The Complete Guide to Gynecomastia Surgeries

Gynecomastia is a condition common among boys and men. It is characterised by enlarged breast tissue, either on one side or both. As a result, people with gynecomastia can experience physical and psychological strain. Understanding the symptoms and causes can help in deciding on treatment options. In many cases, gynecomastia can be treated non-surgically, but surgical options are available. We’ll discuss in more detail the symptoms and causes of gynecomastia and the various treatments available.

What Are the Symptoms of Gynecomastia?

The symptoms of gynecomastia may differ from person to person. The most prevalent sign is the enlargement of breast tissue but it’s worth consulting a GP if you notice any of the following alongside enlargement:

Swelling or enlargement of breast tissue.
Tenderness or pain around the nipple area.
Firm glandular tissue under the skin that can feel rubbery or hard.

Gynecomastia vs Chest Fat: Understanding the Difference

One of the most common concerns men face is determining whether they have gynecomastia or simply chest fat. Here are the key differences:

Gynecomastia involves glandular tissue growth due to hormonal imbalances, often leading to tenderness and swelling.
Chest fat (pseudogynecomastia) results from excess fat deposits, typically associated with obesity or weight gain.

Physical examination and diagnostic imaging can help differentiate between the two. Lifestyle changes like exercise and weight loss may help reduce chest fat but are unlikely to resolve gynecomastia.

Causes of Gynecomastia

The reason gynecomastia is common among men is because of testosterone, or more accurately, the imbalance of this naturally occurring hormone. Men make testosterone during puberty alongside a small amount of estrogen, which is the female hormone.

When the ratio of testosterone to estrogen shifts, either due to reduced testosterone production or increased estrogen levels, it can lead to the development of gynecomastia. Age, medication, or underlying health conditions can contribute to this hormonal imbalance. Understanding these triggers is key to managing the condition effectively.

This imbalance can occur at various life stages. For example:

Puberty: Hormonal fluctuations during adolescence often cause temporary gynecomastia in teenage boys. In most cases, it resolves naturally as hormone levels stabilise.
Adulthood: Factors such as obesity, certain medications (e.g., anabolic steroids or antidepressants), and medical conditions affecting the liver, thyroid, or kidneys can contribute to hormonal imbalances.
Ageing: As men age, testosterone levels naturally decline, which can lead to an increased risk of developing gynecomastia.

Understanding these causes is essential for addressing gynecomastia effectively. Identifying the root cause will guide treatment options, whether through lifestyle adjustments, medication, or surgery.

Drug Use and Gynecomastia

Certain drugs and medications can also contribute to gynecomastia. A study in 2012 found that 20% of gynecomastia in men in the USA was due to drug use. Although this is an older study, as the number of people using both prescription and recreational drugs continues to rise, the prevalence of drug-induced gynecomastia also increases.

This trend underscores the importance of monitoring medication and substance use as potential contributors to the condition. Some of the most common drugs that cause the condition include:

Anti-androgens: Medications used to treat prostate conditions, such as finasteride or flutamide, can lower testosterone levels and lead to gynecomastia.
Anabolic steroids: Often misused for muscle building, these can disrupt the hormonal balance by converting excess testosterone into estrogen.
Antidepressants and anti-anxiety medications: Certain drugs in these categories can interfere with hormone production and regulation.
Heart medications: Drugs like spironolactone and calcium channel blockers may affect testosterone levels or estrogen activity.
Ulcer treatments: Medications like cimetidine, used for stomach ulcers, can have estrogen-like effects when taken in high doses.
Recreational drugs: Substances such as alcohol, marijuana, heroin, and amphetamines have been linked to hormonal changes that may result in gynecomastia.

Surgical Options for Gynecomastia

When non-invasive treatments fail to provide relief, surgical intervention is often the most effective way to address gynecomastia. Surgical procedures focus on removing excess glandular tissue, fat, or skin to restore a more masculine chest contour. Here are the main surgical options available:

Liposuction for Gynecomastia

Liposuction is a minimally invasive procedure that targets excess fat in the chest area. This is often suitable for men with pseudogynecomastia, where fat deposits are the primary concern.

Key Details:

Performed under local or general anaesthesia.
Small incisions are made near the chest, allowing the surgeon to insert a thin tube (cannula) to remove fat deposits.
Recovery is relatively quick, with most patients resuming daily activities within a week.

While liposuction is effective for fat removal, it does not address glandular tissue, making it less suitable for true gynecomastia cases.

Excision Surgery (Mastectomy)

Excision surgery is a popular method for treating gynecomastia caused by glandular tissue growth. This procedure is also used in cases involving excess skin or when the nipples need repositioning for a more natural appearance.

Procedure Overview:

Conducted under general anaesthesia.
An incision is made around the areola or along the natural contours of the chest.
Glandular tissue and, if necessary, excess skin is removed.
The procedure may also include reshaping the chest for a more symmetrical appearance.

Recovery from excision surgery is slightly longer than liposuction, but the results are typically more dramatic and permanent.

Combination Surgery

For many patients, a combination of liposuction and excision offers the best results. This approach addresses both fat deposits and glandular tissue, ensuring a smooth, natural-looking contour.

Who Benefits Most:

Men with moderate to severe gynecomastia involving both glandular tissue and fat.
Cases where the skin has lost elasticity require tightening or removal.

Combination surgery allows surgeons to perform the procedure to the patient’s unique anatomy, providing the most comprehensive solution.

What to Expect Before and After Surgery

Your doctor will give you thorough instructions unique to your needs and procedure. It’s always best to follow the advice carefully, this could impact both the success of your surgery and the recovery time. Here is what to expect when considering surgery:

Before Surgery:

A thorough consultation is conducted to assess the severity of gynecomastia and discuss patient goals.
Patients may need to stop certain medications or lifestyle habits (e.g., smoking) to optimise recovery.

After Surgery:

Most procedures are outpatient, allowing patients to return home the same day.
Post-surgical swelling and bruising are common and typically subside within a few weeks.
Wearing a compression garment for several weeks helps support healing and contouring.
Follow-up appointments ensure proper recovery and address any complications.

Is Surgery Right for You?

Surgical options provide long-lasting and often life-changing results for men struggling with gynecomastia. While non-surgical methods can help in some cases, surgery is often the most reliable way to achieve a flatter, more sculpted chest.

Can I get Gynecomastia Surgery Through the NHS?

Gynecomastia surgeries with the NHS are not always a guarantee. Under some circumstances, it is offered if the condition is caused by underlying or long-term conditions. Other criteria include:

The person is under considerable pain and stress
All other non-invasive treatment options have not worked

If you are eligible for gynecomastia surgery with the NHS you will need to consult with your GP and they will give an assessment.

Non-Invasive Treatment Options for Gynecomastia

As a common condition, there are options beyond surgery for Gynecomastia. These vary from simple lifestyle changes to non-invasive medications and procedures. Usually, this is recommended or prescribed before surgical options.

Lifestyle Changes

For many, lifestyle adjustments can alleviate symptoms, particularly if gynecomastia is linked to weight gain, substance use, or medications. Common changes include:

Weight Loss: Reducing body fat can minimise the appearance of chest fat, especially in cases of pseudogynecomastia.
Avoiding Triggers: Limiting alcohol, recreational drugs, or certain medications can prevent hormonal imbalances.
Exercise: Strength training and cardiovascular exercises can improve overall chest definition, though they won’t target glandular tissue.

In cases where lifestyle changes aren’t enough, non-surgical treatments may be effective:

Hormone Therapy: Medications such as tamoxifen or clomiphene can help balance estrogen and testosterone levels, reducing glandular tissue growth.
Monitoring: In mild or early-stage gynecomastia, especially during puberty, regular check-ups may suffice as the condition often resolves on its own.

Get the Right Gynecomastia Treatment

Surgery is often the last stage for men with gynecomastia. Before you consider it you should explore all non-invasive procedures. This will provide better insight into the root cause and likely improve your health whether it’s through exercise, physiotherapy or removing harmful habits.

If you have questions and need to discuss the matter further, get in contact with your trusted Aesthetic clinic in London Harley Street MD for a consultation. We can discuss treatment plans and help you regain your confidence.

References

Bowman JD, Kim H, Bustamante JJ. Drug-induced gynecomastia. Pharmacotherapy. 2012 Dec;32(12):1123-40. doi: 10.1002/phar.1138. Epub 2012 Nov 16. PMID: 23165798

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Dr. Chia Tan

Founder at Harley Street MD

Dr. Chia Tan is a UK-trained and GMC-registered doctor and a respected member of the Royal College of Surgeons (MRCS) and the British College of Aesthetic Medicine (BCAM). As a former Clinical Education Fellow at the University of Warwick, Dr. Tan has published numerous articles in leading scientific and medical journals, highlighting his expertise.

His extensive qualifications and memberships reflect his profound medical knowledge and dedication to providing exceptional patient care in aesthetic weight loss, and men’s health treatments.