Gynecomastia is a health problem found in male adolescents or in adult men which occurs as excessive pectoral gland hyperplasia in one or both sides of the chest...


Gynecomastia is a health problem found in male adolescents or in adult men which occurs as excessive pectoral gland hyperplasia in one or both sides of the chest. The name “Gynecomastia” (also spelt “gynaecomastia”) derives from the Greek "gyne" - a woman and "matos" - breast, literally “the female breast”, and abnormal breast enlargement sometimes occurs in men as a result of proliferation of glandular tissue, fat and/or fiber. Gynecomastia is a problem which can lead to male breast cancer, and/or psychological distress.


Gynecomastia is caused by hormonal imbalance, and may arise physiologically, pathologically, or as a result of ingested or injected substances eg. steroids or pro-hormones.

Physiological gynecomastia can result from the normal process of male maturation.

  • Gynecomastia can appear in newborns caused by maternal hormones which previously crossed the placenta, and this will disappear a few weeks after birth.
  • Gynecomastia can also appear in maturing adolescent boys, and in these cases it usually disappears within a few years. If it does not disappear by the age of around 18, then the person should visit an endocrinologist.
  • In men over 60 years of age gynecomastia can appear and progress due to the gradual degeneration of the germ cells that produce androgens (the male sex hormones) - gynecomastia of this type does not usually require specialist treatment.

Pathological (or morbid) Gynecomastia can have many causes: deficiency in male sex hormones, excess estrogen medication, steroids, pro-hormones, hormones, drugs (marijuana, amphetamines, heroin), breast cancer, obesity, hyperthyroidism / hypothyroidism, renal insufficiency, cirrhosis of the liver:

  • If the cause of gynecomastia is a medication, the medication should be discontinued or replaced with another !
  • If the cause of gynecomastia is the taking of drugs or abuse of alcohol then often surgery is not required, as after the drug or alcohol abuse is discontinued the chest may return to normal.
  • If the cause of gynecomastia is obesity, then diet and exercise are recommended, with possibly liposuction. Note that obesity can result in either true gynecomastia or pseudogynecomastia (lipomastia).

If people with pseudogynecomastia excess fat in the chest area can cause the appearance of the male chest to begin to resemble female breasts, despite a lack of glandular tissue.

If you have followed the advice in this section but the gynecomastia does not disappear, then, following a visit to an endocrinologist, you can choose to have the gynecomastia removed surgically.

Steroid or prohormone use. Some common pathological causes are the use of steroids, or pro-hormones, or the hormones themselves eg. testosterone. (Occasionally, it is thought that substances found in protein supplements can also cause gynecomastia.) Even a short period of steroid use can result in the appearance of gynecomastia, sometimes a few years after the steroid use.

It is also important to remember that steroid use not only can lead to gynecomastia which requires surgery but can also lead to significant changes to testicular function, adrenal gland function, or to hypertension which can lead to stroke and/or heart attack, as well as disturbing hormone levels. It is important to stop using steroids.


1. Check for cancer.

The first step is to make sure that the gynecomastia is not a result of cancer. To check this a visit to an endocrinologist is necessary. A consultation with your doctor, blood tests, ultrasound of the chest and testicular tissue, and an abdominal examination will assist the doctor in choosing the correct treatment.

2. Treatment for gynecomastia.

There are two ways to treat gynecomastia - conservative (ie. pharmacological treatments) and operative therapy.

Conservative therapy is achieved through advice from an endocrinologist. Pharmacological treatment involves treatment with drugs that inhibit the production of the hormone oestrogen (alternative spelling “estrogen”). Oestrogen is known as a female sex hormone, but in fact is also found normally in males. When in excess in males, however, it contributes to the production of gynecomastia (but note that the precise hormonal causes of gynecomastia are not known, and other hormones might well be involved).

Pharmacological treatment is most effective in the initial or more active phase of the disease, but often brings only partial improvement.

Operative or surgical therapy involves the removal of gynecomastia by operation. This involves removal of glandular tissue by excision and perhaps surrounding fat tissue by liposculpturing (very occasionally only fat tissue is removed - in cases of pseudogynecomastia).

Surgical treatment protects from future possible breast cancer in males, but is also an aesthetic operation which improves the appearance of the chest.

Surgical removal of gynecomastia is often used in the following cases:

  1. For pubertal gynecomastia which persists after age 18 and which has been present for 3 to 4 years.
  2. If gynecomastia is the result of steroid/prehormone/hormone use.
  3. If gynecomastia is accompanied by proliferation of periductal connective tissue.
  4. If the cause of gynecomastia is not known (idiopathic gynecomastia).
  5. If gynecomastia is not resolved by conservative treatment.

Surgical removal of gynecomastia is carried out in healthy men of all ages, and the best results are obtained when the skin is firm and elastic.

A rough guide to the procedure before surgery, during surgery and afterwards is given below - but for full and individual details or variations it is important to take the advice of the Consultant Surgeon.


1. In the U.K.

  • It is important to see your general practioner and have a consultation with an endocrinologist to rule out some of the diseases mentioned in the section “Causes of Gynecomastia”.
  • It is recommended to quit SMOKING for four weeks before and two weeks after surgery because smoking has a dramatic and negative effect on wound healing.
  • You must quit DRINKING at least one week before the operation, and not drink one week after the operation.
  • You should stop taking all supplements, eg. drugs and vitamins at least one month before the operation (THIS INCLUDES ASPIRIN - which can be life-threatening if taken before an operation). IMPORTANT: if your testosterone level is found to be much higher than normal from the blood tests taken on the day - this might result in a necessary additional operation to stop the bleeding - and a surcharge will be needed of 350 pounds to cover costs.
  • Unless you are told otherwise please do not diet before the operation as it is best to come to the clinic with a normal amount of body fat.

2. In Poland.

On the morning before the operation

  • Usually on the morning before surgery blood tests are taken and a chest ultrasound is carried out.
  • You will need to fast before the blood tests (ie. you cannot eat breakfast or drink anything before the blood tests) so as not to disturb the results.
  • We will test: your blood clotting time, morphology, basic ions, glucose and hormone levels, hepatic viruses and HIV.
  • Before the operation you ABSOLUTELY MUST fast (ie. no food or drink) for at least 6 hours, as the procedure is usually performed under general anesthesia. By using advanced anaesthetics with use of both general and local anaesthetics you will wake up within a few minutes of surgery with no feelings of sickness.
  • Contraindications to perform surgery include sudden onset of illness, diabetes, bleeding disorders, inflammatory changes in the skin, active cancer, autoimmune diseases etc.


  • After consultation with the Consultant Surgeon, who will explain in detail the operation, you will meet the Consultant Anaesthesiologist, who will explain the administration of the anaesthesia.
  • After this, the Consultant Surgeon will draw markings on your chest to guide the operative process.
  • Medical photography will be performed, as part of the medical documentation.


  • You will then be taken to the operating theatre where the drip for the anaesthesia will be inserted, and surgery will be carried out.
  • In most cases small drains will be inserted in both sides of the chest, which will be removed in the next day or two.
  • In the post-operative room you will then be given some food and drink, and the nurse will be looking after you throughout the night as you sleep, and administering prescribed medications as needed.
  • On the next morning the Consultant Surgeon will check the dressings, and you will be discharged to the Hotel.
  • On following days you will return to the clinic for check-ups.
  • Please see the section “After Surgery” for further details.


  • In many cases only excision of the glandular tissue is needed. This will result in a flat chest and a satisfying appearance of the chest. In these cases the skin is cut on the lower border of the areola (to minimize the visibility of the scars). We have a policy of removing all glandular tissue at Medimel (as opposed to gland reduction which is sometimes used at other clinics).
  • In cases of lipomastia (pseudogynecomastia) a good result is achieved by liposuction of excessive fat tissue in the chest area. This is done via two stab wounds (3 mm) on each side of the chest and therefore leaves very little external scarring.
  • Very often both of the above methods are used and liposuction (or “liposculpturing”) is performed followed by excision. This is used when the glandular tissue is surrounded by additional fat tissue which grows to keep the shape of the chest. In these cases if only glandular tissue was removed then a step-up would be seen from the space where the gland was removed to this fat tissue. Aesthetically, therefore, sometimes liposculpturing is very necessary.


Immediately after surgery, the patient feels discomfort such as pain, swelling and bruising, and pain can be eliminated with the help of painkillers. Wound dressings are applied, plus a compression band or vest (supplied by the clinic).

Within one or two days the patient will feel well enough to take walks (but care should be taken), and after a few days the patient will feel well enough to drive and return to work (wearing a compression band), as long as the work does not involved strenuous exertion.

Do not drink for one week after surgery, and do not smoke for two weeks after surgery, and do not sunbathe the chest for six months after surgery as this will affect the appearance of the scars. It is also important not to take steroids, prehormones or hormones after surgery, because there are microscopic cells (which cannot be removed by surgery) which will respond to these to produce more glandular tissue.

Details of massaging will be given to you by the Consultant Surgeon, but often massaging should be started one week after surgery, starting gently and then moving to full intensity over the next week for at least 21 days. Massaging should be for one hour daily and the ultimate aim of massaging is to achieve softness of skin and tissue (similar to that before surgery). If softness is not achieved in 21 days, then sometimes it is necessary to continue massaging for 3 to 4 months in order to help break down internal scar tissue.

Sutures are typically removed 8 to 12 days after surgery and can be removed by your G.P. or a nurse.

Bruising will go down within one or two weeks. Fluid build-up will stop after around 6 weeks - which is why the compression band is worn for 6 weeks. The patient must not do strenuous exercise for 6 weeks, but after 6 weeks the patient can return to full activity.

However, internal scar tissue, even with good massaging, will take around 12 to 14 months to disappear completely, although the final appearance of the chest is usually apparent within 6 to 9 months.


All surgery contains an element of risk, and there may be complications, which, however, are uncommon. At the consultation, which occurs before every operation in the one or one and a half hours before surgery, the Consultant Surgeon will list possible complications. The most common include: infection, hematoma, seroma, indentation, keloids, scar tissue overgrowth, DVT (deep vein thrombosis), permanent or temporary desensitization of the nipples. To minimize the risk, listen carefully to the advice from the Consultant Surgeon.


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