Gynecomastia Surgery (Male Breast Reduction)

Definition

Gynecomastia is the benign enlargement of male breast tissue, most commonly caused by hormonal imbalance between estrogen and testosterone, medication side effects, anabolic steroid use, genetic predisposition, or idiopathic reasons. It can occur during adolescence, persist into adulthood, and frequently results in aesthetic and psychological distress.

Gynecomastia surgery (male breast reduction) involves the removal of excess glandular tissue, fatty deposits, or both. Techniques may include liposuction, direct excision of glandular tissue, or a combination approach. The goal is to achieve a flatter, firmer, and more masculine chest contour.

Indications

Surgical treatment is indicated in men who:

Present with abnormally enlarged breast tissue that does not resolve spontaneously.
Have hormonal imbalance leading to persistent breast development.
Experience gynecomastia secondary to drug use (e.g., anabolic steroids, antiandrogens).
Develop psychological distress and reduced self-confidence due to chest appearance

Ideal candidates are in good general health, non-smokers, and have realistic expectations regarding surgical outcomes.

Preoperative Considerations

Medical evaluation: Includes endocrine assessment if hormonal imbalance is suspected.
Lifestyle changes: Smoking cessation at least 2 weeks before surgery; discontinuation of blood thinners under medical supervision.
Surgical planning: : Determining whether gynecomastia is predominantly adipose (lipomastia), glandular, or mixed, to select the appropriate technique.

Surgical Technique

The procedure is usually performed under local anesthesia with sedation or general anesthesia, and lasts 1–2 hours.

Steps of the procedure:

Liposuction: For cases with fatty predominance, a small incision is made and a cannula is used to suction excess fat, creating a flatter contour
Glandular excision: In patients with dense glandular tissue, a small incision is made at the periareolar margin, and glandular tissue is excised.
Combination approach: Most cases require both liposuction and gland excision for optimal results.
Closure: Incisions are closed with fine sutures, usually hidden within the natural areolar border.

A compression garment is applied immediately post-surgery to minimize swelling and support the chest wall.

Postoperative Course (Recovery)

Compression garment Worn for 2–4 weeks to reduce swelling and support contouring.
Swelling & bruising Common in the first 1–2 weeks, resolving gradually.
Pain Usually mild and managed with analgesics.
Stitches Often dissolvable; if not, removed within 7–10 days.
Activity Light activity resumes in a few days; strenuous exercise should be avoided for 4–6 weeks
Full recovery Achieved in approximately 4–6 weeks.

Risks and Complications

While generally safe, potential risks include:

Infection
Bleeding or hematoma
Delayed wound healing
Asymmetry of the chest
Hypertrophic or visible scars

These risks are minimized when surgery is performed by an experienced plastic surgeon, with strict adherence to postoperative care.

Outcomes

Gynecomastia surgery provides:

A flatter, firmer, and masculine chest contour
Relief from aesthetic and psychological discomfort
Permanent results, provided weight stability and healthy lifestyle are maintained

Patients typically report improved self-confidence, enhanced body image, and greater comfort in both clothing and social situations.

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