Gynaecomastia: causes, pseudogynaecomastia and surgery

Gynaecomastia is an enlargement of the male breast. The causes can be hormonal, drug-related or idiopathic, meaning no identifiable cause is found. Surgery makes sense when the problem is stable, does not depend on weight or on reversible causes, and is genuinely affecting your daily life.

Baggy T-shirts, avoiding the beach, gym sessions that change nothing: if this sounds familiar, you are far from alone, even if few men talk about it. Here we look at what causes gynaecomastia, how it differs from pseudogynaecomastia, when surgery is worth considering and what to expect from the procedure, recovery and costs.

At a glance

• Types: true gynaecomastia is glandular, pseudogynaecomastia is fatty, and many cases are mixed.
• Price: pseudogynaecomastia starting from €5,500, gynaecomastia starting from €7,000, all inclusive.
• Recovery: a week to ten days of reduced social activity, with a compression garment worn as instructed.
• Scars: for true gynaecomastia the incision is hidden in the edge of the areola; scars mature over twelve months.

What is gynaecomastia

Gynaecomastia affects a significant proportion of the male population. It can appear in adolescence and never regress, or develop in adulthood. Sometimes it involves one side, sometimes both.

It is not a question of willpower. What you see in the mirror can be down to the breast gland, to fat or to a combination of the two, and working out which applies to you is the first step of any pathway.

Did you know? The word comes from Greek: gyne means woman and mastos means breast. Men also have a small amount of glandular breast tissue behind the areola: this is the tissue that grows in true gynaecomastia.

Gynaecomastia or pseudogynaecomastia: the difference that matters

In true gynaecomastia it is the gland that grows. In pseudogynaecomastia, also called lipomastia or false gynaecomastia, the enlargement is due to fat. Many cases are mixed.

From the outside they can look the same, which is where the misunderstandings begin. A man convinced he has only fat may discover a glandular component that liposuction alone cannot remove, and vice versa. That is why the diagnosis comes before the technique: it is made at the visit, with a clinical examination, measurements and photographic documentation.

This difference also explains why the gym sometimes changes nothing. Diet and exercise can reduce fat, but they do not remove the gland. If your weight has come down and your chest has stayed the same, it is worth having it assessed.

The causes of gynaecomastia

The causes fall into three broad groups:

• Hormonal: an altered balance between oestrogens and androgens, which can occur during puberty, with advancing age or in the presence of certain illnesses.
• Drug-related: certain medicines and anabolic steroids can contribute to it.
• Idiopathic: in some cases no precise cause can be identified.

That is why a medical assessment is carried out before surgery, to rule out reversible causes: a cause that is still active would affect the result. Bring a list of the medicines and supplements you take to your visit.

Gynaecomastia: signs to have checked without waiting

Gynaecomastia is not in itself an emergency, but some signs should be checked by a doctor promptly: a hard lump, especially on one side, rapid growth, discharge from the nipple, or changes to the skin or nipple. They are not a diagnosis, but they do deserve a visit.

Gynaecomastia: when to have surgery

Surgery is offered for stable, structural cases, when the excess depends not on weight or on reversible causes but on the structure of the chest. In practice, the question is not only how much it shows, but whether these conditions are met:

• the cause has been investigated and no reversible cause is still active;
• the situation is stable over time and you are not in the middle of losing weight;
• the discomfort is real and weighs on your daily life.

If gynaecomastia appeared in adolescence, the right time to assess it should be discussed with a doctor: it can regress, but it does not always do so. And sometimes the right plan is a different procedure, or no procedure at all: that too is an answer a consultation can give.

How gynaecomastia surgery works

The technique depends on the diagnosis:

• Chest liposuction: for predominantly fatty forms, with fine cannulas through tiny, millimetre-sized access points, as day surgery.
• Gland excision: for true gynaecomastia, through a periareolar incision hidden in the edge of the areola.
• Combined technique: in most cases liposuction and gland excision are combined in the same procedure.
• Correction of excess skin: in cases with redundant skin, typically after major weight loss, skin removal is combined with repositioning of the nipple-areola complex.

To understand better what liposuction can do, read Liposuction: correcting contour, not weight. At Palazzo Manzoni the lead surgeon for gynaecomastia correction is Dr. Stefano Di Nonno, specialist in General Surgery with a master’s degree in Aesthetic Surgery, within the plastic surgery department headed by Dr. Enrico Motta. The surgeon who plans your procedure is the one who performs it, and the one who sees you afterwards.

Did you know? Gynaecomastia surgery was already being described in the 7th century. Paul of Aegina, a Greek physician and surgeon of the Byzantine era who worked in Alexandria, wrote about it in his Medical Compendium in Seven Books.

Recovery after surgery and scars

Chest liposuction is performed as day surgery; in other cases the length of stay depends on the procedure. The pathway involves a week to ten days of reduced social activity, with the compression garment worn as instructed and check-ups scheduled at the intervals your case requires. The timescales that apply to you are defined at your visit, in the plan you take home.

Scars also depend on the technique. With liposuction alone the access points are a few millimetres long, the periareolar incision stays in the edge of the areola and, when skin has to be removed, the scar is longer. Scars mature over twelve months and their quality is partly down to biology. In the first months they should be protected from the sun, as we explain in scars and sun: it is also one of the reasons many people choose the cooler months, which we discuss in plastic surgery in autumn.

Like any surgery, this procedure has risks and limits, which your surgeon will discuss with you before you decide. When the indication is correct the change in contour is intended to last, but significant changes in weight afterwards remain beyond the control of the procedure.

How much does gynaecomastia surgery cost in Brescia

At Palazzo Manzoni treatment of pseudogynaecomastia costs starting from €5,500 and treatment of gynaecomastia starting from €7,000. These prices are all inclusive: surgeon, anaesthesia, operating theatre, any overnight stay and follow-up visits. You will find all starting prices on our plastic surgery costs page.

The exact figure comes after the consultation, in a written quote: it depends on the technique indicated, the time in theatre and the complexity of the case. The consultation lasts about an hour, costs €100 and is deducted from the price of surgery if you decide to go ahead. It may also end with the advice not to have surgery.

Frequently asked questions

Can gynaecomastia go away on its own?

It depends on the cause. If it appeared in adolescence it can regress, but it does not always do so; if it depends on a reversible cause, that is where to start. When it is stable and linked to the structure of the chest, surgery is the route to consider.

Can exercise and diet get rid of gynaecomastia?

They can reduce the fatty component and so improve pseudogynaecomastia. They do not remove the gland, however: that is why, if your chest does not change despite weight loss, an assessment is worthwhile.

How can I tell whether I have gynaecomastia or pseudogynaecomastia?

From the outside they can look the same, and many cases are mixed. The distinction is made at a visit with the surgeon, and it decides the technique: chest liposuction, gland excision or the two combined.

Does gynaecomastia surgery leave scars?

It depends on the technique. With chest liposuction the access points are a few millimetres long; for true gynaecomastia the incision is hidden in the edge of the areola; with redundant skin the scar is longer. Scars mature over twelve months.

How much does gynaecomastia surgery cost?

At Palazzo Manzoni treatment of pseudogynaecomastia costs starting from €5,500 and treatment of gynaecomastia starting from €7,000, all inclusive. The exact figure comes in a written quote after the consultation.

If your chest has been on your mind for a while, the first step is to understand what is behind it. At the Plastic Surgery department of the Istituto Chirurgico Palazzo Manzoni in Brescia, you can read more on our gynaecomastia page and book a consultation online or by phone on +39 030 294 2437.