44-year-Old Man with Liver Failure

MGM Healthcare successfully performed open surgical chest contouring on a 44-year-old man diagnosed with Grade 3 gynaecomastia and Stage 1 liver failure. Gynaecomastia is characterised by significant enlargement of male breast tissue and, in this case, was associated with excess skin and early-stage liver dysfunction. The patient, a police officer recently approached the hospital after his enlarged breasts began significantly affecting his daily life and professional responsibilities. He found it difficult to run and was unable to change comfortably at his workplace leading to public embarrassment, low confidence, and reduced self-esteem. The medical team at the hospital also diagnosed him with liver cell failure. In this case, it remains uncertain whether the gynaecomastia was idiopathic (with no identifiable cause) or secondary to liver cell failure. Considering the patient’s bleeding abnormalities secondary to hepatic failure, the team decided not to perform liposuction or other conventional techniques. Instead, we opted for open surgical chest contouring, a procedure commonly performed following massive weight loss or as part of gender-affirming surgery for female-to-male (FTM) transition. The surgical team headed by Dr. S. Narayanamurthy, Senior Consultant and Head of Department for Plastic, Aesthetic and Reconstructive Microsurgery and Dr. Suresh Rajendran, Senior Consultant, Department of Plastic Surgery and supported by Dr. Senathi Nanda Kishore, Clinical Director, Senior Consultant C Clinical Lead, Anaesthesiology and Surgical ICU, and Dr. D. Babu Vinish, Senior Consultant, Medical Gastroenterologist. During the three-hour surgery, the team performed a double-incision mastectomy with free nipple grafts after conducting an upper gastrointestinal endoscopy to assess and minimise the risk of gastrointestinal bleeding before and after surgery. Liver-friendly anaesthetic agents were used during the procedure. The entire gland was excised to achieve a flat, masculine chest contour. The team maintained symmetry on both sides and ensured that the chest contour was in harmony with the patient’s overall body proportions. The scar followed the natural crease of the inframammary fold, maintaining a gentle, natural curve. In his comments, 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.” Although gynaecomastia cannot always be prevented, it can be identified and treated at an early stage. Liver failure, testicular failure, thyroid abnormalities, and hormonal imbalances are among the major causes associated with this condition. Therefore, men with enlarged breasts should undergo periodic medical evaluations to identify and address gynaecomastia at an early stage.