Gynaecomastia

Gynaecomastia refers to abnormal enlargement of the male breast, caused by hypertrophy of the mammary gland, excess fat (pseudogynaecomastia), or a combination of both. It can appear at any age (puberty, adulthood) and may be related to hormonal, pharmacological, genetic causes, or weight gain.

Common patient motivations include physical discomfort, difficulty with clothing, and the impact on self-image. The goal of surgical treatment is to achieve a more harmonious chest contour and a natural, flat appearance, adapted to the patient's morphology.

The information below is intended for general guidance and does not replace an individualised medical consultation with the surgeon.

The Different Techniques

Liposuction (aspiration of fat excess)

• Indication: primarily for pseudogynaecomastia where the volume is essentially fatty.
• Principle: aspiration of lipid excess through small incisions using a cannula.
• Advantages: very short scars, often rapid recovery.
• Limitations: ineffective when the glandular component is predominant.

Glandular excision (removal of the mammary gland)

• Indication: true gynaecomastia with glandular hypertrophy.
• Principle: often a peri-areolar incision allowing removal of the excess gland.
• Advantages: direct treatment of the gland; allows deep correction of the chest.
• Limitations: leaves a scar around the areola; recovery is sometimes longer than with liposuction alone.

Combined technique (liposuction + glandular excision)

• Indication: mixed forms with both glandular and fatty tissue.
• Principle: combination of both procedures for a more harmonious result.
• Advantages: complete correction of the chest contour.
• Limitations: longer procedure and sometimes more attentive post-operative follow-up required.

Special approaches

• Peri-areolar incision (semi-lunar or circumferential): used for glandular excision to camouflage the scar.
• Transaxillary or endoscopic access: less common techniques to be discussed depending on the anatomy and aesthetic goal.

Pre-operative Consultation

• Medical interview: past history, current medications (particularly hormonal, psychotropic, steroids), smoking, aesthetic goals.
• Clinical examination: palpation to differentiate glandular from fatty tissue, assessment of skin and areola.
• Possible additional tests: breast ultrasound or mammography if necessary, blood panel, hormonal assessment depending on context.
• Information on anaesthetic modalities, proposed techniques, risks, and post-operative course.
• Provision of a quote and written information document.
• Reflection period: in accordance with regulations, a minimum 15-day delay must be observed between the provision of documents and the procedure for aesthetic surgery.
• Pre-operative advice: stabilise weight if possible, discontinue certain medications (anticoagulants, NSAIDs) and smoking as prescribed by the anaesthetist.

Procedure

• Anaesthesia: deep local sedation or general anaesthesia depending on the extent of the procedure and anaesthetic preference.
• Duration: generally between 30 minutes and 2 hours depending on the technique and degree of correction.
• Hospitalisation: often day surgery (same-day return) or one night depending on the intervention and general condition.
• Main steps: pre-operative markings, infiltration, liposuction if necessary, possible glandular removal, haemostasis, possible drain placement, dressing, and compression.
• Safety and traceability: written consent, operative reports, peri-operative monitoring by anaesthetic and surgical team.

Post-operative Recovery

• Pain: moderate and controllable with prescribed analgesics.
• Swelling and bruising: common in the first weeks.
• Dressings and compression: wearing a compression garment (vest or binder) for 3 to 6 weeks as per the surgeon's recommendations.
• Drainage: sometimes placed for 24–48 hours depending on the procedure.
• Suture removal: generally between 7 and 14 days if non-absorbable sutures were used.
• Resumption of activities: return to work variable (often 3 to 10 days depending on professional activity); progressive resumption of sport after 4 to 6 weeks.
• Medical monitoring: scheduled post-operative appointments to monitor healing and progress.

Results and Limitations

• Evolution: results will develop progressively with reduction of swelling and scar maturation; a notable improvement can be appreciated within a few weeks, with the result generally stabilising between 3 and 6 months, sometimes up to 12 months for the definitive appearance.
• Variability: the result depends on skin quality, the type of gynaecomastia, weight, and lifestyle. Residual asymmetries or contour irregularities may persist.
• Durability: if the underlying factors (weight gain, certain medications, hormonal imbalances) are not corrected, gynaecomastia may recur, requiring medical follow-up.

Risks and Complications

The possible complications are described for informational purposes and will be detailed during the consultation. They include:

• General risks: anaesthetic reaction, infection, haematoma, venous thrombosis (rare).
• Specific local risks: asymmetry, visible scars, skin necrosis (rare), loss of sensation or abnormal sensation in the areola (often transient), contour irregularities, partial persistence of glandular tissue, seroma.
• Possible need for revision surgery in cases of unsatisfactory result or complication. These risks remain rare but must be taken into account and will be explained before the procedure.

Alternatives and Non-surgical Options

• Monitoring and medical treatment: if a hormonal cause is identified, endocrine treatment may be offered in collaboration with a specialist.
• Weight loss: in weight-related cases, reducing body weight may decrease breast volume, but does not correct the excess gland.
• Non-invasive techniques (cryolipolysis, radiofrequency, etc.): can help reduce superficial fat but have limited indications and do not act on the glandular component.
• No intervention: in some pubertal gynaecomasties, spontaneous regression may occur; the decision to operate is based on persistence and the degree of discomfort.

FAQ (Frequently Asked Questions)

Are the scars visible? Scars are generally discreet and most often located around the areola (peri-areolar). They fade over time but may remain perceptible depending on skin quality and individual healing tendency.

Can gynaecomastia recur after surgery? Recurrence is possible if the underlying causes (weight gain, medications, hormonal imbalance) persist. Medical follow-up and preventive measures can limit this risk.

Is the procedure painful? Post-operative pain is generally moderate and controlled by analgesics. Swelling and bruising are common in the first few days.

When can sport be resumed? Intensive physical activities and contact sports are generally restricted for 4 to 6 weeks; progressive resumption depends on the nature of the sport and the surgeon's advice.