gynaecomastia?
Gynaecomastia simply means male breast tissue. Classically, there are two types of male breast tissue:
i) True gynaecomastia: All men have a small amount of glandular breast tissue in the chest but in some men it can over-develop and create a breast-like appearance. This can be due to an endocrine disorder, age-related hormonal changes, a side effect of certain drugs, or it can be genetic. However, usually no cause is ever found.
ii) Pseudogynaecomastia: Commonly, the patient may have an increase in fat deposition overlying the chest muscles. This fat can be very resistant to diet and exercise. If the fat deposition is significant, then the skin can also become stretched.
Most men actually have a combination of the above, so the surgical solution must take into account all the underlying factors.
Am I suitable for a male breast reduction?
Most patients are suitable for gynaecomastia surgery. However, the first step is for us to assess whether there in an underlying cause for the male breast tissue (such as a hormonal imbalance or the use of a particular medication), and assess your overall suitability for surgery during your consultation.
What does surgery involve?
The VAGS (VAser, gland, skin) procedure combines 3 principles:
- VASER liposuction to the chest to remove the fatty tissue
- Gland excision: to remove the over developed breast gland
- Skin excision: to tighten the loose skin
The procedure is usually performed as a daycase operation either under local anaesthetic with sedation or under a general anaesthetic.
Typically, the procedure start with VASER liposuction to the chest through small liposuction holes in the armpit area. This allows us to remove the excess fat in the chest area and to shape the chest. The reason VASER is used rather than traditional liposuction is that VASER is less traumatic to the tissue and thus recovery tends to be faster. In addition, VASER causes more tightening of the skin over the 12 months after the procedure which is beneficial in cases where there is loose skin as well.
After the VASER has been performed, a small cut in the skin is made to remove the breast gland. This can either be a semi-circle cut around the nipple or a straight line cut in the armpit. Once the gland has been removed, the incision is closed with dissolvable stiches. These scars tend to heal well and are not very noticeable.
If there is loose skin, we usually recommend leaving this alone to settle for up to one year, as frequently the subsequent skin tightening caused the by VASER eliminates the loose skin. In this way, patients can avoid or reduce the scar around the nipple which can be more prominent than the semi-circular scar.
Once the surgery is complete, a compression garment is put on. This needs to be in place 24 hours a day for 3 weeks, followed by 12 hours a day for another 3 weeks. During the first few weeks, I would also recommend Manual Lymphatic Drainage (MLD) to the chest.
The VAGS gynaecomastia surgery generally takes between one to two hours, depending on the complexity of the planned surgery.
What are the risks?
All risks will be discussed in full during your male breast reduction consultation before you make the decision to proceed. You will also be shown pictures of patients who have had surgery so that you can understand what the likely result will be.
After your consultation, you will receive further written information about your proposed surgery which will describe the risks in detail. If you decide to proceed with surgery, we will ask to see you again to ensure that you have had an opportunity to ask any questions and to check that you understand the proposed surgery with its associated risks.