FAQs

What is gynecomastia?

Gynecomastia is enlarged male breast tissue; gyno means female, whereas mastia refers to breast, so gynecomastia is enlarged breast tissue in men, and it can range from puffy nipples to enlarged breast with excess skin.

What causes gynecomastia?

Most commonly we don't find a reason and blood tests for hormone levels come back as normal, but physiologically meaning normally, one may have enlarged breast tissue at birth due to maternal hormones, during puberty when male hormone production is increased or old age when there is imbalance of male to female ratio likely due to changes in production or breakdown of male hormones.

Some patients have more fullness in the chest due to fat deposit or enlarged breast tissue sometimes thought to be due to genetic or hereditary reasons where there is more tendency to store fat in the breast area or increased sensitivity breast tissue to circulating hormones leading to pseudo gynaecomastia or true gynaecomastia.

Other known causes are obesity, use of androgenic drugs or substances like androgenic steroids or prohormones or even some prescription medications side effects include gynecomastia.

Other causes can be due to medical conditions like liver or testicular disease or rarely due to sinister causes like cancer of the breast or the pituitary a part of the brain. So we recommend seeing your GP in the first instance to rule these out.

Last but not least lifestyle and environmental causes believed to contribute to gynaecomastia are estrogenic chemicals in pesticides in or plastics present or used in food production. For lifestyle recreational drugs like cannabis use or sedentary living may also contribute to gynaecomastia.

How do I know if I have gynecomastia?

Gynecomastia is enlarged breast tissue in men which can also be caused by fat deposit that is stubborn and not easy to lose. It can range from puffy nipples to enlarged breasts with excess skin. Not all cases of enlarged breast tissue need surgery however, if it is bothering you or if it is affecting your self-confidence or well being then you are likely to be suffering from gynecomastia. Although rare, you might be experiencing physical symptoms from gynecomastia, including:

• Discomfort
• Pain
• Discharge
• Enlarged areolas

If you think gynecomastia is what you are suffering from, then you will know, because it can become obvious.

However, if you’d like a professional opinion on your diagnosis, we strongly recommend that you speak to your GP first to rule out other associated medical or sinister causes.

What grade of gynecomastia am I?

Most surgeons use Simons classification for standardisation. For easier communication I grade gynecomastia in my patients according to how big the gland is and if there is skin laxity.

So for small gland it's type 1.

Moderately enlarged gland with no excess skin is type 2.

With some loose skin but not severe it's type 3 in my opinion. Here you may get away with surgery without skin excision.

Type 4 is when it's severe loose skin and the nipple is over the breast crease or fold and in most cases skin excision is required.

Can anabolic steroids cause gynecomastia?

Yes, men who use anabolic steroids can end up with enlarged breasts due to imbalance of sex hormones leading to enlarged breast tissue. The use of androgenic drugs or substances like androgenic steroids or prohormones or even some prescription medications side effects include gynecomastia.

How we treat gynecomastia

For glandular tissue only surgery can get rid of it as far as we know. And the way we treat gynecomastia depends on what you’re presenting with, the grade of your gynecomastia, it ranges from puffy nipples to large pendulous breasts with excess skin.

That means the treatment can just mean removal of gland or just liposuction only or both, which is more common in our practice ie both gland removal and liposuction for contouring.

Some patients need debulking and chest contouring. If the skin is not taut or it is slightly loose, skin tightening modality like BodyTite or jplasma may be a worthwhile approach or if the skin excess is severe then skin excision is an option.

My approach is to do these procedures using local anaesthesia because I feel it's safer and in my hands it's more efficient and quicker so patients don't have to stay in a hospital and they don't have the downtime they have with general anaesthetic. Also the patient somehow participates in the treatment, is aware of what is happening and can communicate to patients what exactly is happening during the surgery.

How do I know if I need gynecomastia surgery?

Some patients ask us how do they know if they have gynecomastia and need surgery.

Here we look at what is causing the problem. Usually it’s appearance. And that can be caused by enlarged breast tissue or fat.

So it may be that you just need to lose fat. But if it’s gland then surgery unfortunately is the only solution.

However, this is cosmetic surgery. If the causes are benign, not sinister, whether it’s gland or fat, we can remove that for you.

So you can go through exercise and diet first and if that doesn’t work you can first consult your GP to rule out sinister causes and then you can consult with a gynecomastia surgeon to consider your treatment options.

Is the gynecomastia surgery procedure painful?

Everyone's pain threshold is different, luckily with our experience we are able to manage this including the anxiety and apprehension that comes with having this. We use local tumescent anaesthesia meaning you are awake during surgery. We start with injections which can sting initially but goes numb and we are able to do the surgery. Following surgery, the majority of the patients have some soreness for 2 days or so and In fact we only give Paracetamol which is usually enough.

How long does the gynecomastia surgery procedure last?

Depending on what type of gynecomastia surgery you are having done, it usually takes about 1 to 2 hours, depending on whether you're having skin excision, VASER liposuction or radiofrequency skin tightening.

Can you remove the whole gland?

During gynecomastia surgery we leave a bit of breast tissue under the areola, so that the areola doesn’t sink in. This means that what we leave behind is as important as what we take out. So that’s the reason why the gland can grow back, because we’ve left behind a little bit of tissue to support the areola.

Some patients can get away with removing the whole gland. That’s another question, doctor, can you remove the whole gland? In some cases yes, but not in everyone. So if you have thick skin, if you have well-built muscles and very little fat, then probably yes, but I make that judgement during surgery.

But yes, sometimes we can remove the whole gland.

How long does gynecomastia recovery take and how soon can I resume work and exercise?

Basically I do these surgeries under local anaesthesia, the incision in most cases is done just on the lower part of the areola, or the border of the areola, and this incision takes about a week or two to heal.

And after that patients can start jogging, cycling, swimming. But for strenuous training and contact sports we advise to wait a month or longer before surgery.

In terms of work, it depends on what you do. A lot of people are working from home these days, so just a few days it’s enough before you can go back on to your laptop or computer. For office work, if you're commuting we advise you to take a week off just to be on the safe side.

If your work is physical we advise you to take just over a week off as you will be wearing a compression vest and we don’t want you to do anything that will cause pain and such.

So that is the immediate healing. You may or may not have bruising and swelling pain, these are not severe and in most cases they are temporary and go away within 2 weeks.

And for bigger cases where we do skin excision, that is on an individual basis, depending on what method you’ve had done, because if you smoke and if you have other conditions, that can affect your healing.

So it’s very individualised in terms of what to expect, but for most people immediate healing is two week.

And for the final results, it also depends on what grade you have. For the most common types of gynecomastia and mild cases you see the results straight away. For other cases where there is skin excess and we use skin tightening, it may take up to six months before you see the final results.

So don’t panic straight away after gynecomastia surgery, because you may have a bit of hardness and such and the skin may not be as tight as expected. We need to give it up to six months or so before all this healing is complete.

Do you use drains for gynecomastia surgery?

Most of our cases are grade 1 to grade 2 and because of the type of anaesthesia we use bleeding is reduced and hence complication rate is very low. We use double compression and don't see the need for drains but for very big cases occasionally drains are used.

Can the gynecomastia gland grow back?

A lot of patients ask me whether the gland, the breast tissue, that is causing gynecomastia can grow back. Sometimes it’s fat that is also causing the gyno look.

So if we remove fat and a bit of gland and you gain fat, sometimes the fat that has been left behind can grow, so it can give you a bit of fullness in the chest. But the main thing here is that we leave a bit of breast tissue under the areola, so that the areola doesn’t sink in. This means that what we leave behind is as important as what we take out.

So that’s the reason why the gland can grow back, because we’ve left behind a little bit of tissue to support the areola.

Some patients can get away with removing the whole gland. That’s another question, doctor, can you remove the whole gland? In some cases yes, but not in everyone. So if you have thick skin, if you have well-built muscles and very little fat, then probably yes, but I make that judgement during surgery.

So yes, the gland can grow back and yes, sometimes we can take out the whole gland.

How will the scar heal after gynecomastia surgery?

Immediately after surgery the scar is clean and without visible stitches. In the first 2 weeks you may have darkening of areola skin or scabbing and hardening of the incision area, this can take 2-6 months to go back to normal or soft as the skin is remodelling itself after the surgical trauma. That is one of the reasons we wait 6 months. Occasionally we consider medical steroid injection (kenalog) if the scarring is causing some sort of distortion otherwise I prefer to have patience and to avoid injections as your skin is naturally remodelling the scar from hard to soft.

You will have access to our aftercare team if you have concerns about your healing.

What is the scarring like after gynecomastia surgery?

Scarring depends on what sort of surgery you’ve had.

This can range from just liposuction where the incisions are small, and in my practice these are less than half a cm incisions in the areola, one or two in the axillary crease, and depending on how much fat there is, I occasionally add one on the side, but these are all small scars, less than half a cm, which usually fade over time.

In my practice the majority of my incisions are generally in the areola where it’s less obvious after the surgery, and when I do liposuction I make the incision in the axillary crease, in the armpit fold, usually not obvious.

In severe cases, for grade 4 gynecomastia, meaning a lot of loose skin, you may need excising or cutting out the breast and relocating the areola and nipple, for these cases the scarring in my practice is horizontal across the chest and it is advisable to seek second opinion and know what options are available to you. Other skin excision methods depending on severity, patient/surgeon preferences a nipple lift with upper part skin excision is done with scarring in the upper half of the areola or where you can be left with a round scar around the areola, after a donut procedure, which can leave a bit of wrinkling or puckering. Or you may have what we call a t-scar or sometimes a longitudinal scar, this depends on what skin excision methods the surgeon has performed. For very severe cases I prefer to do excision of the breast with relocation of the areola and nipple to a normal or closer to normal position, which leaves you with a flat chest but with horizontal scars across each side.

In terms of scarring, this depends on the patient, because everyone is different. For most patients, the fact that this has changed their life, gynecomastia surgery has improved their quality of life, for many the scarring is usually a non-issue and in my practice most patients don’t notice that they have a scar. It is important you know what options are available and you are willing to accept before going ahead.

What is the patient journey for gynecomastia surgery?

Patients get in touch with the clinic and request for an appointment, we are able to offer initial video calls or telephone consultation after you submit your photos and a MQ and once you are happy with our initial assessment we arrange a face to face appointment but sometimes some patients prefer to come straight for the face to face appointment. During the f2f we revisit the medical history, do a physical examination and go through your goals and expectations. We then discuss what is realistically achievable. After the consultation it is advisable you get a second opinion to weigh your options and after a cooling off period you can book for surgery. It is important you do your research and do not rush into making a decision. Immediate 2 weeks after surgery recovery period is important and in our practice you will have access to aftercare support from Day 1 and answer your queries in case you have side effects of surgery. Remember gentle massage after the wound has closed up may prevent swelling or tissue hardness.

At 2-3 months there may still be residual tissue hardness or scar tissue that is resolving, you will have access to our aftercare team for support throughout your recovery. At 6 months we expect full healing and at this point we plan to discharge you after reviewing your results. It is important you come for the final check up or at least contact the clinic if we cannot reach you.

Day 1 after surgery that is 24 hours you will have an aftercare pack with dressings, a spare compression vest and paracetamol with written instructions.

Gynecomastia Surgery with Skin Tightening - What is it and when we use it

Some patients with gynecomastia who have got a bit of skin excess can benefit from skin tightening.

For easier communication I grade gynecomastia in my patients according to how big the gland is and if there is skin laxity.

So for small gland it's type 1.

Moderately enlarged gland with no excess skin is type 2.

With some loose skin but not severe it's type 3 in my opinion. Here you may get away with surgery without skin excision.

Some patients need debulking and chest contouring. If the skin is not taut or it is slightly loose, skin tightening modality like BodyTite or jplasma may be a worthwhile approach.

For gynecomastia surgery with skin tightening I use BodyTite by InMode, this technology uses radio frequency, which shortens and tightens tissue while minimising side effects related to lax skin.

I like using the BodyTite machine because of the added safety feature of the heat sensor, which reduces the risk of burning the skin. We use local anaesthesia (tumescent solution) for all our gynecomastia surgery procedures. For this reason, skin tightening is not painful.

We are usually able to keep our patients comfortable and have a conversation during the surgery.

Gynecomastia Surgery with Gland Removal Only

For glandular tissue only Surgery can get rid of it as far as we know. And The way we treat gynecomastia depends on what you’re presenting with, the grade of your gynecomastia, it ranges from puffy nipples to large pendulous breasts with excess skin. That means the treatment can just mean removal of gland.

To remove the gland, we inject local anaesthetic around the gland and make a tiny incision, around half a cm, on the areola border. We take out the gland and stitch it back.

The patient will wear a compression vest for 2 weeks and refrain from strenuous activity. The results may show immediately but can take up to 6 months.

Gynecomastia Surgery With VASER Liposuction

VASER liposuction is liposuction using VASER technology. The ultrasound emits pulses of energy that when encounters fat, it liquefies or melts” it without damaging the surrounding tissue.

I like it because I'm trained in high definition sculpting and it helps me achieve the desired contours in the chest.

VASER liposuction also allows me to reduce the recovery downtime of patients, reduce the risk of complications like bleeding, irregularity and minimise bruising. It also allows for quicker surgery.

Not all patients need VASER liposuction. However, depending on the individual case of the patient, both liposuction and gland excision may be needed to achieve the desired results. VASER is just a tool that helps me achieve a good result.

Gynecomastia Surgery With Skin Excision

For severely enlarged gynecomastia or if there is gynecomastia of any size with severe excess skin, skin excision of some sort may be needed.

After we take out the gland and sculpt the chest, we may remove some skin above the areola and lift the nipple to where it is more normal or rarely in a circular fashion when we remove a ring of excess skin with a circumareolar incision one around the areola and another for an outer ring. Then we stitch the outer ring skin to the inner or areola ring and reduce the excess skin. The patient will be left with a round scar around the areola and a flat chest. This may leave some puckering or pleating which is usually temporary.

For very severe cases like type 4 Gynecomastia I prefer to do excision of the whole breast with relocation of the areola and nipple complex or skin to a normal or closer to normal position, this surgery leaves you with a flat chest but with horizontal scars across each side.

How Can I Pay For Gynecomastia Surgery?

We are committed to supporting our patients to have access to gynecomastia treatment, by offering a variety of options to pay for surgery, including 0% monthly payment finance options.

Furthermore, our gynecomastia treatment prices are competitive and depend on the type of gynecomastia surgery procedure you are having, from gland removal only to gland removal with liposuction, skin tightening, skin excision or chest contouring.

You can request more information below to receive a full breakdown of our gynecomastia surgery costs, payment options and the option to book a free consultation with Dr Nurein.

Does Dr Nurein specialise in the internal flap technique for gynecomastia surgery?

Dr Nurein does remove the whole gland where possible and if needed creates subcutaneous flaps sometimes also for revision cases usually from other clinics, but like all our treatments this is individualised and chosen on a case by case basis. Dr Nurein makes this decision based on what he feels medically is the best option for the patient and if there is enough tissue to create a flap hence not everyone is suitable for this.