Breast reduction in men (gynaecomastia)
Gynaecomastia is the excessive development of the male breast. A distinction is made between so-called pseudogynaecomastia and true gynaecomastia (gynaecomastia vera).
The oversized breast in pseudogynaecomastia is caused by an increased accumulation of fatty tissue, for which reason it is also known as lipomastia. The cause of this is mostly excessive weight and/or a change in the patient’s hormonal balance.
True gynaecomastia, by contrast, is an enlargement of the mammary gland, which is situated directly behind the nipple in men. In cases like this, the abnormal growth of the breast is either genetic or hormonal, or it may be a side effect of long-term medication.
Often, however, the patient may have a mixture of the two forms. Many patients suffer in their wellbeing, especially when the male breast takes on forms that are more feminine than masculine. This is also often exacerbated by physical complaints such as feelings of tension and oversensitivity of the nipples. If the enlargement is on one side only, it may be necessary, in rare cases, to exclude the possibility of male breast cancer prior to the operation.
If these changes come about during puberty, they recede spontaneously in most cases. However, if they persist, it’s usually a good idea to look for a treatment solution early on, since the psychological strain is often considerable and the social life of the patient (e.g. as regards sport and intimate relationships) is often severely impaired.
As a matter of basic principle, the success rate of gynecomastia treatment by liposuction, if appropriate in combination with surgical removal of the gland, is high for patients who have developed a male breast.
Preliminary examinations required
Before gynecomastia surgery, those affected should consult a urologist or endocrinologist. They can determine blood levels, particularly of hormones such as estradiol, testosterone, LH, FSH, prolactin, and beta-hCG, and rule out other diseases that may be causing gynecomastia. More rarely, however, gynecomastia can also be associated with liver or kidney disease, result from medication side effects, or be genetically determined, as in Klinefelter syndrome.
An ultrasound examination (so-called sonography) of the breast region is essential to determine whether and to what extent the enlargement of your breast is caused by fatty tissue and/or glandular tissue in order to optimally plan the surgery. In addition, the amount of excess tissue can be estimated.
We ask that you bring all current examination results with you to your initial consultation.
If there is evidence of genuine gynecomastia without treatable causes, you can apply to your health insurance provider to cover the costs of gland removal.
Procedure for breast reduction in men (gynaecomastia)
During an initial consultation, we will discuss your wishes and expectations, review your medical history, and examine your breasts in detail. We will also discuss possible causes for your breast enlargement or gynecomastia based on your preliminary examinations.
Depending on the findings, different surgical techniques are indicated, which vary in operating time. On average, the operating time is approximately 1 to 2 hours.
If the problem is pseudogynecomastia with a pure increase in fatty tissue in the breast region, liposuction (fat removal) is sufficient to reduce the size of the male breast. Only a small incision on the side of the chest is necessary for each side to insert the cannulas. Before liposuction, a so-called tumescent solution is injected, and then the loosened fat cells are suctioned out using a vibration system, and if necessary, the inframammary fold is dissolved. With the help of liposuction in the breast area, the transitions between fat and glandular tissue can be shaped particularly beautifully.
If the condition is true gynecomastia, i.e., an enlargement of the glandular tissue, the tissue must be surgically removed to reduce the breast size. For this purpose, a semicircular incision is made at the lower edge of the areola to perform the gland excision. As with lipomastia, prior loosening of the glandular body through curettage using tumescent and vibration techniques is recommended. The scar is usually very inconspicuous.
In a mixed form (two-thirds of cases), both surgical techniques are combined to reshape the overall appearance of the breast region.
In cases of severe gynecomastia associated with a lot of excess skin, male breast reduction can also be combined with a skin tightening procedure (for example, an incision around the nipple with the option of reducing the size). If the skin is already severely stretched and torn, a tightening procedure may be advisable in the first session. In most cases, however, it is recommended to wait for tissue retraction after gynecomastia surgery and perform a tightening procedure in a second surgical step, which may involve a smaller incision, if necessary. We will also advise you in detail on this during the initial consultation.
We perform gynecomastia surgery on an outpatient basis and, depending on the findings, under local anesthesia or twilight anesthesia (analgosedation), or under general anesthesia upon request.
After male breast reduction
After the gynecomastia surgery, we will fit you in the operating room with a special compression garment for the male upper body, which you can purchase from us in advance. We will then transfer you to our recovery room, where you will be cared for and monitored by a qualified member of staff. In some cases, we will place drains in the wound area to drain blood and wound fluid. These are usually removed between the first and third days after the gynecomastia surgery. The necessary pain therapy will then be individually adjusted. Since the procedure is performed on an outpatient basis, usually only under twilight anesthesia (analgosedation), you can go home the same day. However, you should have a trusted adult by your side for the next 24 hours to look after you and act in an emergency.
The first follow-up appointment with a dressing change will take place on the day following the gynecomastia surgery. During the first few days, fluid may still leak from the small liposuction incisions; this is normal and beneficial, and should not cause you concern. The superficial wounds will heal within the first week. Typically, the skin incisions are only glued and not stitched. If breast tissue also had to be removed, we use very fine, thin sutures to close the wound. This will be removed after approximately 7 to 14 days, at the second follow-up appointment. Until then, you should not shower, but only wash your upper body. Otherwise, cleaning products could cause irritation, or bacteria could be introduced into the fresh wounds.
We will then schedule you for further check-ups and dressing changes at regular intervals. Depending on the findings, we will also give you recommendations for special scar care, for example, in the form of creams or nutritional supplements, some of which we keep in stock in our practice or can prescribe for you.
After gynecomastia surgery or removal of breast tissue, a compression garment must be worn day and night for six weeks to prevent the wound cavities from filling with fluid, accelerate the skin’s regression, and stabilize the shape. The garment can be covered by clothing and is available in various colors.
Avoid strong sunlight or visits to a tanning salon during the first three months, as otherwise the fresh scars may discolor.
Antibiotics are not necessary if the healing process is normal. Painkillers are usually not required for longer than three days. To protect the newly formed breast tissue, sleep on your back for the first few days after gynecomastia surgery.
After about six weeks, the last swelling will usually have subsided and the first results will be visible. The final treatment result will be visible after approximately six months.
DURATION OF OPERATION: 1 – 2 hours
ANAESTHETIC: general anaesthetic / semi-conscious sedation
HOSPITALISATION: out-patient, or in-patient for 1 – 2 days
PAIN LEVEL: low
AFTER-TREATMENT: compression foundation-wear for 6 weeks
PRESENTABILITY, RETURN TO WORK: after approx. 7 days
SPORT: after 4 – 6 weeks
COST: from € 3,000
Ask our advice.
We’ll be glad to provide you with detailed information about this treatment. Simply get in touch with us now and obtain advice at an individual and absolutely personal level.
+49 30 - 94 041 144