Gynecomastia surgery: techniques, the operation, recovery and results

When gynecomastia has been there for more than a year, isn’t shrinking and bothers you, surgery is the only permanent solution. It is a routine operation for plastic surgeons, and the results are generally very satisfying. Here is what you need to know to approach it calmly, from the first consultation to the final result.

Who is it for?

Surgery is for men:

• whose gynecomastia is stable and established, generally for more than a year;
• in whom a treatable cause has been looked for and, where possible, removed;
• who are bothered by it, physically or psychologically;
• in good general health, ideally at a stable weight;
• and, for young people, after the end of puberty.

If the chest is mostly fat, losing weight first is often recommended: it improves the result and may even make surgery unnecessary. See gynecomastia or chest fat.

The consultation with the surgeon

This is a decisive step. The plastic surgeon:

• examines you to assess how much gland, fat and excess skin there is;
• determines the grade (Simon classification);
• checks your test results (and orders some if needed, often including an ultrasound);
• explains the technique chosen, the scars, the risks and the recovery;
• gives you a written quote if you are paying privately. Take time to think it over: in the UK, professional guidance recommends a cooling-off period of at least two weeks before cosmetic surgery.

The techniques

Liposuction

A thin cannula, inserted through one or two incisions a few millimetres long, suctions out the fat. It is enough for pure pseudogynecomastia. It also refines the contours and the transition towards the armpits in mixed cases.

Gland removal (subcutaneous mastectomy)

The dense, fibrous gland disc does not suction out well. The surgeon removes it through a semicircular incision along the lower edge of the areola, leaving a thin layer of tissue under the areola so that it doesn’t sink in.

Usually both

Most gynecomastia is mixed. The typical operation therefore combines liposuction and gland removal in the same procedure.

Skin reduction

In large cases with excess skin (grade IIb and especially III), or after major weight loss, skin has to be removed. This leaves longer scars: around the areola, or under the chest, sometimes with repositioning of the areola.

On the day

• Duration: generally 1 to 2 hours, longer if skin is reduced.
• Anaesthetic: usually general. Some limited procedures are done under local anaesthetic.
• Stay: often a day case (home the same day), sometimes one night.
• At the end: dressings, sometimes small drains for 24 to 48 hours, and the compression vest is fitted.

Recovery

• Pain: moderate, like intense muscle stiffness, eased by the painkillers prescribed.
• Bruising and swelling: normal, fading over 2 to 3 weeks.
• Compression vest: usually worn for 4 to 6 weeks, often day and night at first. It limits swelling and helps the skin settle. See post-op vests.
• Work: often back within 5 to 10 days for a desk job, later for physical work.
• Exercise: walking from the first days, light cardio around week 3, upper-body training after 4 to 6 weeks depending on your surgeon.
• Sun: protect the scars for at least 6 months to stop them darkening.
• Nipple sensation: often reduced or altered for a few weeks to a few months.

The result

The chest is flatter as soon as the operation is over, but swelling hides the result for a few weeks. You can judge it at around 3 months, and the final result after 6 to 12 months, once the tissues have softened and the scars have faded.

Recurrence is rare if the gland has been properly removed and the cause has gone. It is still possible if you go back to steroids, certain medicines or put on a lot of weight.

The risks

Like any surgery, this operation carries risks, generally uncommon:

• haematoma (collection of blood), the classic complication, which may need a return to theatre;
• seroma (collection of fluid), which may need draining a few times;
• asymmetry or remaining irregularities;
• a hollow under the areola (saucer deformity) if too much tissue is removed;
• changes in nipple sensation, usually temporary;
• thickened or darkened scars;
• infection, rare;
• risks linked to the anaesthetic.

A revision is sometimes offered to correct an irregularity, usually under local anaesthetic, after several months.

Cost, funding, going abroad

• In the UK and Ireland, public funding is limited and depends on where you live; most men pay privately. All the details: cost and NHS funding.
• Many men consider having surgery in Turkey or elsewhere. Before deciding, read our guide: surgery abroad.

Talking about it

Many men put this off for years out of embarrassment. Plastic surgeons see this concern all the time: you will have nothing to justify.

Your questions