Gynecomastia surgery

Gynecomastia (male breast enlargement) can make the chest noticeable through clothing. If this fullness bothers you, we can discuss which tissues surgery can reduce during your consultation. In gynecomastia surgery, we reduce excess tissue in the breast.

Gynecomastia has different degrees, so we choose the procedure according to the enlargement and your skin. During the examination, we explain which tissues can be reduced with liposuction (fat removal) and outline surgical options if firm tissue needs to be removed. You can tell us which area bothers you most and what change you hope to see.

True gynecomastia and fat tissue

The male breast contains glandular tissue and fat. Enlargement of the breast gland and an increase in fat can both affect chest volume. Because these tissues can be present in different amounts in the same person, the visible size alone does not reveal the underlying structure.

Enlargement can occur in one or both breasts. The right and left sides may differ in size, and excess skin may also be present. The fat, glandular tissue, and skin on each side of the chest are examined separately to identify the source of the difference.

True gynecomastia means enlargement of the breast gland. Fullness caused by increased fat without gland enlargement is called pseudogynecomastia or lipomastia. Mixed forms, in which both glandular tissue and fat increase, also occur. In these cases, the treatment plan depends on where each tissue is concentrated.

The breast gland and fat layer lie in front of the chest muscle. A prominent chest muscle and enlarged tissue around the nipple are different anatomical features. The shape of the muscle, nipple position, and thickness of the overlying soft tissue together create the chest’s appearance.

Chest exercises work the muscle tissue, and overall weight changes may affect the volume of fat in the chest. The size and firmness of the breast gland are separate examination findings. Exercise habits or body weight cannot identify the tissue type, so the contribution of glandular tissue and fat to chest fullness is assessed during the examination.

Causes of gynecomastia

Hormonal changes can play a role in breast gland enlargement. For this reason, the consultation includes questions about when the enlargement was first noticed and how it has changed. When needed, hormone tests help investigate the cause, and suitability for surgery is considered in light of these findings.

Some medications and externally taken hormone-containing products may be associated with breast tissue enlargement. You can share information about your regular treatments, supplements, and products taken for bodybuilding during the consultation. A history of liver, kidney, thyroid, or testicular disease may also form part of the investigation into the cause.

Hormone tests are selected according to the medical history and examination findings. An endocrinology opinion may be requested when needed; this specialty deals with hormone-related disorders. If a current treatment is thought to be involved, any decision to change it is made in consultation with the prescribing physician.

Gynecomastia during puberty

The breast gland may enlarge during the hormonal changes of puberty. Because the enlargement may subside on its own during this stage, the decision about surgery cannot be separated from physical development. The course of breast tissue changes, pubertal development, and examination findings determine the need for monitoring or treatment.

A consultation for breast enlargement during puberty includes questions about when it began, whether it is continuing to increase, and any products being used. Suitability for surgery takes account of physical development and the person’s own expectations. Monitoring and surgical options can be discussed as the findings that explain the enlargement become clearer.

What we assess during the examination

The examination checks breast size, tissue firmness, and skin elasticity. Nipple position and the size of the areola, the pigmented area around the nipple, are also assessed. The degree of skin laxity and where the volume is concentrated affect the extent of the procedure.

Dense tissue felt beneath the nipple may feel different from the surrounding soft fat layer. However, self-examination alone cannot determine the nature of the tissue. The examination also covers tissue boundaries, their relationship to the nipple, and areas extending toward the armpit. Imaging may be requested according to the findings.

One-sided enlargement can also be gynecomastia, but a new finding or one that differs from the usual distribution is investigated separately. A distinct lump that is not directly beneath the nipple may require diagnostic assessment before cosmetic surgery is planned. The nature of the breast enlargement is clarified before moving on to the contouring part of surgery.

In breasts where fat predominates, liposuction can reduce volume. When dense glandular tissue is present, surgical removal may be needed. Two breasts that look similar in size may therefore require different surgical approaches.

During the examination, you can explain what you would like to change by pointing to an area such as the tissue around the nipple or the side of the chest. Prominence in these areas can reflect different tissue distributions. For example, glandular tissue concentrated beneath the nipple and a fat layer extending toward the armpit are marked separately in the surgical plan. Making this distinction during the consultation clarifies which tissue the proposed procedure targets.

You can bring the results of any previous breast ultrasound or hormone tests to your consultation. These show which questions about the enlargement have already been investigated and how the findings were interpreted. The current examination and medical history guide whether tests need to be repeated or other investigations requested. Details of any previous chest procedure also help clarify the tissue structure.

Classification of gynecomastia

Breast volume and excess skin are separate criteria in gynecomastia classification. The classifications distinguish enlargement without excess skin from enlargement accompanied by a loose skin envelope. When a small, moderate, or marked increase in volume is described, the condition of the skin is also noted. This helps explain why breasts with similar volumes may need different skin adjustments.

In a chest without excess skin, the main procedure addresses the fat and glandular tissue responsible for the volume. When excess skin is substantial, skin removal and adjustment of nipple position may also be considered. Classification describes the form of the enlargement. Hormonal causes or causes related to current treatments are investigated separately.

Who may be suitable for surgery?

For people who want to change the appearance of their chest, surgical options can be discussed after the cause of the enlargement has been investigated. General health suitable for surgery and a stable body weight also form part of this decision. The distribution of fat and excess skin helps identify which areas of the chest need to be addressed.

If a hormonal condition or a disease affecting the body as a whole explains the enlargement, treatment for that condition is planned first. Ongoing substantial weight changes, incomplete pubertal development, or an uncontrolled systemic illness may change the surgical decision. Surgery aims to reduce excess chest tissue. Any treatment needed for the underlying cause is planned separately.

Liposuction and removal of breast tissue

We perform liposuction using cannulas, thin tube-shaped surgical instruments, passed through small entry points. Suction applied through these instruments removes excess fat. We use ultrasonic liposuction, which is assisted by sound waves, for this procedure.

When firm tissue cannot be removed with liposuction, we remove it through a small incision in the nipple area. Fat removal and removal of firm tissue can be performed in the same operation, depending on the nature of the excess breast tissue.

Fat can extend around the nipple, beneath the breast, or toward the sides of the chest. Liposuction planning considers how this distribution creates transitions over the chest muscle. The central projection of the breast is marked along with the tissue thickness at its side and lower borders.

For removal of glandular tissue, the incision may lie along part of the areola border. This provides direct access to the dense tissue, and the portion to be removed is separated from the surrounding tissues. Since cannula-based fat removal and removal of dense glandular tissue target different tissues, both may be included in the plan for a mixed structure.

Gynecomastia surgery can be performed under general anesthesia. Anesthesia planning considers the areas for fat removal, removal of glandular tissue, and any skin adjustment together. Previous operations, existing illnesses, and current treatments form the medical history component of the anesthesia assessment.

The entry points made for liposuction allow the cannula to move through the fat layer. The incision used to reach glandular tissue allows the dense tissue to be separated under direct vision. These different access points may be present on the same chest because the procedures target different tissues. The surgical markings can show which area will be addressed through each entry point.

Excess skin and combined procedures

When excess skin is substantial, skin removal may be added to volume reduction. How far the skin extends downward, nipple position, and folds at the sides of the chest influence incision placement. Where the nipple needs to be repositioned, its tissue attachments are also considered in the surgical plan.

Excess fat at the side of the chest may continue as fullness toward the armpit. In suitable individuals, these areas can be included in the liposuction plan for gynecomastia surgery. If localized fat is also present in the abdomen or waist, whether to include these areas in the same surgical plan is determined separately according to general health and the extent of the procedure.

Areola width is a separate feature from the nipple’s position on the chest. Adjustment of the diameter of this pigmented area may also be considered in a volume reduction plan. If excess skin extends downward, the planned nipple position is marked together with the surrounding skin envelope. Reducing the areola diameter and removing excess skin across the chest involve different surgical scopes.

The amounts of fat, glandular tissue, and excess skin may differ between the right and left sides of the chest. One side may need a plan focused on fat removal, while the other may also require removal of glandular tissue. The location of tissue to be removed is marked according to each breast’s nipple position and tissue distribution over the chest muscle.