Gynecomastia: Causes, Symptoms and Surgical Treatment

Gynecomastia — the enlargement of glandular breast tissue in men — is far more common than most people realise. Estimates suggest that one in three to four men will experience it at some point in their lives. It is a medical condition, not a personal failing or the result of poor lifestyle choices. For those who live with it, however, it frequently has a significant impact on confidence, comfort with clothing, and overall quality of life. The good news is that effective solutions exist — both for understanding the underlying cause and for achieving a lasting resolution.

What is gynecomastia and what causes it?

It is important to distinguish between two conditions that may look similar from the outside. True gynecomastia involves the proliferation of glandular breast tissue and has a hormonal basis. Pseudogynecomastia, on the other hand, is an enlargement of the chest caused solely by excess fat deposits, with no change in the underlying glandular tissue — it is common in men who carry excess body weight.

The causes of true gynecomastia include:

• Hormonal imbalance during puberty — a shift in the ratio of oestrogen to testosterone is the most common cause; in adolescents this form is very common and in the majority of cases resolves on its own.

• Medications — anabolic steroids, certain blood pressure drugs, antidepressants, and several other preparations can trigger gynecomastia.

• Liver disease — the liver plays a key role in hormone metabolism; impaired liver function disrupts hormonal balance.

• Obesity — adipose tissue produces oestrogen, and excess body weight can tip the hormonal balance unfavourably.

• Unknown cause — in adult men, gynecomastia sometimes develops without a clearly identifiable cause (idiopathic gynecomastia).

Distinguishing between true gynecomastia and pseudogynecomastia is important because it directly informs the appropriate treatment approach.

When does gynecomastia resolve on its own?

In adolescents who develop gynecomastia during puberty, a watchful waiting approach is appropriate in most cases. Pubertal gynecomastia frequently resolves completely within 12 to 24 months without any intervention, as the hormonal fluctuations that cause it settle naturally with physical maturation.

In adult men the picture is different. Gynecomastia that has been present for more than two years rarely resolves on its own without some form of intervention. Where a specific medication is the identified cause, it may be possible to work with the prescribing doctor to switch to an alternative — this can sometimes be enough to produce improvement.

A medical consultation is recommended promptly when:

• the breast tissue is painful or tender,

• the tissue is growing rapidly,

• the condition is causing significant psychological distress,

• gynecomastia develops suddenly in an adult man.

In these situations, an earlier assessment is both sensible and advisable.

When is surgery the right option?

Surgery becomes the appropriate choice when conservative approaches are insufficient or unsuitable. Gynecomastia surgery is indicated in the following circumstances:

• Gynecomastia in an adult man that has been present for two years or more and is not caused by a medication that can be changed.

• Pseudogynecomastia or a mixed type with a significant fatty component, which can be effectively addressed in combination with liposuction.

• Men who have reached a stable body weight and are seeking a lasting solution.

• A significant psychological impact on quality of life that conservative measures cannot address.

Surgery is not the appropriate first step for pubertal gynecomastia — it is worth waiting to see whether the condition resolves spontaneously before considering an operation.

What does gynecomastia surgery involve?

Gynecomastia surgery is an outpatient or short-stay procedure that is tailored to the extent and nature of each individual case. It typically involves two components:

• Excision of glandular tissue — the surgeon removes the glandular tissue through a small incision along the lower edge of the areola (the pigmented ring around the nipple). The resulting scar is small and naturally concealed.

• Liposuction of the fatty component — where a fatty component is also present (pseudogynecomastia or mixed type), it is addressed simultaneously using liposuction, often the VASER technique, which allows for precise contouring.

The procedure is performed under local anaesthesia with sedation or under general anaesthesia and takes one to two hours. Most patients return home the same day or after a single overnight stay.

After the procedure:

• A compression vest or garment is worn for 4 to 6 weeks.

• Return to desk work is typically possible after one week.

• Strenuous physical activity and sport should be avoided for 4 to 6 weeks.

• The final result becomes visible once swelling has fully resolved — usually 3 to 6 months after the procedure.

What results can you expect?

The goal of gynecomastia surgery is a flat, natural-looking male chest contour. The surgical removal of glandular tissue is permanent — the tissue does not regenerate. Where a fatty component was also addressed, it too will not return as long as body weight remains stable.

Scars are small and positioned along the edge of the areola, where they are naturally camouflaged. In the majority of men, scars fade over time and become barely noticeable.

The impact on quality of life is often profound. Freedom in choosing clothing, physical comfort during activity, and restored confidence are frequently cited by patients as the most meaningful outcomes of the procedure.

One important note: where fat was also removed during surgery, significant weight gain after the procedure can cause a partial return of the fatty component. Maintaining a stable body weight after surgery is therefore worthwhile.

Next step: consultation at Klinika Višnjar

Every case of gynecomastia is different — the cause, the extent, and the type of tissue involved all vary from person to person. Before considering any form of treatment, a clinical assessment is the sensible first step. This clarifies whether you are dealing with true gynecomastia, pseudogynecomastia, or a combination of the two, and whether there is an underlying cause that can be addressed in another way.

At Klinika Višnjar, we are available for consultations in which we assess your situation together, answer your questions, and propose the most appropriate path forward — without pressure and without unnecessary procedures. We welcome you to get in touch and arrange an appointment.