Gynecomastia is enlargement of the male breast. Surgery removes the gland behind the nipple, the fat around it, or both — but only after the cause has been looked for, because some causes are medical and some are reversible.
True gynecomastia is glandular tissue — a firm disc behind the nipple — and it does not go away with training. Fat alone is pseudogynecomastia, and it is treated differently.
Before any operation, the cause is excluded. Drugs — cannabis, anabolic steroids, alcohol, some blood pressure and prostate medicines — are the most common reversible cause. Hormonal problems, thyroid disease, liver or kidney disease and, rarely, a testicular tumour also present this way. Blood tests and a testicular examination come first; if something is found, it is treated, not operated around.
The operation is planned around what is actually there — gland, fat, or skin — and the three are present in different proportions in different men.
The gland is removed through a semicircular incision around the lower half of the areola. It is the only way to remove firm glandular tissue, and the incision usually heals well because it follows the edge of the pigment. A small drain is often left for a day or two.
Used for the fat component, and to feather the edges so the chest does not look operated. On its own it does not remove gland, which is why liposuction alone often leaves a hard lump behind the nipple — the most common reason for a revision.
In significant enlargement, or after major weight loss, there is excess skin that will not retract. It is removed, with the scar placed around the areola or horizontally across the chest. A larger operation, and a scar that has to be accepted.
The chest is examined lying and standing, the gland is distinguished from fat, and the testicles are examined. Blood tests for hormones and liver function, and an ultrasound of the chest or testicles where indicated, before anything is scheduled.
Any causative drug is stopped with the treating doctor's agreement — never on your own if it is prescribed. Smoking stops four weeks before, blood thinners about ten days before, and you fast for six to eight hours. A compression vest is ordered in advance.
Under general anaesthesia, one to two hours. Gland is excised, fat is liposuctioned, and the contour is checked with you sitting up. The vest is fitted in theatre. Most patients go home the same day, some stay one night.
The vest is worn day and night, and a drain — if used — comes out in a day or two. Swelling and bruising are significant, and the chest feels tight. Desk work after three to seven days; no lifting, no chest exercises.
The vest continues for three to four weeks in total. Aerobic exercise at three to four weeks, weights and chest work at six. Swelling settles over three months, and the final contour — including any minor irregularity — is judged at six.
Most of the risks here are about contour, and one is about leaving the cause untreated.
Say honestly what you take — steroids, cannabis, supplements, prescribed medicines. This is not a judgement; it is the difference between an operation that works and one that comes back. If a hormonal cause is found, it is treated separately.
Gynecomastia itself is not breast cancer, and in men it is usually benign. But a unilateral, hard, fixed or discharging lump is not the same thing and must be investigated — which is why examination and, where needed, ultrasound come before surgery rather than after.
If the gland is properly excised and the cause is removed, recurrence is uncommon. It returns more often when liposuction alone was done, when gland was left behind to preserve the nipple, or when steroids or cannabis continue. A small residual fullness is not the same as recurrence.
Yes — and not only for healing. Both can drive the enlargement, and continuing them after surgery is the most reliable way to undo it. Prescribed medicines are different: they are changed only with the doctor who prescribed them.
The incision follows the lower edge of the areola and usually fades to a fine line over six to twelve months. If skin has to be removed, the scar is longer — around the areola or across the chest. It is permanent, and it is the main trade-off of the operation.
A front view and a side view are enough to judge whether this is gland, fat or skin — and whether blood tests are needed before anything else. A coordinator replies with a plan and a written quote.
This page is general information, not medical advice. Suitability, technique and risks are decided in a consultation with a surgeon.
