Gynaecomastia: why the gym does not get rid of it

It is more frequent than people think and it is usually lived with in silence: men who have spent years not taking their shirt off at the beach, avoiding the pool or choosing clothes to disguise it. And almost all of them have tried the same things first: diet, weights, more chest work at the gym. It does not work, and there is a specific reason.

You can feel the difference

Gynaecomastia is enlargement of the breast gland. It feels like a firm, well-defined disc just under the nipple, and is sometimes tender to touch.

Pseudogynaecomastia is simple fat accumulation: soft, diffuse, with no central disc, spread across the chest. That one does respond to losing weight.

The test at home is straightforward: lie on your back and feel around the nipple with your fingers together, approaching from the outside. If you find a firm edge that starts abruptly, that is gland. If everything is soft and even, it is fat.

Glandular tissue is not fatty, so neither a calorie deficit nor exercise reduces it. In fact, in someone who loses weight and builds pectoral muscle, the gland becomes more obvious because it loses what was disguising it.

The cause must be investigated before operating

This is often skipped and should not be. Behind gynaecomastia there may be some common medications, anabolic steroid use, cannabis, hormonal disturbances, thyroid, liver or kidney problems and, less often, a testicular tumour.

In some of those cases, treating the cause resolves the problem without surgery. Operating without looking is fixing the symptom and leaving what produces it.

A hard, fixed lump, on one side only, or with changes in the skin or the nipple stops being a cosmetic matter. There the priority is diagnostic, and it is investigated before anything else is discussed.

Breast cancer in men is rare, but it exists. Marked asymmetry, nipple retraction or discharge are always investigated.

In adolescence, waiting is usually right

Pubertal gynaecomastia is very common and in most cases resolves on its own within one or two years. Operating on a teenager mid-process is pre-empting something that was probably going to correct itself.

The exception is when it persists beyond that, when it is very bulky, or when the impact on the boy's life is serious and sustained. That is assessed case by case and not by calendar.

What the surgery is like

The gland and the fat accompanying it are removed to restore a masculine contour. It takes one to two hours, as a day case, under general anaesthesia or local with sedation. What is removed is sent for pathology, always.

The recovery is short: compression garment at all times in the first week, back to work at seven to fourteen days, no exercise or lifting for three or four weeks. There may be firm areas that soften with massage. The final result appears between three and six months, once the skin has finished retracting.

What is not promised

If there is a lot of excess skin — common after major weight loss — removing the gland is not enough and skin has to be excised, which adds visible scars. That is the trade-off and it is discussed beforehand, not after.

And if you return to whatever caused it, it can come back. Surgery removes the gland that was there, not the one that may form again.