Gynecomastia is enlargement of the breast gland in men. The surgery removes that gland and the fat that comes with it to give the chest back a masculine contour.
It is more common than people think and is usually lived with in silence: men who have gone years without taking their shirt off at the beach, who avoid the pool, who choose clothes to disguise it. The gland can be felt as a firm disc just under the nipple, and that is the difference from a simple build-up of fat — pseudogynecomastia — which is soft and diffuse.
Before operating there is something that is sometimes skipped: looking for the cause. Some medications, anabolic steroid use, cannabis, certain hormonal disorders, thyroid, liver or kidney problems and, infrequently, a testicular tumour can be behind it. In some of those cases, treating the cause resolves the problem without theatre. And in others — a hard, fixed lump, on one side only or with changes in the skin — the priority stops being cosmetic and becomes diagnostic.
It usually helps when there is
- A palpable breast gland under the nipple, stable for more than a year.
- A cause already investigated and, if there was one, corrected.
- Stable weight, with the fatty component already worked on.
- Discomfort or pain on pressing the area.
- A real limitation on everyday or sporting activities because of its appearance.
Worth discussing first if
- Gynecomastia of recent onset or still growing: it is investigated first.
- Current use of anabolic steroids or other substances involved.
- Adolescence: pubertal gynecomastia resolves on its own in most cases.
- Significant excess weight, where part of the volume is fat and will go down with the weight.
- A hard, fixed or one-sided lump, or skin retraction, which needs urgent investigation.
None of these rules the procedure out on its own; all of them change the conversation.
According to what predominates
The technique depends on the proportion of gland, fat and excess skin.
Liposuction alone
When the component is mainly fatty. Incisions of a few millimetres and a quick recovery. It does not remove the gland.
Glandular excision with liposuction
The most usual technique. The gland is removed through an incision at the lower edge of the areola and the rest is treated with a cannula, for an even contour.
With skin excision
Necessary when there is also excess skin, above all after significant weight loss. It adds scars, and in exchange it is the only way to achieve a flat contour.
Do not leave a hollow under the nipple
The most visible mistake in this surgery is removing the whole gland right under the nipple without leaving a layer of tissue. The result is a hollow in the centre of the chest, with the nipple depressed and stuck to the muscle, which looks worse than the original problem and is hard to correct. A thin disc of tissue is always kept under the areola.
The transition towards the edges is the other thing that defines the result: the cannula is worked beyond the area of excision, towards the armpit and towards the breastbone, so that no step is left between the area operated on and the area that was not.
The glandular tissue removed is always sent for pathology. It is a standard part of this surgery and the reason it is not done with liposuction alone when there is gland present.
What the process is like
The consultation includes a step that does not exist in other operations: ruling out a treatable cause.
Consultation and investigation
The area is palpated to tell gland from fat, medications and history are reviewed, and hormone tests and ultrasound or mammography are requested where appropriate.
Before surgery
Laboratory tests and anaesthetic assessment. Stopping smoking and any substances involved. The informed consent is signed.
Surgery
As a day case. Liposuction of the fatty component and excision of the gland through a periareolar incision, keeping a layer under the nipple. A compression garment at the end.
Follow-up
Reviews at one week, one month and three months, with the pathology result handed over.
Week by week
The compression garment is the instruction that most influences the final contour.
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Days 1 to 7
Compression garment at all times, swelling and bruising. Moderate discomfort. No raising the arms above the shoulders.
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Weeks 2 to 4
Back to work at around seven to fourteen days. Garment all day. No exercise and no lifting.
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Weeks 6 to 12
Exercise built back up once authorised. There may be firm areas that settle with massage. The contour starts to define itself.
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Months 3 to 6
Final result, once the skin has finished pulling back and the swelling has gone completely.
Risks, and what is not promised
The general risks of surgery and those specific to this one: haematoma — the most frequent in gynecomastia, which is why the garment and the rest of the first few days matter so much — seroma, infection, contour irregularities, asymmetry, temporary or permanent altered nipple sensation and a visible periareolar scar.
A hollow under the nipple from excessive excision is the characteristic cosmetic complication of this surgery, and the reason a layer of tissue is always kept. Correcting it is difficult and usually needs a fat graft.
Gynecomastia can recur if the cause persists: anabolic steroids, medications or an untreated hormonal disorder. No particular chest is promised, and no absence of scarring either. These risks are reduced by investigating the cause beforehand, a conservative excision under the areola and adequate compression. They are not eliminated. The ones that apply to your case are set down in writing in the informed consent.
The information on this page is for guidance and does not replace an in-person medical consultation. Medical practice is an obligation of means, not of result.
The questions we are asked most about gynecomastia
Fat does go down with diet and exercise. The gland does not: it is firm tissue that does not respond to training, which is why many slim, fit men still have the lump.
When that firm disc can be felt under the nipple, the only way to remove it is surgical.
Because in some cases gynecomastia has a treatable cause — a medication, a hormonal disorder, a thyroid or liver problem — and correcting it can make surgery unnecessary.
And because in a small number of cases the lump is not gynecomastia. It is a short step that avoids operating on the wrong thing.
The incision goes at the lower edge of the areola, where the change in colour disguises it well. In most cases it goes unnoticed from six months onwards.
If skin also has to be removed, the scars are larger and they do show. That is the trade-off for achieving a flat contour when there is excess skin.
The gland removed does not grow back. What can reappear is volume if the cause returns: anabolic steroid use, certain medications or a significant weight gain.
With the cause under control and a stable weight, the result holds.
Question not answered here? There are more answers in the frequently asked questions.
