Gynaecomastia is enlargement of the glandular breast tissue in men. It is common — it affects a substantial proportion of men at some point — and it is one of the things men research for years before mentioning to anybody. Most of what is written about it online is written by clinics selling the operation, so the parts they leave out are worth stating first.
- True gynaecomastia
- Firm glandular tissue beneath the nipple
- Pseudogynaecomastia
- Fat, with no glandular component — a different operation
- Surgery
- Gland excision, usually with liposuction for the surrounding contour
- Compression vest
- 4–6 weeks, continuously. Not optional
Three things worth excluding first
Adolescent gynaecomastia is very common and a large proportion resolves without any treatment, usually within a couple of years. Operating during that window can mean operating on something that was going to settle.
Several medications are recognised causes — some used for the prostate, some cardiac drugs, certain antidepressants and antipsychotics, and anabolic steroids. So is significant alcohol use and some recreational drugs. If the onset coincided with starting something, that is worth investigating before booking surgery rather than afterwards.
Less commonly there is an underlying hormonal or medical cause. Rapid onset, one side only, pain, or a hard irregular lump all warrant medical assessment first — not because surgery is wrong, but because the assessment comes first regardless.
Gland or fat — and why it matters
True gynaecomastia is firm, rubbery tissue concentrated under the nipple. Pseudogynaecomastia is fat spread across the chest with no gland. They feel different and they need different operations.
Liposuction alone removes fat but leaves glandular tissue behind — so a chest treated with liposuction when there was a gland will still have a firm disc under the nipple, which is precisely the thing the patient wanted gone. Conversely, excising a gland that was never there achieves nothing and leaves a scar.
Most real cases are mixed, which is why the common operation is gland excision through a small incision at the edge of the areola combined with liposuction to blend the surrounding contour.
What recovery is actually like
Within a week
Desk work resumes.
Weeks 2–3
Bruising and swelling can make the chest look uneven, or as though tissue remains. It usually is not.
Weeks 4–6
Compression vest throughout. No chest exercise, lifting or strenuous activity.
Around 3 months
The final contour is apparent.
A year
Scars fade.
The vest is the part most often skipped and it is a common cause of a poor contour: it controls swelling and helps the skin redrape onto a flattened chest.
Will exercise fix it?
It will reduce fat, so it helps pseudogynaecomastia. It does nothing to glandular tissue, which is why men who lose significant weight sometimes find the firm disc under the nipple more prominent rather than less.
Can it come back?
Excised gland does not regrow, but the cause can persist. If it was driven by a medication or by anabolic steroid use that continues, the surrounding tissue can change again.
Will there be a visible scar?
The usual incision follows the lower edge of the areola, where the colour change hides it well. Larger cases with significant excess skin may need more, and that should be discussed before rather than after.
Is it done under general anaesthetic?
Commonly, though smaller cases are sometimes done under local with sedation. It depends on the extent and on you.