Gynecomastia (or gyno) describes the growth of breast tissue in men. All men have breast tissue, but normally it is so small that it does not cause swelling – or a boob – that can be seen or felt. However, as in women, breast tissue remains under the influence of hormones.

Men and women both produce some ‘male’ hormone, testosterone, and ‘female’ hormone , estrogen. If for any reason the testosterone level drops or the estrogen level rises, the man’s breast tissue will respond to this and get bigger. This results in the appearance of man boobs, or gynecomastia.

Gynecomastia is common in babies, adolescents and older men, although it can occur at any age. It can be very distressing or embarrassing, and if the swelling is significant or stays for a long time, the man may request treatment to help get rid of the problem.

Gynecomastia treatment options

The first step is to see a doctor to discuss what options might be possible. The doctor will examine the man to ensure there are no worrying causes for the gynecomastia.

This should include a full physical and discussion about any drugs or medications the man is taking. In many men this is all that is needed, but in some the doctors may organise some further tests such as blood tests or scans.

Once these are done the team can start to discuss how to get rid of the problem. For many men changing or stopping some medication may be what is required. For others a drug to help reduce the swelling of the breast gland tissue may be possible – although often this is not recommended.

The final treatment option is surgery. Obviously this is a big step and needs to be carefully discussed with the surgeon who will be performing the procedure before proceeding.

Surgery for gynecomastia is a mastectomy to remove breast glandular tissue, however in some men some liposuction may also be done to suck away any excess fatty tissue.

Surgery for gynecomastia

A mastectomy is an operation to remove the breast tissue. It should be carried out by someone familiar with performing the procedure in men; this is often a plastic surgeon. The operation can be completed using either a standard ‘open’ approach or with ‘keyhole’ surgery.

For a standard mastectomy the scar is made in a curve along the line of the lower edge of the nipple. With keyhole surgery there will be several scars where the operating camera and instruments are inserted. These are each tiny (around 5mm in length) and may be spread across the chest and sides.

How the operation is done depends on a range of factors, including the size of the swelling and the expertise of the surgeon. In addition, when the gyno is especially large, the surgeon may carry out some liposuction to remove additional fatty tissue and may even suggest removing some of the excess skin on the chest.

This makes the procedure (and potentially the scars) much larger but can mean the final appearance of the chest is much better. Talking to the surgeon ensures that the man fully understands what is going to happen and has realistic expectations of the outcome.

Things to discuss with the surgeon before agreeing to a procedure include:

  • The length of hospital stay
  • Which painkillers are likely to be needed
  • Where the scars will be
  • How long to rest post-procedure
  • A timeline for returning to activity
  • How long until full recovery
  • Who to contact with any concerns during the recovery period

Recovery from gynecomastia surgery

Surgery for gynecomastia is usually carried out under a general anesthetic, meaning the man is asleep while the procedure is done. Often, gynecomastia surgery recovery is quick and the man will be able to go home on the same day as the surgery.

While the medicines used for a general anesthetic are very good and wear off very quickly, the man may find he feels drowsy or perhaps sick as he recovers from the procedure. He will usually be advised that he must have a responsible adult take him home and stay with him for the evening and night following the operation.

All operations are painful. During the procedure the medical team will give some strong pain medication – often including some ‘local’ anesthetic to numb the area involved – to make sure this is as comfortable as possible when the man wakes up.

Pain relief is a very individual experience however, and extra painkillers may be needed post-procedure. Most men will need to take regular painkillers for at least the first few days of their recovery.

Depending on the amount of breast tissue that needed to be removed and how the procedure was done, the surgeon may leave a small plastic tube, or ‘drain’, in the operation site. This is most likely if the gyno has been very large or if liposuction was needed.

The tube comes out of the patient’s body at the side of the chest and is often attached to a small bottle. The drain draws any swelling fluid away from the wound so it collects in the bottle. This can reduce swelling at the site of the operation.

Drains do feel uncomfortable while they are in place. However, they can be very helpful to reduce post-operative swelling and improve recovery, and are usually only in place for a few days.

Some bruising or swelling after the procedure is normal. Bruising usually increases for the first three to four days of recovery before gradually going away over the next few weeks. The bruises can be a range of colours from red and black through to violet and green. The colour will change over time and generally does not mean there is a problem.

Each surgeon has their own preference of which type of stitches to use to close the scars, and which type of dressing to put on the outside. Many stitches need removing after the wound has healed – at around 5-10 days after the operation – while others are designed to gradually dissolve during the first weeks of recovery.

Some surgeons like to apply a dressing which gently squeezes or compresses the area to prevent swelling. This can be kept on for a few days, or much longer.

It is always best to discuss these details with the surgeon who will be doing the procedure so as to fully understand what to expect.

For the first few days and weeks after the operation, the man will be given instructions as to what he is allowed and not allowed to do as he recovers. The timeline for returning to various activities will vary for each patient.

In most cases for the first few days he will be advised to rest – meaning generally to stay at home and spend most of the time sitting down or in bed. After that exercise levels can gradually increase, with longer periods of running or jogging allowed after around two weeks.

More strenuous exercise – particularly bodybuilding or sports involving significant use of the arms – may not be allowed for two to three months after the procedure.

6 days after gynecomastia syrgery

6 days after gynecomastia syrgery

Post-procedure complications

For most men, surgery and recovery from gynecomastia surgery proceed smoothly, however there are occasionally problems. So it can be helpful to know what to look out for.

Possible post-operative complications include:

  • Pain
  • Bruising
  • Seroma or haematoma formation
  • Wound infection
  • Numbness
  • Thickening of the scar

In general, if the wound or operation area seems to be getting more swollen or the pain is getting worse, it is best to discuss this with the medical team. In the first few days after a mastectomy a large bruise or swelling can develop under the skin.

This is called a haematoma or a seroma depending on what fluid it contains. This usually happens on only one side, tends to be in one local area, can feel quite hard and is often painful to touch. Sometimes the fluid needs removing, and sometimes this becomes an emergency.

The fluid may be taken out either by sucking it out with a syringe or by re-opening the scar with a second operation. The medical team will assess each patient separately and decide on the best plan.

In addition, wound infections do happen from time to time. If one of the surgical scars is becoming more red, sore and hot to the touch – and there may be some fluid leaking from the wound – this may suggest there is an infection. Many wound infections are simply treated at home with oral antibiotics; it is always best to seek advice.

Long-term outlook

The surgical team who have carried out the procedure will arrange to review the man a few days or weeks after the procedure to see how his recovery is going. They will be able to discuss the appearance of the wounds and the chest in general and what to expect going forward.

An area of numbness around the site of an operation is common. Post-mastectomy, there can be some numbness around the nipple. For most men this recovers over the first few months after surgery. Some men notice that the area around the nipple (called the areola) may get smaller after surgery.

This can be normal and is nothing to worry about. Many men have scar tissue that may be felt as ‘hard’ under the skin. In most cases this will gradually get better over a few months. Usually this does not mean there is breast tissue that has been left behind, but the surgeon will assess this in the post-operative follow-up visit.

Most men recover quickly after surgery, are very happy with the new post-operative appearance of their chest, and long-term results are very good.

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