Liposuction for men: chest and flanks

Male fat deposits in a different pattern from the female one, and two areas account for most requests: the flanks, and the chest. They are different problems and the second is frequently not a fat problem at all.

Gynaecomastia is not always fat

Enlargement of the male breast may be adipose tissue, glandular tissue, or both, and the treatment differs accordingly. Establishing which is present is the substance of the consultation, because liposuction removes fat and does not remove gland.

Causes include the hormonal shift of puberty, which in most cases settles within about two years; several classes of medication, including anti-androgens and some antidepressants and cardiac drugs; anabolic steroid use, where the exogenous androgen is aromatised to oestrogen; and systemic conditions affecting the liver, kidney, thyroid or testes. Where the history or examination suggests any of these, that is investigated before an operation is planned.

How it is graded and treated

Where the enlargement is mild and predominantly fatty, liposuction alone is usually sufficient, through small incisions at the edge of the areola or in the axillary fold.

Where there is a firm disc of glandular tissue behind the nipple, liposuction will not remove it and excision through a semicircular incision at the lower areolar border is added. Liposuction alone in this situation leaves the disc behind and produces a poor result.

Where enlargement is marked and the skin envelope is significantly redundant, skin has to be removed as well, and that carries more visible scars. This is the group in whom the trade-off has to be discussed explicitly before proceeding.

The flanks

Flank fat responds poorly to diet and training in men and is a straightforward liposuction target. Access is through small incisions; tumescent technique is standard. Chest and flanks are commonly treated in the same operation, which means one anaesthetic and one recovery.

What liposuction will not do

It removes fat; it does not create muscle definition, and it does not tighten skin. Where the skin has lost elasticity — after significant weight loss, with age, or with sun damage — reducing the underlying volume can make laxity more apparent. That is a reason to plan a different operation, not a reason to remove more fat.

Fat cells removed are gone permanently. Those remaining still respond to a sustained calorie surplus.

Preparation and recovery

Pre-operative bloods, and clearance where there is a cardiac or respiratory history. Nicotine has to stop for the interval your surgeon specifies. Aspirin, NSAIDs and several supplements are stopped beforehand on advice.

The first days are the most uncomfortable, with swelling at its peak. Movement is encouraged early. Compression is worn for several weeks. Desk work is generally resumed within about a week and training is reintroduced in stages with clearance. Residual swelling resolves across the following months, and the final contour is apparent at three to six.