Gynecomastia is corrected surgically, depending on its degree, provided that all possibilities of secondary gynecomastia have been ruled out.
At a glance
Gynecomastia is corrected surgically, depending on its degree, provided that all possibilities of secondary gynecomastia have been ruled out.
Severity
Medium
Type of Anaesthetic
Local / General
Clinic Stay
Same Day Discharge or 1 Night
Stitch removal
No
Recovery
4 - 6 weeks
Gynecomastia surgery cost
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The term gynecomastia (or lipomastia), although internationally widespread, is not entirely accurate and men who experience this condition may find it derogatory. It typically refers to an overgrowth of fat and glandular breast tissue and usually appears during adolescence.
In the majority of cases, there is no underlying hormonal disorder. It is usually the result of a hormonal imbalance during puberty, when the sexes begin to differ hormonally and secondary sexual characteristics develop.
Often, boys who struggle with this issue, in an attempt to camouflage it, allow themselves to gain weight so that the enlargement of the chest appears to be a consequence of obesity. However, once they lose the excess weight, it may result in additional skin laxity.
Gynecomastia: What are its main forms?
Depending on the case, we distinguish the following types of gynecomastia:
- Adolescent gynecomastia: occurs during puberty and usually resolves on its own
- Gynecomastia due to obesity: occurs when BMI is above 30
- Idiopathic gynecomastia: the most common form, with no apparent cause, usually hereditary
- Gynecomastia in older men: caused by hormonal changes
- Pathological gynecomastia: caused by hormonal disorders, medications, or underlying diseases
- Breast cancer: a very rare condition, usually presenting with unilateral enlargement of the breast
The surgical correction of gynecomastia by the plastic surgeon mainly concerns cases of idiopathic gynecomastia, adolescent gynecomastia, or gynecomastia due to excess body weight. Before we can proceed with surgical correction, a hormonal evaluation by an endocrinologist and possibly an andrological assessment is required. If there is any suspicion of another breast condition, an ultrasound and possibly a mammogram must definitely be performed.
How is gynecomastia distinguished depending on the size of the condition?
In general, we could say that depending on the case, there are 4 grades based on the extent of the condition. These are as follows:
- Grade 1 gynecomastia: this is the simplest case, where there is a slight enlargement of the gland and fat, without a female breast appearance. It is estimated that up to 80% of men present grade 1 gynecomastia and very often it does not cause aesthetic concern.
- Grade 2 gynecomastia: there is greater enlargement of the gland, which usually pushes the nipple outward and causes discomfort, as the nipple is often visible through clothing. This is the most common case in which surgical intervention is performed.
- Grade 3 gynecomastia: the breast now resembles more of a female breast, with a pronounced nipple projection and a well-defined inframammary fold, with a large distance from the fold to the nipple. These cases cause significant discomfort and surgical correction is recommended, even during adolescence.
- Grade 4 gynecomastia: these cases are mainly seen in the context of obesity or after major weight loss. In addition to significant breast enlargement, the breast usually has a fully feminine appearance and sagging may also coexist.
Techniques to surgically treat gynecomastia
The correction of gynecomastia, provided that there is no hormonal or other disorder causing it, is purely surgical. The choice of technique depends on the severity of the gynecomastia and the fat-to-glandular tissue ratio. The truth is that there are 3 different methods of gynecomastia correction.
Each of these corresponds to different cases and has its own advantages and disadvantages. Therefore, the correct choice to address such a condition is always made after a consultation with an experienced plastic surgeon and following a detailed discussion. However, so that the interested person can have a general idea, below we will see some key points for each of these methods.
Before and after: harmony in the chest
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Treatment of gynecomastia
with liposuction
Regarding the tissue, we distinguish the following cases:
Liposuction is the method of choice when there is no enlargement of the mammary gland, meaning in cases of lipomastia. Liposuction is also used as a complement towards the armpits and around the breast perimeter in order to perfect the result.
Traditional liposuction, however, is not sufficient to remove the firmer parts of gynecomastia, which is why we use power-assisted liposuction techniques, such as Microaire. With the help of the cannula, it is easier to “break” the connective tissue that surrounds the gland, or even remove a part of the gland when it is relatively small. The advantage of correcting gynecomastia with liposuction is the absence of scars, as well as the faster recovery.
Treatment of gynecomastia with surgical gland removal
When there is a larger gland enlargement or there is not a large amount of fat in the chest, surgical gland removal is preferred. In the standard procedure, a small semicircular incision is made on the lower half of the nipple, through which the mammary gland is almost entirely removed, and then, if necessary, liposuction is performed around the gland to smooth the entire breast surface.
The removal method is performed using tumescent solution, which allows us to perform the procedure even under local anesthesia, reduces the recovery period and usually renders the use of drains unnecessary.
Surgical intervention for 3rd and 4th degree gynecomastia
In more advanced cases of 3rd or 4th degree gynecomastia, where there may also be significant skin laxity, a circular incision is made around the nipple, through which the gland is removed and at the same time a periareolar skin tightening is performed, or the scars may need to be extended to both sides of the nipples when the laxity is more extensive.
"I was looking for a perfect, natural result, without pain. My doctor suggested the dual plane technique. The result couldn't be better!"
In very severe gynecomastia, it may be necessary to perform a modified mastectomy or a breast reduction technique.
Recovery after surgery
Gynecomastia correction includes many different techniques, and the recovery — as with other breast plastic surgeries — depends greatly on the type of procedure performed.
In cases of 1st or 2nd degree gynecomastia, gland removal can be performed under local anesthesia or a combination of local anesthesia and sedation. Recovery is quite fast, with almost no postoperative pain, and the scar under the nipple becomes almost invisible after a few weeks. To prevent fluid accumulation and optimize the aesthetic outcome, compression with a chest band or special gynecomastia vests is required, as well as avoiding physical exercise for 6 weeks.
When dealing with lipomastia and choosing liposuction as the treatment approach, the procedure is performed under general anesthesia or local anesthesia with sedation. It usually results in more bruising than surgical gland removal and mild pain for 3–4 days. However, the advantage is that compression is required for a shorter period — typically 2–3 weeks — and daily activities and exercise can usually resume after the 3rd week. Additionally, the incision is much smaller and both sides of the chest can be corrected from a single entry point near the sternum.
In 3rd and 4th degree gynecomastia, recovery is usually longer and scars take more time to heal and become less visible. Exercise must also typically be avoided for 2–3 months.
Gynecomastia surgery results
Given that gynecomastia is a condition that can have a significant psychological impact on men, its correction brings both physical and emotional relief, offering very high levels of satisfaction and self-confidence. The results of the procedure are visible immediately afterward, although healing typically takes 3–6 months to fully complete and finalize the outcome. With minimally invasive techniques such as liposuction or gland removal through very small incisions, no visible trace remains after surgery, making it almost impossible to detect whether any intervention was performed in the area. In cases requiring more extensive correction, although scars may be somewhat visible in certain areas, patients feel a strong sense of relief and gratitude, as they are freed from something that feels foreign to their masculine identity and causes significant discomfort. Scars fade considerably over time, and dense chest hair helps camouflage them even further. We emphasize that these scars concern only severe forms of gynecomastia and not 1st or 2nd degree cases.
Is it right to correct gynecomastia in adolescence?
Is there a chance that gynecomastia will reappear after surgical intervention?
Is there a possibility of breast cancer in men?
Dr. Prodromos Papaioannou
He completed his plastic surgery specialization in Germany, at the Pirmasens Hospital, the Asklepios Wandsbek Hospitals in Hamburg, the University Hospital in Magdeburg and the Braunschweig Clinic. He worked as a specialist-deputy director at the Braunschweig Clinic (specializing in breast reconstruction after cancer and cosmetic surgery). He also participated in scientific research and completed his doctoral thesis (Dr. Med.) at the Magdeburg Clinic.