What the procedure is
Gynecomastia is enlargement of breast tissue in men. It may be genuinely glandular, fatty, or a mixture of both, and this distinction determines the approach to treatment.
Before surgery is considered, a medical assessment is made to exclude treatable causes, including hormonal disorders, liver, kidney or thyroid disease, and certain medications, supplements and anabolic steroids.
Gynecomastia appearing in adolescence frequently resolves on its own within about two years, so surgery at that stage is usually deferred in favour of observation.
Where the component is mainly fatty, liposuction may be sufficient; a glandular component requires surgical excision, because glandular tissue is denser and is not removed by suction alone.
Who is a suitable candidate
- Men in whom gynecomastia has persisted after medical causes have been excluded and after an adequate period of observation.
- Men whose weight is stable, since weight gain increases the fatty component.
- Men who have stopped any contributing substance, including anabolic steroids, for a period determined by the surgeon.
- Men in good general health.
How it is performed
Performed under general anaesthesia, or local anaesthesia with sedation, usually taking one to two hours.
Where the component is fatty, liposuction is used through small incisions.
Where glandular tissue is present, a small incision at the lower border of the areola is added to excise it directly.
In cases with marked excess skin, skin excision may also be needed, which leaves longer scars.
Recovery
- Discharge is usually the same day.
- A compression garment is worn on the chest for several weeks as directed.
- Return to desk work is often within days to a week.
- Chest exercise and weightlifting are usually deferred to around four to six weeks.
- Swelling takes weeks to settle, and the final shape usually stabilises within three to six months.
Scars
An incision at the areolar border sits at a natural colour boundary, which makes it less noticeable over time.
Liposuction incisions are small.
In cases requiring skin excision the scars are longer and more visible; this is discussed beforehand.
Risks and complications
Every operation carries risk. This is an educational list, not an exhaustive one; the risks specific to your case are discussed during consultation.
- Risks of anaesthesia.
- Asymmetry between the two sides.
- A localised depression or flattening behind the areola if too much tissue is removed.
- Altered sensation in the nipple or areola, which may be temporary and in some cases permanent.
- Haematoma or fluid collection.
- Infection.
- Thickened scarring.
- Recurrence if the original cause persists, such as continued use of a contributing substance or weight gain.
Combining with other procedures
Liposuction of the flanks or the chest circumference is often carried out in the same sitting to improve the overall contour of the torso.
Common questions
Does gynecomastia return after surgery?
Excised glandular tissue does not grow back, but recurrence is possible if the original cause persists, such as continued use of contributing substances or significant weight gain.
Is liposuction alone enough?
It is sufficient when the enlargement is mainly fatty. Where there is dense glandular tissue, suction alone will not remove it and excision is required. Clinical examination, and sometimes imaging, determines which applies.
Are tests needed before surgery?
Usually yes. Hormonal tests and liver, kidney and thyroid function are requested where a medical cause is suspected, because treating the cause may remove the need for surgery or change its timing.