Patient Guide
A concise clinical guide covering types, Simon's classification, who qualifies for surgery, what the procedure involves, and what to expect in recovery.
Gynecomastia is the most common breast pathology in males. It results from an increased oestrogen-to-androgen ratio — oestrogens stimulate breast tissue while androgens antagonise its effects. Around 25% of cases have no identifiable cause.
Three natural peaks: neonatal (maternal oestrogen), pubertal (most common — resolves on its own by 17–18), and ageing. These are self-limiting. Reassurance is the standard approach.
Gynaecomastia secondary to these causes is managed as part of treating the primary disease. If corrected early, breast enlargement may regress.
No underlying cause found despite thorough investigation. These patients — particularly those with persistent, bothersome gynaecomastia — are the primary candidates for surgical correction.
Cancer accounts for less than 1% of cases. Most gynaecomastia is benign and self-limiting.
| Grade | Description | Accepted treatment |
|---|---|---|
| Grade I | Minor enlargement. No skin redundancy. Small subareolar button of tissue. | Observation if recent onset. Gland excision ± liposuction if persistent or >1 year. |
| Grade IIa | Moderate enlargement. No skin redundancy. Visible feminised contour. | Liposuction + open gland excision via periareolar incision. Most common presentation. |
| Grade IIb | Moderate enlargement with minor skin redundancy. | Liposuction + gland excision. Assess skin contraction at 3 months before deciding on skin excision. |
| Grade III | Marked enlargement with significant skin redundancy and ptosis. | Liposuction + excision + formal skin reduction (Inverted-T / Lejour / Wedge / Lalonde). Single-stage preferred. |
| Pseudo | Fatty chest enlargement only. No glandular tissue. Often obesity-related. | Weight loss first. Liposuction alone if weight stable and fat localised. No gland excision needed. |
Not an immediate candidate if: on anabolic steroids, obese with planned major weight loss, uncontrolled diabetes, or active hormonal disorder.
Surgery is the mainstay for gynaecomastia lasting more than one year, or where the underlying cause has been addressed but the tissue persists.
1 · Liposuction
First step for most cases. Removes the fatty component, reduces bleeding for subsequent excision, and creates a natural plane for gland removal. Suitable for moderate to diffuse enlargement without significant skin excess. Not used alone when firm glandular tissue is present.
2 · Open gland excision
Glandular disc removed through a periareolar, circumareolar, trans-areolar, or circumthecal incision — performed after liposuction for better haemostasis and cleaner tissue planes. Standard approach for Grades I through IIb.
3 · Skin reduction — Grade IIb and III
Techniques
Inverted-TLejour short scarWedge excisionLalondeMinor
Significant
Sudden increase in chest swelling or firmness · Fever above 38°C · Discharge from wound · Nipple darkening or rapid loss of sensation · Chest pain or breathlessness
Minor asymmetry and mild swelling at 3–4 weeks: attend your scheduled follow-up, do not self-medicate. Seromas are aspirated in clinic under local anaesthesia. Haematomas may need small re-exploration. Infections are treated with antibiotics and rarely require wound opening.
Keep your surgeon's emergency number saved. If unreachable and symptoms are severe, go directly to the nearest emergency department and inform them of your recent procedure.
The majority of cases fall into the physiological or idiopathic category. Within this group, most men are comfortable with their body and go through life without any intervention — which is entirely appropriate.
Treatment becomes relevant only when gynaecomastia is causing distress, affecting confidence or quality of life, or hampering daily activity — such as avoiding certain clothing, sports, or physical contact due to embarrassment or discomfort.
If you are not bothered by it, there is nothing that needs to be done. If you do want treatment for this condition, liposuction combined with gland excision is one of the accepted and widely performed procedures.
General patient information only. Individual assessment by a qualified MCh (Plastic Surgery) surgeon is essential before any surgical decision.
Book a consultation with Dr. Sinnet Roy — online or in person at Lakeshore Hospital, Ernakulam.
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