Gynaecomastia — true enlargement of male breast tissue — affects up to 50% of adolescent boys and around 30% of adult men at some point. Most cases settle on their own. When they don't, surgical correction is straightforward, safe and discreet.
What causes gynaecomastia
An imbalance between oestrogen and testosterone activity in breast tissue. Common triggers:
- •Puberty (most common, self-limiting)
- •Ageing
- •Obesity (often pseudogynaecomastia — fat alone)
- •Medications — spironolactone, finasteride, anabolic steroids, certain antipsychotics
- •Recreational drugs — cannabis, anabolic steroids
- •Underlying conditions — liver, kidney, thyroid disease, testicular tumours (rare)
True gynaecomastia vs pseudogynaecomastia
True gynaecomastia: firm, rubbery, disc-like tissue directly behind the nipple-areolar complex. Often tender.
Pseudogynaecomastia: soft, fatty tissue with no firm disc. Common with general weight gain.
Examination — and sometimes ultrasound — easily distinguishes them.
Investigations
Most cases need only clinical exam. If onset is sudden, asymmetrical, painful, or in a man over 50, consider ultrasound, hormone profile (testosterone, oestradiol, LH, FSH, prolactin), thyroid and liver function. Mammogram and core biopsy if a suspicious mass is felt.
When surgery is appropriate
- •Persistent for over 2 years
- •Causing significant distress or interfering with activity
- •Cosmetic asymmetry
- •Failed trial of medical management or weight loss
The procedure
Day-care surgery under general anaesthesia. Liposuction removes the fatty component through two small (3 mm) incisions in the lateral chest, then a small (2 cm) curved incision around the lower areola allows excision of the firm glandular disc. Drains are rarely needed for typical cases.
Recovery
Compression vest worn day and night for 4 weeks. Return to desk work in 3–5 days. Light cardio at 2 weeks, full gym including chest at 6 weeks. Final shape settles at 3–6 months.