Gynaecomastia is the enlargement of breast tissue in men. Because of its appearance, it can restrict clothing choices and lead men to avoid activities such as swimming in the sea and sport. It is one of the most commonly performed aesthetic operations in men. Before deciding on treatment, the cause of the enlargement needs to be investigated — because not every case of gynaecomastia requires surgery.
What causes gynaecomastia?
- Changes in hormonal balance (including puberty and older age)
- Weight gain and loss and irregular eating habits
- Supplements and anabolic steroids used for bodybuilding
- Alcohol use
- Certain medications (including antidepressants)
- Thyroid, liver and certain hormonal diseases
For this reason, tests are carried out before surgery to identify the underlying cause. Knowing the cause directly affects how the operation will be performed and whether the treatment will be permanent.
Does every case of gynaecomastia require surgery?
No. In two situations, surgery is either deferred or may not be needed:
- Pubertal gynaecomastia: The temporary breast tissue enlargement that appears during this period usually regresses spontaneously within 3 years without the need for treatment.
- Medication-related gynaecomastia: If a medication being used is causing the condition, changing or stopping it under medical supervision may be effective in reducing the enlargement.
In addition, an appearance caused only by fat accumulation (pseudogynaecomastia) is different from true gynaecomastia; in this case, weight loss and exercise can make a noticeable difference. In true gynaecomastia, the enlarged structure is breast gland tissue and does not shrink with diet and exercise.
How is gynaecomastia surgery performed?
The method is chosen according to whether the enlargement is caused by fatty tissue or breast gland tissue. The operation usually takes 2 hours.
| Tissue structure | Method used | Scarring |
|---|---|---|
| Enlargement of fat cells only | Liposuction — fatty tissue is removed by suction through cannulas | No scar is visible in the operated area |
| Breast gland tissue predominates | Excess tissue is removed through a 1-2 cm incision at the dark area around the nipple | An inconspicuous scar may remain |
| Both together | Liposuction combined with surgical tissue removal | An inconspicuous scar may remain |
| Significant excess skin is also present | In addition to the above, excess skin is removed | Scars form along the suture lines |
The post-operative period
If general anaesthesia is used, the patient stays in hospital for one night. Most people return to work after about a week. A medical compression garment must be worn for 1-1.5 months after surgery; wearing the garment regularly directly affects the resolution of oedema and the settling of the chest contour.
Bruising and oedema that decrease within a week may be seen in the operated area. Movements that strain the chest muscles and weight training are postponed for about a month. It takes a few months for the chest contour to reach its final shape.
Risks and recurrence
Possible issues include a depression in the nipple area, asymmetry between the two breasts, temporary numbness of the skin, blood collection and infection. In cases where skin is removed, scars form along the suture lines.
Breast gland tissue that has been removed does not grow back. However, if the cause of the gynaecomastia has not been eliminated — anabolic steroid use, certain medications, an untreated hormonal problem or significant weight gain — the appearance may change again over time. For a lasting result, the cause needs to be addressed.
For other procedures, you can visit the breast aesthetics and body aesthetics pages, and for an assessment you can contact the clinic.
Frequently Asked Questions
What is gynaecomastia and what causes it?
Gynaecomastia is the enlargement of breast tissue in men. It most often develops due to changes in hormonal balance during puberty and in older age. Certain medications, anabolic steroids, alcohol, thyroid and liver diseases and some hormonal disorders can also cause it. Fat accumulation due to excess weight (pseudogynaecomastia) produces a similar appearance but is a different condition; the two are distinguished by examination and, if necessary, imaging.
Does gynaecomastia go away with exercise or weight loss?
If the appearance is due only to fat accumulation, weight loss and regular exercise can make a noticeable difference. However, in true gynaecomastia the enlarged structure is not fat but breast gland tissue; this tissue does not shrink with diet and exercise. Gynaecomastia that begins in puberty may regress spontaneously within the first 1-2 years. Surgical treatment comes into question in cases that last longer than two years and remain firm.
How is gynaecomastia treated?
Treatment is planned according to the cause of the enlargement and the structure of the tissue. If there is an underlying disease or medication use, this is evaluated first. If fatty tissue predominates, liposuction may be sufficient; if gland tissue predominates, this tissue is removed through a small incision around the nipple. If there is advanced sagging, excess skin may also need to be removed.
What is recovery like after gynaecomastia surgery?
The procedure is usually performed as a day case or with an overnight stay. After surgery, a compression garment is worn continuously for a few weeks. Return to desk work is usually possible within a few days. Movements that strain the chest muscles and weight training are postponed for about a month. It takes a few months for the swelling to resolve and for the chest contour to reach its final shape.
Does gynaecomastia come back after surgery?
Breast gland tissue that has been removed does not grow back. However, if the cause of the gynaecomastia has not been eliminated — such as anabolic steroid use, certain medications, an untreated hormonal problem or significant weight gain — the appearance may change again over time. For this reason, investigating the cause before surgery is important for the permanence of the treatment.