Gynaecomastia surgery in Thessaloniki and Athens, Greece

Gynaecomastia (gynecomastia) is enlargement of the male breast caused by overgrowth of the breast gland, of fat, or of both. It usually starts in adolescence and is rarely caused by an organic hormonal disorder. When the swelling is fat alone, it is called lipomastia and is treated with liposuction.

It is often a temporary hormonal imbalance of puberty. Many boys gain weight to camouflage the swelling; when they lose that weight later, loose skin is added to the problem.

Surgery removes the gland, the fat or both, and in the severe grades it also tightens the skin. I choose the technique according to the grade and the make-up of the swelling. If fat is the main component, see the liposuction page.

What types of gynaecomastia are there?

• Adolescent gynaecomastia: appears during puberty and often resolves in adulthood.
• Gynaecomastia with obesity: usually with a body mass index (BMI) above 30, often with a large fat component.
• Idiopathic gynaecomastia: the most common type, with no apparent cause, often hereditary.
• Gynaecomastia in older men: caused by hormonal changes.
• Pathological gynaecomastia: caused by hormonal disorders, medicines or underlying diseases.
• Rarely, breast cancer presents as swelling of one side only and needs immediate investigation.

How is gynaecomastia graded?

Gynaecomastia surgery suits healthy men at a stable weight whose breast swelling persists after puberty and bothers them. A hormonal, medication-related or other cause that needs treating first must have been ruled out. The correction is then purely surgical, and the grade of gynaecomastia determines the technique.

Who is a typical candidate?

• Men with idiopathic gynaecomastia, or adolescent gynaecomastia that has not resolved.
• A nipple that projects or shows through clothing.
• Lipomastia that does not improve at a stable weight.
• Loose chest skin after weight loss.
• Asymmetry between the two sides.
• Teenagers with grade 3 or 4 gynaecomastia and marked distress.

When do I advise against it?

• While a hormonal or medication-related cause has not been ruled out or treated, because the gynaecomastia may come back.
• For grade 1 or 2 gynaecomastia in adolescence; I prefer to wait until the age of 22 to 24.
• When your weight has not yet stabilised.
• When the swelling affects one side only or there is a suspicious finding, until imaging has been completed.
• When there is an active infection.

Preparation starts with a hormonal assessment by an endocrinologist, because a hormonal or medication-related cause must be ruled out first. At the consultation I examine your chest, assess the grade and how much of the swelling is gland or fat, and explain the technique, the incisions and the recovery. You receive a written plan and quote.

What happens at the consultation?

I examine the chest and, by feeling it, I judge how much of the swelling is gland and how much is fat; when confirmation is needed, I ask for an ultrasound scan. I assess the grade of gynaecomastia, the position of the nipple, the quality and laxity of the skin, and symmetry. We discuss the technique that suits you, where the incisions will be and what recovery will be like. You receive a written plan and quote.

Which tests do I need before surgery?

First comes a hormonal assessment by an endocrinologist and, where needed, an andrological assessment. When another breast condition is suspected, an ultrasound scan or mammogram is done. Pre-operative blood tests and an assessment for general anaesthesia follow. Smoking increases the risk of complications: stop at least 4 weeks before and 4 weeks after surgery. If you take anticoagulants or antiplatelet medicines, tell me; they are stopped only in agreement with the doctor who prescribes them. The date of surgery is set once these tests are complete.

Gynaecomastia surgery takes about an hour under general anaesthesia. There are three main approaches, often combined in the same operation. In all of them I use tumescent solution, which reduces bleeding and usually makes drains unnecessary. The aim is a flat chest with a smooth transition from the nipple to the rest of the chest.

Power-assisted liposuction (MicroAire)

This is the method of choice when the breast gland is not enlarged, that is, in lipomastia. It is also used as a complement towards the armpits and around the edge of the breast, to refine the contour. Because conventional liposuction does not remove the firmer parts, I use power-assisted liposuction (MicroAire), which breaks up the connective tissue around the gland and can also remove a small gland. Its advantages are very small scars and a faster recovery. You will find more about the technique on the liposuction page.

Gland removal through an incision under the nipple

When the gland is large or there is little fat, I remove the gland surgically through a small semicircular incision at the lower edge of the areola (the Webster incision). I remove almost all of it, but I keep a small portion directly under the nipple so that the nipple does not sink. Where needed, liposuction around the area follows to give a smooth surface.

Correcting grade 3 and grade 4 gynaecomastia

When there is also loose skin, I make a circular incision around the nipple, through which I remove the gland and at the same time tighten the skin around the areola (periareolar tightening). If the laxity is extensive, the incisions extend on both sides of the nipple. In very large gynaecomastia, a modified mastectomy or breast reduction technique may be needed.

Incisions and stitches

In grades 1 and 2 the incision is small and crescent-shaped, at the lower edge of the areola, and the scar usually becomes almost invisible within a few months. Liposuction needs only small entry points; often one entry point at the breastbone is enough for both sides. In grades 3 and 4 the incisions around the nipple, and on both sides when needed, are more visible and take longer to mature. All stitches are absorbable and do not need to be removed.

Combining techniques

Liposuction and gland removal are often combined in the same operation, because in most cases gland and fat coexist. Liposuction can be extended towards the armpits or the sides of the chest, for a more even contour.

Do I need to stay in hospital?

No overnight stay is needed. You go home the same day, with someone to accompany you, wearing the compression vest. You must not drive after general anaesthesia.

Discomfort after gynaecomastia surgery is usually mild, and you can return to office work in about 5 days. You wear a compression vest for 2 to 3 weeks after liposuction and for up to 6 weeks after gland removal. Exercise starts after 6 weeks, or after 3 weeks with liposuction alone.

Gynaecomastia surgery needs no overnight stay in hospital: you go home the same day. The stitches are absorbable, so there is no appointment to remove them. Plan to stay in Greece for 5 to 10 days, until I have checked your chest and confirmed that you are ready to fly.

On the day of surgery you leave with someone to accompany you, wearing the compression vest, and you must not drive after general anaesthesia. Bruising and mild pain are most noticeable on days 2 to 4, more so after liposuction, and are controlled with the painkillers I prescribe. I see you in person the day before you travel.

Once you are home, follow-up continues by video call at 10 days, 1 month, 6 months and 1 year. At home you keep wearing the vest for 2 to 3 weeks after liposuction or up to 6 weeks after gland removal, avoid lifting, and plan about 5 days off office work. Exercise resumes after 3 weeks with liposuction alone and after 6 weeks with gland removal; in grades 3 and 4, allow 2 to 3 months before returning to the gym. All follow-up checks are done by me; nursing care at home can be arranged if you would like it.

The result of gynaecomastia surgery is visible straight away, while healing completes and the contour settles over 3 to 6 months. The gland that is removed does not grow back, so the result is permanent, provided there is no ongoing hormonal cause. Significant weight gain or certain medicines can affect it.

In grades 1 and 2 the scar under the nipple becomes almost invisible. In the severe forms the scars may stay visible in places, but they fade with time, and chest hair helps to camouflage them. Because gynaecomastia often has a strong psychological impact, its correction usually brings great relief and self-confidence.

Gynaecomastia surgery carries risks related to general anaesthesia and to the technique. Most are rare and can be treated. The most typical are a collection of blood or fluid and a hollow under the nipple, both prevented with careful technique. I explain the risks for your own case at the consultation.

Smoking. Stop at least 4 weeks before and 4 weeks after surgery; smoking increases healing complications.

Blood thinners. Tell me if you take anticoagulants or antiplatelet medicines. They are always stopped in agreement with the doctor who prescribes them.

I do not publish prices, because the cost depends on the grade, the ratio of fat to gland and whether the skin needs tightening. You receive a written quote after I have examined you at the consultation. These are the factors that shape it:

• The grade of gynaecomastia.
• The technique: liposuction alone, gland removal or a combination of the two.
• The need for skin tightening or skin removal, in grades 3 and 4.
• The extent of liposuction, for example towards the armpits.