Gynaecomastia is a symptom of men’s breasts growing.

It is a development of the breast glands which is not uncommon. Gynaecomastia cannot be exercised away; in fact, it becomes the opposite with exercise. The breasts become even larger due to muscles and glandular tissue.

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What is gynaecomastia?
Gynaecomastia reduces breast size in men, flattens out, and improves breast contours.

In severe cases of gynaecomastia, the weight of excess breast tissue can cause the breasts to hang and stretch the areola. In these cases, the position and size of the areola can be surgically improved, and excess skin can be reduced.

Gynaecomastia is a condition of overdeveloped or enlarged breasts in men that can occur at any age. The condition can be the result of hormonal changes, heredity, obesity, or the use of certain drugs.

Gynaecomastia can cause emotional discomfort and impair your self-confidence. Some men may even avoid certain physical activities and intimacy simply to hide their condition.

Gynaecomastia is characterised by:

• Excess localised fat
• Excess glandular tissue
• Sometimes excess breast skin
• Can occur unilaterally (one breast) or bilaterally (both breasts)

Who is a good candidate for gynaecomastia?

• Men whose condition cannot be corrected through alternative medical treatments
• Healthy patients who do not have a life-threatening illness or medical conditions that can impair healing
• Non-smokers and non-drug users
• Men who are physically healthy and of relatively normal weight
• Men who have realistic expectations
• Men whose breast development has stabilised
• Men bothered by the feeling that their breasts are too large
• Adolescents may benefit from surgery, although secondary procedures may be needed in the future if breast development continues.

What can I expect during a consultation for gynaecomastia?
During your consultation, be prepared to discuss:

• Your surgical goals
• Medical conditions, drug allergies, and medical treatments
• Current medications, vitamins, herbal supplements, alcohol, tobacco, and recreational drug use (including steroids)
• Previous surgeries

Your surgeon may also:

• Evaluate your general health status and any pre-existing health conditions or risk factors
• Perform diagnostic tests to determine the underlying cause of gynaecomastia; this may include testing your endocrine function
• Examine your breasts and may take detailed measurements of their size and shape, skin quality, and the placement of your nipples and areolas
• Discuss your options
• Recommend a treatment plan
• Discuss likely outcomes of gynaecomastia and any risks or potential complications
• Discuss the use of anaesthesia during your procedure

It is very important to understand all aspects of your surgical procedure.

What questions should I ask my plastic surgeon about gynaecomastia?
Prepare for the consultation by:

• Writing down all your symptoms with a timeline, medications, and health history, so you can talk about your issues systematically.
• Writing a list of your questions.
• Informing about your health and any health problems.
• Asking questions and demanding answers.
• Reading your medical records and bringing a copy or requesting access to them.
• Bringing a friend so they can support you.

Suggested questions to ask:

• Am I a good candidate for this procedure?
• What is expected of me to get the best results?
• Where and how will you perform my procedure?
• What surgical technique is recommended for me?
• How long can I expect the recovery period to be, and what kind of help will I need during my recovery?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• What are my options if I am dissatisfied with the outcome of my surgery?
• Do you have before and after photos that I can look at for this procedure and what results are reasonable for me?

Be sure to ask specific questions to your plastic surgeon about what you can expect during your individual recovery period.

• Where will I be taken after my operation is completed?
• What medication will I be given or prescribed after the surgery?
• Will I have dressings/bandages after the surgery? When will they be removed?
• Are stitches removed? When?
• When can I resume normal activity and exercise?
• When do I return for follow-up care?

What are the risks of gynaecomastia?
The decision to undergo surgery for gynaecomastia is extremely personal. You must weigh whether the benefits against the risks and potential complications of the surgery for gynaecomastia are acceptable.

Risks of surgery for gynaecomastia include:

• Anaesthesia risks
• Bleeding (haematoma)
• Blood clots
• Breast asymmetry
• Breast contour and shape irregularities
• Changes in nipple or breast sensation, which may be temporary or permanent
• Damage to deeper structures – such as nerves, blood vessels, muscles, and lungs – which may be temporary or permanent
• Deep vein thrombosis, cardiac and pulmonary complications
• Fatty tissue in the breast may die (fat necrosis)
• Fluid accumulation (seroma)
• Infection
• Persistent pain
• Poor wound healing
• Possibility of revision surgery
• Reactions to tape, sutures, glues, topical preparations, or injected agents
• Unfavourable scarring

It is important that you address all your questions directly with your plastic surgeon.

How should I prepare for gynaecomastia?

• Take tests or undergo a medical evaluation
• Take certain medications or adjust your current medications
• Stop smoking
• Avoid taking aspirin, anti-inflammatory drugs, and herbal supplements as they can increase bleeding
• You should arrange for a friend or family member to pick you up after surgery and stay with you the first night.

The success and safety of your gynaecomastia depend very much on your complete candour during your consultation. You will be asked a number of questions about your health, desires, and lifestyle.

What are the steps in a gynaecomastia surgery?
Gynaecomastia surgery includes the following steps:

Anaesthesia

Medications are given for your comfort during the surgical procedure. Your doctor will recommend the best option for you.

Liposuction Technique

In cases where gynaecomastia is primarily the result of excess fatty tissue, liposuction techniques alone may be used. This requires the insertion of a cannula, a thin hollow tube, through several small incisions.

The cannula is moved back and forth in a controlled motion to loosen excess fat, which is then removed from the body through vacuum suction.

There are various liposuction techniques that can be used; the technique that is most appropriate in your case will be defined before your procedure.

Excision Technique

Excision techniques are recommended where glandular breast tissue or excess skin must be removed to correct gynaecomastia. Excision is also necessary if the areola will be reduced or the nipple will be repositioned to a more natural male contour. Incision patterns vary depending on the specific conditions and surgical preferences.

Combination of Liposuction and Excision Techniques

Sometimes, gynaecomastia is treated with both liposuction and excision.

What can I expect during my recovery?
After your surgery, you will be given dressings or bandages around your chest. These are used to minimise swelling and support your new breast contour as it heals after surgery.

A small, thin tube may be temporarily placed under the skin to drain excess blood or fluid that may collect.

You will be given specific instructions that may include:

• How to care for your breasts after surgery
• A pain relief schedule with instructions on how to take pain medication to avoid breakthrough pain
• Specific issues to be aware of
• Time for follow-up visits

It is very important to follow your plastic surgeon’s instructions and attend follow-up visits as planned.

The final results of gynaecomastia surgery are permanent in many cases. However, if gynaecomastia resulted from the use of certain prescription drugs, drugs (including steroids), or weight gain, you must be completely free from these substances and remain at a stable weight to maintain your results.

Discuss this with your doctor before making changes to your prescription medications.

Following your doctor’s instructions is crucial for the success of your surgery.

It is important that the surgical incisions are not subjected to excessive force, swelling, abrasion, or movement during the healing period. Your doctor will give you specific instructions on how to take care of yourself.

What results should I expect after gynaecomastia?
The results after gynaecomastia are immediately visible. Over time, post-surgical swelling will subside and scars will fade.

The final results of your gynaecomastia may take 3-6 months to achieve. The scars are permanent but will continue to fade over time.

Scars after Gynaecomastia

All surgical treatment to correct gynaecomastia will require incisions. Most scars are hidden in natural contours, but some may be visible and are a necessary result of gynaecomastia.

Surgery is not an exact science. Although good results are expected from your procedure, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure to treat gynaecomastia.

Another operation may be necessary:

• To perform additional tightening or repositioning of the breasts
• To treat any complications that may arise