A multidisciplinary team at MGM Healthcare has successfully treated a 44-year-old man with severe gynaecomastia complicated by liver dysfunction. The patient had Grade 3 gynaecomastia, excess chest skin and Stage 1 liver failure, making the surgical procedure more challenging because of associated bleeding abnormalities.
The patient, who works as a police officer, sought medical help after the condition began interfering with both his personal and professional life. Physical activities such as running had become difficult, while changing clothes at work was also uncomfortable. The visible chest enlargement had further affected his confidence and caused significant social embarrassment.
During evaluation, doctors identified liver cell failure. However, they could not conclusively determine whether the gynaecomastia had developed independently or was related to the liver disorder.
Why a Conventional Approach Was Avoided
The patient’s liver condition had resulted in abnormalities affecting bleeding control. Because of this added surgical risk, the medical team decided against liposuction and other commonly used techniques for treating gynaecomastia.
Instead, the surgeons selected an open chest-contouring procedure. This approach enabled them to directly remove the enlarged glandular tissue and excess skin while providing greater control during surgery.
The operation was led by Dr. S. Narayanamurthy, Senior Consultant and Head of the Department of Plastic, Aesthetic and Reconstructive Microsurgery, along with Dr. Suresh Rajendran, Senior Consultant, Department of Plastic Surgery. The team also included Dr. Senathi Nanda Kishore, Clinical Director, Senior Consultant and Clinical Lead, Anaesthesiology and Surgical ICU, and Dr. D. Babu Vinish, Senior Consultant, Medical Gastroenterology.
Three-Hour Procedure
The approximately three-hour operation involved a double-incision mastectomy followed by free nipple grafting. An upper gastrointestinal endoscopy was carried out before the procedure to evaluate the patient’s risk of gastrointestinal bleeding and help the team plan the surgery more safely.
Anaesthetic drugs selected with the patient’s liver condition in mind were used during the operation.
The surgeons removed the excess breast gland completely and reshaped the chest to produce a flatter and more masculine appearance. Care was taken to achieve comparable contours on both sides and maintain proportions suited to the patient’s body frame.
The surgical scar was positioned along the natural inframammary fold, helping create a smoother and more natural-looking chest contour.
Dr. S. Narayanamurthy said, “Gynaecomastia is relatively common among men, but this case presented a unique surgical challenge because the patient also had liver dysfunction and associated bleeding abnormalities. Given these concerns, conventional approaches such as liposuction were not considered appropriate because it can be tricky with higher risk of bleeding during or after surgery. We therefore opted for an open surgical approach, which allowed us to remove the excess glandular tissue and skin while carefully controlling the surgical field. Our goal was not only to address the physical condition but also to achieve a well-proportioned, masculine chest contour that was in harmony with the patient’s overall body structure. The procedure required meticulous planning and coordination among the surgical, anaesthesia, and medical teams to ensure the patient’s safety.”
Importance of Early Evaluation
Gynaecomastia can arise from several underlying conditions and may not always be preventable. Liver disorders, testicular problems, thyroid abnormalities and hormonal disturbances can be associated with the development of enlarged breast tissue in men.
Medical assessment is therefore important when abnormal breast enlargement occurs. Identifying a possible underlying cause early can help doctors determine whether medical management or surgery is appropriate.
The case demonstrates the value of individualised treatment when a relatively common condition is accompanied by complex medical issues. Close coordination between plastic surgery, anaesthesia and gastroenterology teams allowed the doctors to address the patient’s functional concerns while carefully managing the additional risks associated with liver dysfunction.
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