Gynecomastia

Gynecomastia — enlargement of male breast tissue — affects up to 40% of men at some point. Most cases are physiological and self-limiting. Surgery is indicated when the condition persists beyond puberty, a reversible cause has been excluded, and it is causing genuine distress.

• Persistent glandular enlargement present for more than one year
• Embarrassment affecting clothing, sport, or physical contact
• Tenderness or discomfort in the breast area
• Idiopathic case — no correctable hormonal or drug cause identified
• Stable weight, age 18+, not on anabolic steroids

• The scar sits at the lower areolar border. It fades significantly by 12 months but does not disappear
• Nipple sensation changes in the first weeks are normal — sensation almost always recovers by 3–6 months
• Do not judge the result at 3 weeks. Final contour is visible at 3–6 months
• Pseudo-gynecomastia (fatty tissue only, no firm gland) is treated with liposuction alone — no areolar incision needed
• Recurrence is possible if the cause — steroids, medication, hormonal disorder — is not addressed

Surgery takes 1–2 hours under general anaesthesia. Liposuction is performed first to remove the fatty component and reduce bleeding. The glandular disc is then excised through a periareolar incision. In most Grade I–IIb cases no skin excision is required. A compression vest is applied in theatre immediately after.

Most patients are discharged the same evening. An overnight stay is occasionally needed for Grade III cases or when drains are placed.

• Days 1–3: Swelling and mild soreness peak. Compression vest worn continuously
• Week 1: Wound review. Discomfort typically resolved
• Week 2: Return to desk work. No lifting or exertion
• Weeks 4–6: Lower body exercise allowed with garment on
• 3 months: Chest contour clearly visible, most swelling gone
• 6–12 months: Final result. Scars at their resting state

This must be your own decision. A lot of men come in because someone else has been commenting on their chest. I ask directly: does this bother you, or does it bother someone around you? I operate only when the answer is clearly the former.

Be honest about what you use. Anabolic steroids cause gynecomastia. If you are on them and we operate without addressing that, the tissue will return. Tell me — not because I am judging, but because it changes the entire plan.

Wear the compression vest. Four to six weeks, no exceptions. Patients who stop early get contour irregularities, seromas, and prolonged swelling. This is the single most controllable factor in your result.

Who I will not operate on: Anyone still in active puberty, actively losing significant weight, or with an uncontrolled hormonal condition. The result will not hold, and that benefits neither of us.