A frequent reason for consultation, and often kept quiet
Gynecomastia affects a significant proportion of men at some point in their lives — during adolescence, after weight gain, or with no identifiable cause. The discomfort is rarely physical: it is social (swimming pool, sport, close-fitting clothes) and psychological. Many men wait years before mentioning it, even though its management is well codified.
First step: gland or fat?
The everyday term 'gynecomastia' actually covers two different conditions:
- True gynecomastia: development of the mammary gland, firm, centred on the areola, sometimes tender
- Pseudogynecomastia (adipomastia): an accumulation of fat, soft and diffuse, common with excess weight
The two often coexist (mixed form). The clinical examination tells them apart, supplemented if necessary by an ultrasound or a mammogram.
Second step: the pre-operative work-up
Before any surgery, true gynecomastia requires a search for an underlying cause: medications and substances (certain treatments, anabolic steroids, cannabis), hormonal, liver or kidney disease, and exceptionally a tumour. A work-up is prescribed according to the context, in coordination with your general practitioner or an endocrinologist.
This is not an administrative formality: treating the cause may be enough to make recent gynecomastia regress, and operating without a work-up risks failing to identify a disease or condition causing the gynecomastia — for example testicular cancer.
When is surgery indicated?
Surgery is considered when the gynecomastia is stable, bothersome and without a treatable cause — or after the cause has been corrected if the excess persists — particularly when the gland is predominant. Depending on the glandular and skin excess, several surgical options are possible, ranging from simple liposuction to surgery with a scar around the areola, or even a large pectoral and areolar scar (the equivalent of a mastectomy):
- Predominantly glandular: excision of the gland through an incision at the lower edge of the areola
- Predominantly fatty: liposuction of the pectoral fat, which may be sufficient
- Mixed form: a combination of both, the most frequent situation
- Associated skin excess: in some cases the excess skin must also be treated, leaving a more extensive scar
The operation takes about an hour, most often as day surgery. Recovery: a compression vest for 4 to 6 weeks, return to work within a few days to a week, gradual return to sport from 3 to 4 weeks, final result at 3–6 months. Gynecomastia surgery leaves a discreet peri-areolar scar in the majority of cases.
Insurance coverage: possible, under conditions
The French public health insurance (Assurance Maladie) may cover surgery for documented true gynecomastia, after an aetiological work-up. Pure pseudogynecomastia, on the other hand, falls under aesthetic surgery: expect from €4,500 depending on the procedure.
Here again, a detailed quote and, where relevant, your complementary health insurance's position on any extra fees give you the real cost before you decide.
Sport and body shape: what surgery does not do
The operation removes the excess gland and fat; it does not build up the pectoral muscles and replaces neither weight loss nor stopping a causative substance. Conversely, in an athletic man whose discomfort persists despite serious training, it often delivers the result that effort alone could not. It fits into a broader reflection on the male body.
Key takeaways
- True gynecomastia (gland) ≠ pseudogynecomastia (fat): the diagnosis guides everything
- A pre-operative work-up is mandatory before considering surgery
- Procedure tailored to the form: gland excision, liposuction, or both
- Coverage possible for true gynecomastia; from €4,500 otherwise
For a precise diagnosis and a treatment plan, book a consultation with Pr Ignacio Garrido, plastic surgeon in Paris 16.