Gynecomastia: Dynamic Solution for a Common Male Problem
Gynecomastia in men and children: causes, stages, symptoms, diagnosis, surgery, cost, images, before and after photos, videos, and everything you want to know in the text that follows.
Gynecomastia or macromastia: The etymology derives from the Greek words “woman” and “breast” and is mostly a benign condition. It consists of an increased breast volume due to benign hypertrophy of the glandular tissue and localized fat accumulation, resulting in the male chest resembling a female breast.
Gynecomastia is not a problem of modern times. Historical literature reveals that the physician Paul of Aegina developed a surgery for removing breasts from men during the 7th century AD, recognizing it as a social discomfort issue. He defined it as a medical problem requiring surgical treatment: the same gynecomastia surgery that is performed today, albeit in a different form.
Stages of Gynecomastia
Depending on the severity of the problem, gynecomastia stages are as follows: Stage 1, where there is a slight swelling of the male breast without excess skin. Stage 2, where there is moderate swelling of the male breast without excess skin. Stage 3, where there is moderate swelling of the male breast with excess skin. And Stage 4, where there is significant swelling of the male breast with excess skin.
Causes of Gynecomastia
Gynecomastia can occur at any stage of a man’s life, from adolescence to advanced age, predominantly with idiopathic (without pathological cause) etiology. However, there are cases where the cause of gynecomastia is hormonal or due to medications (iatrogenic or drug-induced). Therefore, a specialized hormonal check-up is necessary preoperatively.
In cases where gynecomastia is due to pathological causes, these can be related to testicular problems, thyroid or liver diseases, and chromosomal abnormalities.
In hormonally induced gynecomastia, imbalances between estrogen and testosterone and the dominance of estrogen can cause swollen breasts in men and adolescents. Although obesity is not a cause of gynecomastia, the accumulation of fat in the breast area gives the appearance of gynecomastia but constitutes pseudogynecomastia.
In iatrogenic or drug-induced gynecomastia, specific medications such as cardiovascular drugs, prostate cancer treatments, antidepressants, and anabolic steroids are implicated. This category of causes also includes the use of illegal substances and excessive alcohol consumption.
Sometimes, gynecomastia in adolescents proves to be a temporary condition that normalizes when hormone levels return to normal. However, gynecomastia in men is neither treatable with diet nor with exercise, and the earlier it is addressed, the less likely it is to cause skin sagging.
In cases of adults who suddenly develop unilateral gynecomastia, i.e., swelling of only one breast, the plastic surgeon will recommend immediate examination by a breast surgeon as it may conceal potential malignancy.
Correct diagnosis, the experience of the plastic surgeon you choose, the selection of the appropriate technique for you (or a combination of techniques), and its flawless execution will lead you to successful and definitive treatment of gynecomastia!
Symptoms
Men suffering from gynecomastia may experience sensitivity or pain in the chest or feel a distinct mass under the areola. The extra tissue in the breast and the skin may also cause dermatological irritations or even infections. More painful, however, are the emotional and practical impacts of gynecomastia, as it poses a significant blow to male identity, complicating personal and social relationships and daily life.
Gynecomastia: Diagnosis
The diagnosis of gynecomastia is made through the clinical examination of the man by the plastic surgeon, who will evaluate whether it is true gynecomastia or pseudogynecomastia, combined with taking a detailed medical history. Depending on the diagnosis results, a specialized hormonal check-up and a series of other laboratory tests will follow for the patient to determine the most appropriate treatment for their gynecomastia. Overall, gynecomastia treatment is decided based on the clinical image of the candidate, the detailed medical history, specific hormonal tests (including thyroid hormones, testosterone-estrogen, LH, FSH, prolactin), and any other necessary laboratory tests, as well as the potential collaboration of the plastic surgeon with an endocrinologist or other specialists.
Surgery for the Treatment of Gynecomastia
Today, surgery to combat gynecomastia involves reducing the hypertrophic male breast with liposuction and removing the excess glandular tissue through a tiny incision in the areola. The surgery lasts about 1-2 hours and is performed under general anesthesia. The modern 4D liposuction technique Vibrasat Pro offers greater precision and control in removing unwanted fat with simultaneous skin tightening and contouring, says Plastic Surgeon in Athens Aris Damagas.
In cases of more severe gynecomastia (second and third degree), skin removal around the nipple is often necessary. Even then, modern aesthetic plastic surgery ensures almost invisible scars, as the incisions are limited around the areola, and the re-suturing is done with a special purse-string technique.
However, in cases of post-massive weight loss, the use of more extensive incisions is, unfortunately, unavoidable to achieve an aesthetic result harmonious with the rest of the body. The patient will be informed about the position and extent of the incisions by the plastic surgeon during the preoperative session, where the surgery goals will be set, and the surgical plan will be designed.
Surgical treatment of gynecomastia restores the normal chest contour and simultaneously corrects the appearance of the nipple or areola. The relief from negative emotions, a more masculine appearance, the improvement of the overall male body image, and the quality of life that the restoration of gynecomastia provides make it particularly popular. Often, the surgery is performed in combination with liposuction on the abdomen, “love handles,” waist, and back folds, offering a total makeover of the male body.
Cost of Surgery
The cost of surgery for gynecomastia treatment depends on the extent of the problem, whether a biopsy of the glandular tissue or hospitalization is needed, but the result rewards the patients for life.
Recently, minimally invasive methods for combating gynecomastia, such as the new method without incisions, have gained popularity. The innovative aspect of this method is that all surgical maneuvers are performed through a tiny incision that does not require even a single stitch to heal.
The key factor ensuring the permanence of the gynecomastia result is maintaining a stable body weight.
Postoperative Recovery
After the surgery is completed, the patient undergoes hospitalization, which is day-long. Therefore, the patient is discharged from the hospital the same evening. It is recommended not to drive due to the influence of anesthesia medications and to have arranged preoperatively for a loved one to accompany them home.
Following the individualized postoperative instructions of the plastic surgeon is crucial for quick recovery and a successful aesthetic outcome. It is usually recommended to take antibiotics for a few days after the surgery and mainly keep the operated area dry. The tolerable pain is managed with mild analgesics, while the postoperative swelling (edema) – primarily in cases requiring more extensive surgical maneuvers due to the problem’s size – subsides within the following days, allowing the final result to become apparent.
Returning to work and other daily activities can occur 3-7 days after the surgery unless it involves physically demanding work, in which case the plastic surgeon will inform the candidate preoperatively about the required period of absence.
Using a special elastic vest for the period recommended by the plastic surgeon is crucial for rapid healing and achieving the ideal aesthetic result.
Intense shoulder movement, lifting weights, and general strenuous physical activity should be avoided in the early postoperative period. Additionally, to avoid risking their aesthetic result, patients need to wait 2-3 weeks before returning to the gym, regardless of their physical condition.
Even though swimming is allowed just a week after the surgery, the eagerness to reveal the new appearance should not lead men to sun exposure without sunscreen protection. Thus, those interested in perfection and wanting to avoid even minor discolorations need to protect the incision area from sunlight or tanning beds without high SPF sunscreen for the next six months.
Results Maintenance
The results of gynecomastia surgery are permanent unless there is significant weight gain. For ideal results from gynecomastia surgery, candidates should approach their ideal weight for their body type and stabilize at it. If they are obese, it is ideal to follow a weight loss program before proceeding with the surgery. Additionally, adopting an active lifestyle that includes physical exercise, and specifically chest workouts, will not only maintain but also further enhance their aesthetic result.
Another important factor for the perfect result is the good elasticity of the candidate’s skin. Sometimes, in older individuals, reduced skin elasticity may create excess skin or wrinkles, which significantly decrease over time. Therefore, even skin laxity should not discourage older men, as gynecomastia can be effectively and safely corrected at any age.
Remember, therefore, that it largely depends on you to “keep” forever all that you gained with gynecomastia surgery!
High Levels of Postoperative Satisfaction
Beyond the impressive external changes, the results of the surgery are evident in every aspect of the patients’ daily lives. Improved posture, achieving desired dressing styles, overall self-presentation, relief from negative emotions, restoration of masculinity, and male identity sense provide quality of life, significantly impacting personal and social relationships and professional life. Particularly impressive are the results regarding adolescents, as the restoration of gynecomastia is associated with overall behavioral improvement, playing a decisive role in their educational path and psychosocial development.
Just as high postoperative satisfaction accompanies breast plastic surgery in women, the results of relieving hypertrophic breasts are impressive in adolescents’ and men’s behavior and lives: “I had to ‘hide’ permanently in loose clothing… what could be better than wearing your favorite t-shirt without inhibitions or feeling comfortable with your body on the beach!”, “I had third-degree gynecomastia, so in my case, skin needed to be removed… despite my concern, the result was impressive… ten days later I was already swimming in the sea… a year later I enjoy my body, exercise systematically, and the result has become even better!”, “after addressing my son’s gynecomastia, I see him happy again… he returned to sports activities and his friends with more enthusiasm. Everything developed smoothly, as discussed preoperatively with the doctor… justifying our decision for the timely correction of the problem!”, “dedicating a few days of my time permanently solved a problem that limited my life. Now I can enjoy my personal moments more and better present myself in social interactions.”
Gynecomastia FAQs
Is gynecomastia related to obesity and poor eating habits? Does gynecomastia usually coexist with obesity?
True gynecomastia involves hypertrophy of the glandular tissue, which is not related to eating habits. Concerning weight, there are thin men with large breasts and overweight men with flat chests. The appearance of gynecomastia that an overweight person may exhibit is not always true gynecomastia; it is pseudogynecomastia, as overweight individuals store additional fat in the chest area. However, obesity and true gynecomastia often coexist.
How is skin elasticity related to the success of the surgery?
Good skin elasticity of the candidate for the surgery is a factor that ensures an even more successful aesthetic result. In some individuals with reduced skin elasticity (more often in older individuals), there may be excess skin or wrinkles that are more noticeable postoperatively. Most of these folds will remain for six to twelve months and then significantly reduce, as loose skin usually tightens.
If I am overweight, can it affect the success of the surgery?
Although gynecomastia surgery can help you and effectively address your problem, the aesthetic results will not be as successful if you are overweight. Usually, excess weight worsens the problem of existing gynecomastia or alone causes pseudogynecomastia. For the ideal result, it is good to try to reach a reasonably satisfactory weight and then consult the plastic surgeon. In cases of significant weight loss and accompanying sagging, the need for incisions may be unavoidable.
Can gynecomastia surgery be combined with another surgery simultaneously?
Gynecomastia often coexists with fat deposition in other body areas. Therefore, gynecomastia treatment is often combined with liposuction on the “love handles,” abdomen, waist, or back folds to improve the contour. Combining all these achieves a total makeover of the male body.
When might breast swelling indicate health problems?
In younger individuals, apart from the aesthetic problem, there is no health risk. However, in adult cases where sudden swelling occurs in one or both breasts and there is no history of using drugs that are implicated in glandular hypertrophy (anabolics, marijuana, some cardiovascular drugs, etc.), immediate investigation by a breast surgeon is necessary as it may conceal the potential for malignancy.
What hormonal tests need to precede the surgery?
While we always recommend consulting an endocrinologist or pediatric endocrinologist, the necessary tests include: thyroid hormones, testosterone-estrogen, LH, FSH, and prolactin.
When should I worry about my teenage son’s gynecomastia problem? How long should I wait before visiting a plastic surgeon?
I understand the parents’ concern, especially the mother’s, for her son. Mothers have sometimes reported feelings of guilt about this problem, thinking they might be responsible for their child’s eating habits. However, it is not the case: diet is not to blame because other factors contribute to gynecomastia in adolescents. During adolescence, there is a very high production of testosterone and, to a much lesser extent, estrogen. It is not known if excessive estrogen is produced or if there is an imbalance between estrogen and testosterone: although the exact mechanisms of gynecomastia development are unknown, hormones play a significant role, along with hereditary factors.
I understand the parents’ concern, especially the mother’s, for her son. Mothers have sometimes reported feelings of guilt about this problem, thinking they might be responsible for their child’s eating habits. However, it is not the case: diet is not to blame because other factors contribute to gynecomastia in adolescents. During adolescence, there is a very high production of testosterone and, to a much lesser extent, estrogen. It is not known if excessive estrogen is produced or if there is an imbalance between estrogen and testosterone: although the exact mechanisms of gynecomastia development are unknown, hormones play a significant role, along with hereditary factors.
Is there a chance of losing chest sensitivity after the surgery?
You may notice reduced sensitivity in the operated area. This is usually more common in men with enlarged breasts requiring significant liposuction. Most men find this temporary loss of sensitivity insignificant. Sensation returns fully within a year for most.
I exercise intensely and have developed swollen breasts in recent months. Should I be careful about something?
Intense physical exercise, such as weight lifting and bodybuilding, causes muscle strengthening and enlargement. In this case, hypertrophy of the pectoralis major muscle (the “athlete’s chest”) should not be confused with gynecomastia. However, this condition should not result from taking illegal substances that may create future glandular hypertrophy. The “athlete’s chest” will continue to be attractive, provided there is corresponding support, because if you stop exercising, the area will be accompanied by sagging and deformity.
Are there long-term health consequences after gynecomastia surgery?
It is a very safe surgery, which, apart from solving the aesthetic problem, also acts preventively, as it essentially performs “preventive” subcutaneous mastectomy.
How can I best prepare for my surgery?
If you do chest hair removal, avoid it for 2 weeks before the surgery, and it is good to reduce smoking a few weeks before the surgery, as nicotine can delay the healing process. Two weeks before the surgery, stop using all products containing aspirin, anticoagulant drugs, vitamin E, and herbal supplements. Ensure you have provided the plastic surgeon with all the required laboratory results. Also, have some comfortable shirts ready to wear during the first weeks of recovery.
When is it necessary to remove skin?
In second and third-degree gynecomastia, where the problem is more severe and the candidate does not have good skin quality or is older, skin removal may be necessary. However, this is usually achieved only by removing skin around the nipple and re-suturing it with a special purse-string technique, resulting in almost invisible scars.
What will happen if I lose weight after the surgery?
Losing weight will improve and highlight your aesthetic result further.
Can I sunbathe after undergoing gynecomastia surgery?
We live in a country with plenty of sunshine all year round, and sun exposure is inevitable. Anyway, the incisions of this surgery are tiny, so the skin trauma is minimal. However, to avoid even minor discolorations, protect the area with a high SPF sunscreen. With continuous sunscreen application, you can safely expose yourself to the sun and show off your aesthetic result, highlighting your masculinity.
Is unilateral gynecomastia possible?
It is common to have asymmetry between the two male breasts. If this exists from childhood and the necessary laboratory and imaging tests are done, it can be effectively treated with unilateral surgery. If one breast is more swollen than the other, provided there is no underlying health problem, the plastic surgeon will suggest unilateral surgery to achieve symmetry between the two breasts.