Gynaecomastia

Gynaecomastia is the medical term for enlargement of male breast tissue. It’s a common condition, affecting a significant proportion of men at some point in life, and the underlying cause varies between patients. Some cases are related to hormonal changes during adolescence and resolve on their own. Others persist into adulthood. Some are related to medications, recreational drug use, or underlying medical conditions that affect hormone balance. A small number are linked to specific medical conditions that need investigation before any cosmetic correction is considered.

Surgery for gynaecomastia removes the enlarged tissue from the male chest, with the goal of producing a flatter, more typical male chest contour. The specific approach depends on whether the enlargement is mostly fatty (in which case liposuction may be sufficient), mostly glandular (where the breast tissue itself is enlarged and needs to be removed surgically), or a combination of both. We’ll work out which approach suits your situation at consultation, after a thorough assessment of the underlying cause.

Gynaecomastia is sometimes a sign of an underlying medical condition that needs investigation before any cosmetic correction is considered. Conditions that can produce gynaecomastia include hormonal imbalances (including some that come from medications), liver and kidney disease, and in rare cases tumours that produce or respond to hormones. New onset gynaecomastia in an adult man, particularly when the enlargement is rapidly progressive or affects only one side, warrants assessment by a doctor before any cosmetic surgery is planned.

The assessment may include a discussion of medications and supplements you’re taking, a review of your medical history, a physical examination, and in some cases blood tests or imaging. Where an underlying cause is identified, addressing the cause is generally the first step. Sometimes this resolves the gynaecomastia without the need for surgery.

Patients with long-standing gynaecomastia (particularly when it dates back to adolescence and has been present for many years without other symptoms) generally don’t need extensive investigation. Surgery is reasonable to consider in these patients without lengthy work-up. We’ll discuss what investigations are appropriate for your situation at consultation.

Gynaecomastia is broadly grouped by the predominant tissue involved, and the surgical approach is matched to the tissue type.

Gynaecomastia surgery is performed under general anaesthesia in an accredited hospital. The operation usually takes between one and three hours, depending on the technique used and the amount of tissue being removed. Most patients go home the same day or stay one night, depending on the size of the operation.

A compression garment is fitted at the end of the operation and worn continuously for several weeks to support the operated tissues, reduce swelling, and help the skin retract over the new contour. Drains aren’t routinely used in standard gynaecomastia surgery but may be placed in larger procedures.

Most patients describe moderate discomfort for the first few days, with the chest feeling bruised and tender. Bruising can persist for two to three weeks. Swelling continues for several weeks and the final chest contour isn’t apparent until the swelling has settled fully.

The compression garment is worn continuously for four to six weeks, including overnight. Heavy lifting, vigorous exercise and any activity that puts strain on the chest are restricted for around six weeks. Most patients with desk-based work return after one to two weeks. Patients in physical roles need longer, particularly if the work involves significant upper body use.

Driving generally waits until the pain is controlled without strong analgesia and the patient can move comfortably enough to handle the steering wheel safely. Sleeping position can be uncomfortable in the early weeks, with most patients preferring to sleep semi-reclined initially.

The recognised risks include:

Gynaecomastia surgery may attract a Medicare rebate where the condition meets specific clinical criteria. Eligibility depends on factors including the diagnosis being documented, the absence of an underlying reversible cause, and other criteria set out in the Medicare Benefits Schedule. Not every patient qualifies. We’ll assess your likely eligibility at consultation and provide a written quote covering all surgical, anaesthetic and hospital fees.

Dr Henry Shepherd, BMed MD MS (Plast.) FRACS (Plast.) | Specialist Plastic Surgeon | AHPRA registration: MED 0001860545