Dr. Kusai Awni Ibrahim El Musa Clinic
Dr. Kusai Awni Ibrahim El Musa is a plastic and reconstructive surgeon. He studied medicine at the University of Jordan, trained at the American University of B…
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Male Breast Reduction (Gynecomastia) Doctors in Jordan
عملية إزالة التثدي عند الرجال
Gynaecomastia surgery in men removes the enlarged glandular tissue behind the nipple and the excess chest fat, then reshapes the surface so that it lies flat and in proportion with the chest wall. Gynaecomastia is common, appearing in adolescents, adults, and older men, and it is not a rare defect; many affected men live for years hiding it and avoiding taking off a shirt. The first step is not surgery but distinguishing three situations: true gynaecomastia, in which firm glandular tissue is palpable behind the nipple; pseudogynaecomastia, in which there is only fat and no gland; and a mixed picture with both. This distinction dictates treatment, because fat alone may be managed by liposuction, while firm glandular tissue is not removed by suction and requires excision. The second step matters even more: looking for a cause. Gynaecomastia may accompany a hormonal imbalance, a problem of the liver, kidney, or thyroid, medicines, supplements, and substances that affect hormonal balance, or rarely a testicular problem. Your full list of medicines and supplements is therefore reviewed, and blood tests and a complete clinical examination are requested. In adolescents it is frequently a phase that resolves on its own within months up to about two years, and for that reason **surgery is not rushed during adolescence** except in specific situations decided by the doctor. The limits of surgery must be stated plainly. **The operation treats the tissue, not the cause;** if the cause is a medication or an ongoing hormonal disturbance, the enlargement can return. **It is not a treatment for obesity** and not a substitute for weight loss, and anyone whose weight is fluctuating is advised to stabilise it first. **The scar is permanent,** even though it is small and hidden at the areolar border. **Complete symmetry between the two sides is not guaranteed.** Loose skin may remain after volume is removed and need further management, a depression or flattening of the nipple area can occur if too much tissue is taken, sensation may change temporarily or permanently, and some patients need a second corrective procedure. **The effect of the procedure on breast imaging (mammography) — and, in comparable procedures in women, on breastfeeding — is discussed before the decision is made.** After tissue excision the area looks different on imaging and shows scarring, so the radiologist must be told the surgical history at every future study. Removed tissue is normally sent for laboratory examination. It must also be said clearly that men do develop breast cancer, even though it is less common, and that a firm one-sided lump sitting away from the centre of the nipple, or fixed, or accompanied by nipple discharge, skin change, or an armpit node, is not ordinary gynaecomastia but a situation that is examined and imaged first. Candidacy for surgery is decided by clinical examination, not by reading. **Any new breast lump that is not explained by the cosmetic procedure must be assessed to rule out cancer, no matter how long ago the surgery was performed.**
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Procedure steps
- 1
Clinical examination: gland versus fat
The doctor palpates behind the nipple to establish whether there is firm glandular tissue or fat alone, measures the volume and degree of skin laxity, and compares the two sides. He also checks for a firm off-centre or fixed lump, nipple discharge, or an armpit node, because these signs move the case out of the cosmetic realm and into diagnosis.
- 2
Looking for a cause before considering surgery
Your full list of medicines and supplements is reviewed, with questions about any substances or performance products, about liver, kidney, and thyroid disease, and about puberty and fertility. Blood tests are requested according to the picture, imaging of the chest or testis may be needed when there is doubt, and referral to an endocrinologist may precede any surgical decision.
- 3
Choosing the technique and explaining the limits
If it is fat only, liposuction through small incisions may suffice; if glandular tissue is present it is excised through an incision at the areolar border, and suction is frequently combined with excision. It is explained that the scar remains, symmetry is not guaranteed, and loose skin may need further management, then photographs are taken and consent is signed.
- 4
Performing the operation in theatre
Surgery is performed under general anaesthesia or strong sedation with local anaesthesia in a fully equipped theatre. Fat is suctioned first to feather the borders, then a calculated amount of glandular tissue is excised while leaving a layer beneath the nipple to prevent it becoming depressed, bleeding is controlled, and both sides are compared in a semi-sitting position before closure.
- 5
Compression garment and follow-up
A compression garment is worn for a period set by the surgeon, because it reduces swelling and fluid collection and helps the skin adhere, and a small drain may be left. Activity and exercise restrictions are explained, the removed tissue is sent to the laboratory, and reviews are scheduled for the wound and later for shape, scar, and any need for correction.
Before the procedure
Give your doctor a complete list of everything you take: prescribed and over-the-counter medicines, sports supplements, herbal products, performance substances, and anything else, and hide nothing, because some of these are recognised causes of gynaecomastia and identifying one may spare you surgery or prevent the enlargement returning afterwards. Say when the enlargement began and whether it is one-sided, whether there is pain, nipple discharge, a firm lump, or an armpit node, and whether there has been any change in libido, fertility, or testicular size. Mention liver, kidney, and thyroid disease and long-term medicines, and ask about blood thinners and aspirin rather than stopping anything yourself. Stabilise your weight beforehand, since gaining or losing afterwards changes the result, and stopping smoking before and after reduces healing problems and infection. Fast as the anaesthetist instructs, arrange a driver and help for a few days, and buy the compression garment and loose front-buttoning shirts before your appointment.
After the procedure
Wear the compression garment continuously for the period your surgeon specified and do not abandon it early, because it is the single biggest factor in reducing swelling and fluid collection and in the final contour. Expect swelling, bruising, firmness, and numbness around the nipple that improves gradually over weeks to months, and expect the chest to look uneven at first. Avoid chest exercises, weight lifting, strenuous sport, swimming, and soaking baths until your surgeon allows them, walk around the house early and drink enough fluids to reduce clot risk, care for the small incisions as taught, and begin sun protection for the scars. **Seek immediate review if you develop sudden swelling on one side, severe and increasing pain unrelieved by painkillers, fever with purulent wound discharge, a sudden change in chest shape or an obvious fluid collection, darkening of the nipple skin, or shortness of breath or calf pain.** If the enlargement returns, come back so an ongoing hormonal or drug cause can be sought. **Any new breast lump not explained by the cosmetic procedure must be assessed to rule out cancer regardless of how long ago the surgery was,** because men develop breast cancer too.
Expected duration
Usually one to two and a half hours depending on whether it is liposuction alone or liposuction with excision, most often as a day case, with a return to desk work within days to a week and chest exercises after four to six weeks, depending on your surgeon's assessment.
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