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Gynaecomastia Surgery

Gynaecomastia (Male breast reduction)

Base-line information you need to know about breasts in order to make the informed choices if you are considering surgery to your breasts

It is important to realise several facts:

  • Both men and women have breasts – but under the influence of female hormones they develop to be larger in women.
  • Breasts are composed of a mixture of fat and glandular tissue. The glandular tissue (the part which secretes breast milk in women) weighs more than the fat so the larger the proportion of glandular tissue your breasts have the heavier and more fibrous they are
  • Breast fat increases and decreases in tandem with variations in body fat generally.
  • Breast glandular tissue increases and decreases in tandem with variations in the ratios of your body’s hormones
  • Conditions or drugs which affect your body’s fat distribution or your hormone balance will cause male breast enlargement

Armed with these pieces of information, you will understand why your breasts may have grown larger and therefore, find it much easier to decide whether surgery on your breast mounds is for you.


Male breast growth (gynaecomastia) is a common problem, especially as obesity becomes more prevalent – estimates of the prevalence of this condition vary from 30% – 50% of the population. It is an embarrassing condition for men of all ages and is often resistant to weight loss and exercise. Male breast reduction involves removal fat and glandular tissue from the breasts either using liposuction or surgery. In very large breasts, surgery rather than liposuction is the only sensible treatment course to follow because it is also often necessary to excise excess skin and re-drape it on the chest wall.

Commonly asked questions about gynaecomastia and male breast reduction

  • What causes gynaecomastia?
  • Am I a good candidate for male breast reduction?
  • What should I expect from my consultation?
  • How is the surgery performed?
  • What does my operation involve?
  • What about my recovery and return to normal activities?

What causes gynaecomastia?

There are a variety of causes for this condition, some of which are treatable medically rather than surgically, with resolution of the gynaecomastia thereafter. Most gynaecomastia is idiopathic – it has no treatable cause, but this is a diagnosis we reach by excluding all the others which can be classified as follows:

  • Physiological changes in hormone ratios just after birth at puberty and late in life
  • Various drugs:
  • cannabis
  • digoxin spironolactone and other drugs that mimic oestrogens
  • methyldopa phenothiazines and other drugs that raise prolactin levels
  • cimetidine cyproterone acetate and drugs that inhibit testosterone
  • gonadotrophins
  • Liver disease:
  • cirrhosis
  • hepatitis
  • Testicular diseases:
  • Primary testicular failure: Anorchia; Klinefelter’s Syndrome; Bilateral Cryptorchidism
  • aquired testicular failure: mumps; irradiation
  • secondary testicular failure: Hypopituitarism; isolated gonadotrophin deficiency
  • Endocrine (hormonal) diseases:
  • pituitary failure
  • thyroid disease
  • Growths in the:
  • testicles
  • breasts
  • adrenal glands
  • and vanishingly rarely in the lungs; liver or kidneys

Usually you will have been referred for treatment by your GP who knows what drugs you take and after doing the relevant physical examination and special investigations to exclude the above conditions – meaning an idiopathic cause for your gynaecomastia is all that remains and so surgery is indicated to rid you of your problem.

It is best, therefore, to have seen your GP before seeking a surgical referral, otherwise I shall have to order these tests myself which will delay your treatment and incur you in potentially needless expense.

Am I a good candidate for male breast reduction?

This is best decided during a consultation, but generally speaking if you are a healthy, emotionally stable man, with firm, elastic skin that will contract to your chest’s new contours after breast reduction, you will benefit from either liposuction or surgery to decrease your breast mounds. Obese men will gain some benefit, especially if they realise that this may help them overcome mechanical problems if their breasts get in the way during exercise, or manual work, or make it difficult to get clothing that fits. However, it must be understood that this is not an operation to correct obesity and that it will almost certainly need to be repeated if it is performed before you have reached and maintained your goal weight for 6 months.

Patients who continue to use cannabis, or take any of the drugs listed above will have poor results from surgery and risk their gynaecomastia reforming with time.

What should I expect from my consultation?

During your consultation, I will take a full medical history. I will ask you specifically about any conditions and drugs listed above. I will examine you completely, and then focus on your breasts to assess their size, composition and the quality of their skin envelope. During the consultation I will take standardised photographic views for your medical records. Depending on my findings, I may ask your GP to perform further tests, or if you prefer, order them myself at your expense.

How is the surgery performed?

The aim of either liposuction, or surgery for this condition is to produce as predictable, stable and aesthetic a breast shape for you as possible.

Liposuction is best suited to small breast mounds composed mostly of fatty tissue in men with good elastic skin tone. It involves making 2 – 3 small incisions through which the excess tissue is sucked out.

Surgical technique depends on the size of your breast mounds and the elastic tone of your skin. At the least, incisions are made around half the circumference of the areolar skin, but may stretch all the way around the areolar, then vertically down the chest wall and then in a symmetrical curve below – to leave an anchor-shaped scar.

What does my operation involve?

Before surgery, you will meet and be assessed by your anaesthetist who will prescribe medications for your comfort and to lessen anxiety if need be.

On the evening before, or the morning of your operation I will review what we have discussed and planned previously and we will both sign your operative consent forms. Then I will measure and draw guidance marks for surgery on your chest and breasts with you sitting upright.

The operation is performed under General Anaesthesia – you will be asleep. The operation usually takes an hour or so, depending on the technique used. After surgery, you will awake in a recovery area and soon afterwards you will be returned to your room. A drain is placed under the incision in each breast to remove the normal healing fluid that the body produces and stop it accumulating within your reduced breasts. These drains will be removed when the drainage is minimal – usually after a day or two and once they have been removed you can shower normally. Most patients go home a day or two after surgery on simple pain relieving medications and a short course of antibiotics.

What about my recovery and return to normal activities?

You will feel tired and somewhat sore for a week or two following your surgery, but you will be able to move around and function relatively normally.

You will be swollen and bruised after surgery or liposuction, and this can have an effect on your healing and final result, so to counter this you will need to wear an elastic pressure garment 24 hours a day, 7 days a week, for 4 weeks after surgery – except when your are washing you or it! Thereafter, you should wear it at night for a further 4 weeks. Your final result will mature over 3 – 6 months.

I encourage you to start gentle exercise immediately. You can return to work as soon as you feel able, but if your work involves heavy, manual work, you should have at least a week off, or on lighter duties.

New scars benefit from friction-free massage (using vaseline, for instance, to lubricate the massaging process). Beginning to massage scars two to three weeks after surgery, will help them mature, soften and flatten faster than if left to their own devices. New scars should be protected from sunlight for 2 years to avoid them pigmenting differently from the surrounding skin and becoming a different colour permanently. Factor 15 sun block should be applied whenever they are exposed – even to a British winter sun.

In the longer term, final size, shape, symmetry and aesthetic result of breasts after reduction surgery will vary according to individual factors. If asymmetry is significant, a second procedure may be performed to remove additional tissue.

You may find you lose nipple sensation, which although usually a temporary loss, may take up to a year to return, and may remain permanently diminished or absent.

You may also experience altered pigmentation in the nipple-areolar skin, which may be permanent.