Gynaecomastia surgery — it is not just removing fat. The glandular tissue has to be cut out

Gynaecomastia is enlarged breast tissue in a man. This operation reduces it.

The first thing that belongs on this page is not about the operation.

There can be another cause behind gynaecomastia — certain medicines (some blood pressure drugs, stomach drugs, antiandrogens, some psychiatric drugs), hormonal conditions, liver or kidney disease, and rarely a tumour. Gynaecomastia that appears in adolescence resolves on its own in a large share of cases.

So this operation is decided after the cause has been looked at, and that judgement belongs in a consultation. This site does not make it for you.

Now the operation. There is one key point: it is not only fat.

An enlarged male chest holds fat and glandular tissue mixed together. Fat is soft and comes out with suction. Glandular tissue is firm and does not. The coin-like firmness you can feel right under the areola is that.

So the two are usually done together.

• liposuction — reduces fat over a wide area and softens the edges
• glandular excision — a crescent incision at the lower edge of the areola, cutting it out directly

Liposuction alone leaves the firm disc under the areola in place. This is described as the most common reason gynaecomastia surgery gets revised.

If the chest has stretched a great deal, skin has to come off too, and then the scar runs outside the areola. Ask in the consultation which applies to you.

The area under the areola can end up sunken. Take out too much glandular tissue and the areola dishes inward. Unlike other operations on this site, here taking less is the safe direction. Too little can be revised; a crater is hard to fill.

The scar sits at the edge of the areola. The colour change there hides it relatively well, but it is not absent. If skin has to come off, the scar runs outside the areola.

Nipple sensation can change — duller or more sensitive, and some of it persists.

Haematoma is described as a relatively common complication of this operation. If one side suddenly swells and hurts, make contact immediately.

The two sides will not come out identical, particularly if they differed to begin with.

Gaining weight brings the result back. The fat that remains grows again. Glandular tissue that has been cut out does not return, but fat is different.

If a causative medicine is still being taken, it can recur. That is why the cause has to be looked at before surgery.

Have the cause checked before surgery. Bring a full list of what you take, and ask whether hormone, liver or kidney testing is needed. Operating while the cause stays in place means it comes back.

In adolescence, waiting is an option. A large share of adolescent gynaecomastia resolves on its own. It is not something to settle in a hurry.

Check whether the plan is liposuction alone. Ask clearly what will be done about the glandular tissue. If you are told suction alone will do it, ask why.

Do it at a stable weight. If a large weight loss is coming, afterwards is better. Losing weight separates what will improve from what will not.

Wear the compression garment for as long as you are told. It takes a direct part in haematoma, swelling and how the skin redrapes.

Stop smoking. Blood supply to the areola and nipple decides the result.

Put off chest exercise for as long as you are told after surgery.

It cannot be undone. Excised glandular tissue does not return, and the scar stays.

Surgery without looking at the cause is half an operation. If a medicine or a condition is behind it, operating while that stays in place can mean recurrence. That is why this page put the cause before the technique.

A crater is harder to fix than a remainder. Areolar depression is the best-known bad outcome of this operation, and reversing it means putting fat back in. Ask in the consultation how much will be left behind.

It changes with weight. Excised gland does not return, but fat follows your weight.

Separate what this operation changes from what it does not. The shape of the chest changes; this is not an operation that changes the shape of a body.

Whether to have it is decided in consultation, and it is better not to decide from one clinic's account.