Gynecomastia

Gynecomastia Surgery

Gynecomastia is the enlargement of breast tissue in men due to hormonal, genetic, medication-related, or idiopathic (unknown cause) factors. Beyond physical discomfort, this condition can have significant social and psychological effects. Gynecomastia surgery ensures the restoration of masculine chest wall contours by removing excess glandular tissue, fatty tissue, and, if necessary, excess skin.

Who Does Gynecomastia Affect?

• Hormonal changes during puberty
• Excessive weight gain and loss
• Steroid and supplement use
• Certain medications (antipsychotics, antiandrogens, etc.)
• Liver or thyroid disorders
• Genetic predisposition
• Idiopathic (unknown cause) cases

Types of Gynecomastia

Correct identification of the gynecomastia type is crucial for surgical planning:

Glandular Type

• The breast tissue (gland) is firm
• May be related to medications and hormones
• Liposuction alone is not sufficient
• Gland excision is mandatory

Fatty Tissue Dominant Type (Pseudogynecomastia)

• Occurs after weight gain
• Can be fully corrected with liposuction

Mixed Type (Most Common)

• Both gland and fatty tissue are excessive
• Requires combined surgery

Surgical Techniques

Liposuction (Liposuction-Only Gynecomastia)

May be sufficient on its own for patients with dominant fatty tissue.

• Minimal scarring
• Shorter recovery time
• Natural transition on the chest wall

Gland Excision (Gland Removal)

Firm breast tissue is removed through a small incision made at the edge of the areola. True gynecomastia cannot be corrected without removing the gland tissue.

Liposuction + Gland Excision (Combined Surgery)

The most effective method for patients with both fat and gland tissue. The chest contour appears smoother and more masculine.

Excess Skin Removal

Applied in rare cases:

• Advanced-stage gynecomastia
• After extreme weight loss (post-bariatric patients)

A mini-mastopexy may be required for these patients.

Pre-Operative Preparation

• Breast ultrasound (to evaluate gland structure)
• Hormone profile, if necessary
• Blood tests
• Smoking cessation at least 2 weeks prior
• Regulation of blood-thinning medications
• Evaluation of post-operative expectations

The Surgical Process

• Can be performed under general or sedation + local anesthesia
• Average duration: 45–90 minutes
• Liposuction is applied
• Gland tissue is removed through the areola edge
• Symmetry check is performed
• Special bandages and a compression vest are applied

Post-Operative Recovery

• Pain and sensitivity are normal for the first 1–3 days
• Return to daily activities is possible within 3–5 days
• A compression vest is worn for 3–4 weeks
• Heavy exercise is not recommended for 4 weeks
• Edema subsides within 2–3 months
• The masculine chest contour becomes more prominent over time

Possible Risks and Complications

Early Period

• Hematoma
• Infection
• Seroma
• Sensitivity

Late Period

• Slight asymmetry
• Skin contour irregularities (rippling)
• Sensory changes in the nipple
• Inadequate gland removal
• Rarely, the need for revision

Permanence of Results

Results are permanent as long as weight control is maintained. Fatty tissue can grow back; however, once glandular tissue is removed, it does not reform. In patients who exercise, the masculine chest appearance becomes more pronounced.