Fat, gland or both
A full male chest is made of two things. Fat is soft and spreads across the chest. Gland is a firm, rubbery disc sitting right behind the nipple, and it's what makes the nipple look puffy. Many men have both. A chest that is only fat is sometimes called pseudogynaecomastia.
The surgeon tells them apart by feeling the chest. Which you have decides the operation.
The three operations
- Liposuction only: a thin tube through two or three small cuts removes fat. It suits a soft, fatty chest with little gland.
- Gland excision with liposuction: liposuction first, then the gland is cut out through a short cut along the lower edge of the areola, where the scar hides in the colour change. The most common operation.
- Excision with skin removal: for a large chest with loose or hanging skin, often after big weight loss. Longer scars, and the nipple may be moved and made smaller.
Liposuction can't remove gland. A clinic that offers liposuction alone for a puffy, firm nipple is selling the wrong operation.
How big it is: the grades
Surgeons often grade the chest to plan the operation:
- Grade 1: a small swelling, no extra skin.
- Grade 2a: moderate, no extra skin.
- Grade 2b: moderate, with some extra skin.
- Grade 3: large, with a lot of extra skin, so skin usually has to come away.
Grades 1 and 2a usually need excision and liposuction; skin removal comes in at 2b and 3.
On the day
The operation takes about one to two hours, under a local anaesthetic with you awake or a general anaesthetic with you asleep. Smaller cases are often done under local. Most men go home the same day. Someone has to drive you home and stay with you for the first 24 hours. Some surgeons leave a small drain for a day or two. You wear a firm compression vest day and night, usually for three to six weeks, to keep the swelling down and help the skin settle.
Who it suits, and who it doesn't
It suits men over 18 whose chest has been full for a year or more, whose GP has checked for a cause, and whose weight is steady.
Surgery isn't the right step yet if:
- you're under 18, or it started in the last year or so
- a GP hasn't checked the cause, or a medicine or steroids could be behind it
- it's on one side only, or there's a hard lump, and a GP hasn't seen it
- your weight is still going down or up
Realistic results
The chest is flatter straight away, under the swelling. You can start to judge it at about six weeks, and it keeps settling for months. The result is usually permanent, because removed gland doesn't grow back. The chest can fill out again if you gain a lot of weight, or if the cause returns: anabolic steroids, some medicines, or a hormone problem.
More on what before and after really looks like.
Choosing a surgeon
Every doctor practising in Ireland must be registered with the Medical Council, and only a doctor with specialist registration can practise independently as a specialist. For gynaecomastia surgery, check that the surgeon is on the Specialist Division of the Medical Council's online register: usually in Plastic, Reconstructive and Aesthetic Surgery, or a general surgeon who specialises in breast surgery.
Nobody needs urgent gynaecomastia surgery. If a clinic pushes you to book or pay a deposit on the day, walk away and take your time.
Questions people ask
Is gynecomastia surgery done under general anaesthetic?
It can be done either way. Smaller cases are often done under local anaesthetic; larger ones, or skin removal, under general.
Can liposuction alone fix gynecomastia?
Only when the chest is mostly fat. Firm gland behind the nipple has to be cut out.
Where is the scar?
Liposuction leaves a few small marks. Gland excision leaves a short scar along the lower edge of the areola. Skin removal leaves longer scars across the chest.
How long does the operation take?
About one to two hours.
Is gynecomastia surgery permanent?
The result is usually permanent, because removed gland doesn't grow back. The chest can fill out again if you gain a lot of weight, or if the cause returns: anabolic steroids, some medicines, or a hormone problem.