Cosmetic plastic surgery is seldom essential and always carries risk. But some men do decide they need it. Male plastic surgery increased by 21% in 2009 according to the British Association of Aesthetic Plastic Surgeons. The most popular procedure for men was a breast reduction which went up by 80%. Consultant plastic and reconstructive surgeon John Pereira explains what’s involved.

How popular is plastic surgery for men?

We get about one man to every ten women for plastic surgery. In our clinic, the main procedures for men are for man boobs, noses, ears, liposuction and dealing with skin excess after major weight-loss.

Tell us more about the man boobs op.

Male breast development usually starts in early teenage years as hormones change. It’s usually a hard, tender lump just behind the nipples, usually on both sides. It usually disappears during puberty but not always. There are syndromes that can cause this too so blood tests may be needed.

Is there anything men can do themselves?

Yes, if you’re just overweight, the advice is diet and exercise.

But if you’re not overweight, it's more difficult. There are two techniques that men sometimes try, neither of which really work. Some men eat too much to put on weight to make the breast look better compared to rest of body. But the breast just gets bigger with the stomach. Others work out to develop their chest muscles but the muscle makes the breast look bigger.

At what age can you consider surgery?

Men need to be out of their teens and have finished puberty before considering this surgery unless the breast is huge. Most men I see have kept their breast growth to themselves during puberty and realise in their early 20s that it’s not going away.

What do you do?

There are two types of procedure. For a small, soft breast we’d just use a little liposuction. There’s little scarring and it all heals quickly. A larger, more fibrous breast needs an open procedure called a gynaecomastia reduction. We cut around the areola, the coloured skin around the nipple. This leads to visible scars so a patient may go from being self-conscious about his breasts to self-conscious about the scars on his chest.

It’s usually day surgery but that depends on the anaesthetic used. Either way, I advise people to take a week off work but that’s not always possible if people are self-employed. The longer you take off the better your recovery will be. You’ll need to wear a thin support under your clothes for about four weeks.

Will you operate on anyone?

No. We try to discuss the pros and cons.

The reaction of most men we see to prominent breasts is what you might call ‘appropriate’. They’re not overly concerned about their body in general just about their prominent breasts which they’d like reduced. But there is a smaller group with a disproportionate reaction compared to what I can actually see and they may show concern about other areas of body too. They may have a tendency for body dysmorphic disorder and are best helped in the first instance through talking therapies.

Are you concerned about people using surgery as an alternative to living healthily?

Yes, I am a little worried that some people use this as an alternative to exercise. These clinics where everybody is on a commission worry me. As I say, I personally don’t say yes to everybody. I probably only operate on between half and two-thirds of those who see me but I know that some of them might go elsewhere and find a less ethical surgeon.

How will you look 20 years after the procedure?

Liposuction removes a percentage of the active fat in a particular area. If you put on weight it won’t go on in this area so any general weight gain with the years won’t be more prominent on the breast.

In fact sometimes the opposite can occur with the open operation and the chest can look a little like a saucer. It’s one of the reason why the liposuction technique is preferable.

Can you get this on the NHS?

These days it’s generally not available although you might if you’ve had hormone treatment for prostate cancer which has caused the growth.

Private health insurers won’t pay either. There’s usually a clause about not paying for the removal of non-diseased tissue.

So you’re going to have to pay. How much does it cost?

The ball park fees for the ops at our clinic which include surgeon, anesthetists, general anesthetic and hospital stay are £3870 for open operation and £3320 for the liposuction.

What advice would you give when it comes to choosing a surgeon?

Make sure you choose a surgeon who is doing these operations regularly. Make sure you see him not just a nurse/counsellor or a salesperson. Ask to see the surgeon’s before and after pictures and to be put in touch with someone else who has the same procedure.

Choose a decent clinic. Some plastic surgery clinics do not have the right back-up or facilities in the event of a problem. The establishment should be registered as a health care facility by the Care Quality Commission.

The big three private health care providers are BMI, Spire and Nuffield.

Don’t book without seeing the surgeon and don't even book on the day you first talk with the surgeon. Don’t fall for any routine that encourages you to pay non-refundable deposit immediately to secure some special deal or whatever. This is all marketing, more suited to replacement windows. Go away and think about it.

If you’re tempted to go abroad make sure you check it out very, very thoroughly. This is not something you should fit in on a holiday. There tend to be fewer regulations outside the EU.

• John Pereira is based at the McIndoe Surgical Centre in West Sussex. He has carried out around 200 operations for male breast reduction.