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A Guy’s Guide to Gyno & Male Breast Reduction Surgery

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When I wrote an article on the cost of gynecomastia surgery, I didn’t think it would end up so widely read. I don’t have gyno—knock on wood—but in my work writing for Drs and M.D.s, a small handful of whom are among America’s most famous plastic surgeons, I’d run across things that told me gyno was something a ton of guys needed help with.

But if you were to hit Google for a guide to gyno or gyno surgery, you’d likely find brief bit-and-piece articles that leave you jumping from source to source to answer your ever-evolving questions.

I think we can fix that.

I hope this guide gives you what you need to know about gyno, its treatments, and how to deal with it until you can have it looked at professionally.

None of this is nor is intended to be medical advice of any kind. Always, always, always, consult a qualified surgeon or primary care physician. Surgery, if you go that route, involves personal and financial decisions best made with the help of qualified pros.

That said, here’s everything you need to know about gynecomastia and male breast reduction surgery.

We discuss surgery in depth because it’s the most common and effective way of treating it.

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I. What Is Gynecomastia
& How Do I Know If I Have It?

What is gynecomastia?

Gynecomastia is the physically harmless, non-cancerous appearance of female-like breasts in a male.

It can affect one or both breasts, uniformly or asymmetrically, and it can range from a mild mound of tissue localized under and around the nipple(s), or be so advanced the entire breast looks more feminine than it does masculine.

Gynecomastia comes from the Greek word gynec (female) and mastos (breast).

Femine breasts. On a male physique.

Also referred to as man boobs, moobs, or bitch tits, the effects of gyno are often more mental/emotional than they are physical, with men suffering from the condition experiencing extreme shame, introversion, self doubt and low self esteem or self worth.

But that doesn’t even vaguely mean it’s not real or shouldn’t be treated.

Far from it.

Thankfully, there are ways of tackling gynecomastia so that it’s no longer a problem.

What is pseudogynecomastia?

When the male breast has excess fat tissue under and around the nipple, it’s sometimes called pseudogynecomastia.

This excess fat causes the area around the nipples and areola to look puffy and swollen.

The difference between it and “actual gynecomastia” is in the nature of the tissue—people with gynecomastia have glandular tissue, not just fat, under and around the nipple and of course spreading outward as the condition progresses.

Because it is fatty tissue and not glandular tissue, people with pseudogynecomastia can exercise and lose weight to create a reduction in the fatty tissue over time.

People with gynecomastia could exercise till the end of time and still have gynecomastia, because it’s glandular tissue causing the problem and glandular tissue doesn’t disappear with exercise.

In fact, bodybuilders get gynecomastia all the time, since steroids and even certain supplements and some medications cause hormonal fluctuations that cause excess glandular tissue to develop in the male breasts.

How can I tell if I have gynecomastia?

Itchy nipples are often a first sign, as typically occurs when going through puberty. (We’ll discuss adolescent gyno thoroughly—don’t panic or take any brash action just yet.)

But if you are now asking if you have gynecomastia, chances are the itchy nipple phase probably happened long ago.

Gynecomastia can be easily identified with the naked eye and by palpation of enlarged breasts. To palpate means to “examine (a part of the body) by touch, especially for medical purposes.”

You’re likely to be able to grab the breast tissue and separate it out from the pectorals (chest) muscle.

If you have gynecomastia you would have one or more of the following:

  • Enlarged, swollen, and/or sagging breasts
  • Stretched areolas
  • Tenderness in the nipples or chest (and less often, pain)
  • Possible asymmetry between the left and right pecs
  • Occasional discharge from one or both breasts,
  • And a moveable mound of tissue beneath the nipples. In most cases, you can actually physically separate out the glandular tissue from the muscle tissue and identify it as two distinct tissues.

The breasts may increase in size by as little as a centimeter, or as much as 10 centimeters. Most people will experience a mid level range of about 3.5 to 4 centimeters.

Gynecomastia can also occur at almost any age, with young people and the elderly being the most likely to get it.

  • 35 percent of patients getting gyno surgery are between 20 – 29-years-old
  • 26 percent are between 13 – 19-years-old
  • 18 percent are between 30 – 39-years-old
  • 13 percent are between 40 – 54-years-old
  • 08 percent are 55-years-old and older

Symptoms of Gynecomastia

The following symptoms may indicate gynecomastia.

  1. Swelling and tenderness of the breast tissue. The breasts may also be painful.
  2. A small, hard lump under the nipple
  3. Nipples appearing plainly / clearly /obviously from beneath the fabric of a regular shirt
  4. Taking hormonal supplements, certain medications, steroids, and anti-androgens would also be factors in making gynecomastia more likely

What are the grades of gynecomastia?

Gynecomastia is rated against a graduating scale that indicates the severity of the condition.

The grading scale stems from 1973 and some of the earliest research on gynecomastia by surgeons.

In January 1973, three doctors from the Mount Sinai School of Medicine in New York published their study, “Classification and Surgical Correction Of Gynecomastia.”

Gynecomastia was then the most common breast lesion in males and accounted for 65 percent of male breast disorders. Their highest collective complaint was embarrassment, but some experienced tenderness and pain in the breasts.

Excision (removal) of the hypertrophied breast tissue was the “most satisfactory treatment.” Hypertrophied is defined as the increased volume of an organ or tissue due to the enlargement of the cells that comprise it.

Classifying the severity of gynecomastia from a surgical viewpoint, the doctors assigned the following Grades to gynecomastia:

GRADEINDICATIONS% OUT OF 70 CASES, 1973
Grade 1“Small, visible breast enlargement—no skin redundancy.”36%
Grade 2A“Moderate breast enlargement without skin redundancy.”27%
Grade 2B“Moderate breast enlargement with skin redundancy.”23%
Grade 3“Marked breast enlargement with marked skin redundancy, i.e., pendulous female breasts.”14%

Today, the scale has been updated as follows.

According to the American Society of Plastic Surgeons, this is the “Gynecomastia Scale adapted from the McKinney and Simon, Hoffman and Kohn scales [the scale mentioned above]:

Grade I — Small breast enlargement with localized button of tissue that is concentrated around the areola.

Grade II — Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest.

Grade III — Moderate breast enlargement exceeding areola boundaries with edges that are distinct from the chest with skin redundancy present.

Grade IV — Marked breast enlargement with skin redundancy and feminization of the breast.”

How common is gynecomastia?

Gynecomastia affects up to 70 percent of boys in early- to mid-puberty due to routine hormonal fluctuations, and affects up to 65 percent of men middle-aged and older men.

What causes gynecomastia?

Decreased testosterone and increased estrogen. A number of factors can cause that imbalance, including factors that block the results or effects of testosterone, factors that reduce it, and factors that increase your estrogen levels.

Some of the conditions in which gynecomastia can be found are:

  • Klinefelters’s syndrome
  • Trauma to the breast
  • Adrenal or testicular tumors
  • Bronchogenic carcinoma
  • Hyperthyroidism
  • Chronic kidney infection
  • Hypertension
  • Paraplegia
  • Cryptorchidism” – Classification and Surgical Correction of Gynecomastia, 1973

What is drug-induced gynecomastia?

It is estimated that between 10 and 25 of all cases of gynecomastia result from the use of certain drugs and medications.

What drugs can cause gynecomastia?

  • Anabolic steroids
  • Alcohol abuse
  • Marijuana
  • Heroin
  • Amphetamines
  • Spironolactone (treating heart failure)
  • Ketoconazole (treating fungal infections)
  • Cimetidine (treating ulcers and serious heartburn)
  • Antiandrogens (treating prostate cancer)

Does gynecomastia increase your risk of getting breast cancer?

Gynecomastia itself is a non-cancerous breast tissue growth, however studies suggest that, yes, it increases one’s odds of contracting cancer.

In January 2011, Dr. Lonzetta Neal and Dr. Sandhya Pruthi, answering on behalf of the Mayo Clinic, stated that gynecomastia may “slightly increase your risk of breast cancer,” but that, “even with gynecomastia, your risk of developing male breast cancer is very small.”

“In most cases,” they said, “gynecomastia resolves on its own with minimal treatment and little risk of long-term complications.”

However, in February 2014, a comprehensive study out of the National Institute of Health determined that gynecomastia was indeed actually “associated with a 10-fold increased risk of breast cancer in men.” 

The study involved 54,400 men: 2,400 of whom had breast cancer and 52,000 of whom did not.

As of April 2018, the American Cancer Society lists Klinefelter syndrome—which may incidentally spawn gynecomastia since affected persons have (among other things) elevated levels of estrogen—as a risk factor for breast cancer in men.

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II. How To Hide Gynecomastia
& How To Reduce It

How can I hide my gynecomastia?

Until you can have it treated, you can conceal gynecomastia by:

  1. Using compression undergarments like this one that’s fully purpose made, or this one that works almos just as well for half the price.
  2. Wearing clothes with small patterns and a strong color contrast; dark plaids work well.
  3. Wearing thicker clothing or clothing that’s more rigid
  4. Wearing clothing that’s neither too tight nor too loose. Tight clothing obviously accentuates gyno, and loose clothing tends to tent on larger male breasts
  5. Wearing darker colors and avoiding white or light colors
  6. Wearing clothing with vertical lines rather than horizontal lines or no linear pattern at all

How can I hide gynecomastia at the beach?

Wearing a compression shirt or vest under a beach or swim shirt is the most effective way to conceal gynecomastia at a beach or water park. Just be sure to check the labels. Salt water isn’t usually a problem for most compression vests, but the chlorine in pools might be. If you’re concerned, be sure to wash the compression vest in plain water when you get home. Wearing it in the shower is easiest.

“Shapewear” and “performance apparel” also works well, even if not specifically designed to conceal gynecomastia. Another option is a swim shirt or rash guard. Rash guards are tight tops worn by surfers. Finally, you can also simply wear a dark or patterned (dark and patterned is best) Hawaiin or button up shirt.

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III. Gynecomastia Treatments

What are the treatments for gynecomastia?

Treatments for gynecomastia include the following:

Surgery: Male breast reduction surgery is considered the most effective way to treat gynecomastia.

Medication: No drug or medication is FDA approved specifically for the treatment of gynecomastia. Two drugs have shown mild hope: the anti-estrogen drug Tamoxifen has a reported 80 percent success rate in fully or partially resolving recent-onset gynecomastia. Another anti estrogen drug, Clomiphene, produced a partial reduction of gynecomastia in 50 percent of patients, and full resolution in 20 percent.

Exercise and losing weight. This is a longer term solution and because hormonal changes and abnormalities are involved, it doesn’t work for everyone. However, neither do all surgical and treatments, since their price puts them out of range for so many. Chest exercises can help reduce excess fatty tissue, but they won’t impact or reduce glandular tissue.

Non-surgical: Coolsculpting and laser therapy can help temporarily reduce the appearance of gynecomastia. Non-surgical fat reduction procedures like Coolsculpting and laser therapy will reduce fat over time, but won’t affect or reduce the glandular tissue that is often the biggest cause of the unwanted large breasts. Money spent on nonsurgical treatments for gynecomastia would likely be much better saved and spent on a surgery. 

Balancing hormones. Gynecomastia occurs due to hormonal imbalances, with excess estrogen being produced by the male body, or problems in producing and utilizing testosterone. Balancing hormones may prevent an increase in gynecomastia but is unlikely to reduce existing gynecomastia.

Medication assessment. Certain medications can produce gynecomastia as a side effect. “Drug-induced gynecomastia” affects adults more often than it does children. Talking to your primary care physician about drugs or meds you’re taking that might be contributing to gynecomastia could help reduce the problem.

What is the most effective treatment for gynecomastia? 

According to the American Board of Cosmetic Surgery, “male breast reduction [surgery] is the most effective known treatment for gynecomastia,” as it “removes excess fat and glandular tissue.”

Gynecomastia.org likewise suggests  that, “The most effective way to treat gynecomastia is with surgery.” 

But, while that’s not necessarily wrong—since the surgery literally removes the fat and/or glandular tissue that makes the condition so obvious—a less surgically vested and yet credible source, the Mayo Clinic, says that “Most cases of gynecomastia resolve over time without treatment.”

Adolescent Gynecomastia Requires Surgical Intervention “Very Rarely”

In adolescents particularly, the Mayo Clinic tells us, “Gynecomastia often goes away without treatment in less than two years.” 

The Mayo Clinic goes on to say that treatment might be necessary if it “doesn’t improve on its own or if it causes significant pain, tenderness or embarrassment.”

According to Dr. Ran D. Goldman of BC Children’s Hospital, “Adolescents who use anabolic steroids, or who abuse alcohol, marijuana, heroin, or amphetamines, should be alerted to the fact that gynecomastia might develop. Treatment of drug-induced gynecomastia includes discontinuation of the offending drug. Very rarely is surgical intervention required.” (Emphasis added).

Speaking of gynecomastia in general (not solely adolescent gyno), in 1973, doctors from New York’s Mount Sinai School of Medicine suggested that “If the enlargement does not disappear in a reasonable length of time (two years) surgery may be indicated.”

By 2013, some doctors suggested reducing that 2 year period to about 1 year: “When gynecomastia in adolescents persists for more than one year, surgical management may be considered.”

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IV. Gynecomastia Surgery: Preparation

How much does a male breast reduction surgery cost in 2021?

Please see this article for a full rundown on costs and all associated fees.

Is it worth getting gynecomastia surgery?

Because gynecomastia produces no significant adverse physical issues, surgery is a personal choice, with the individual deciding if the negative psychological effects are worth mitigating with a quick but costly surgical procedure.

Male breast reduction surgery is the fourth most popular cosmetic surgery for men in the US, with 24,000 men undergoing the procedure in 2019. 

Is gynecomastia surgery covered by insurance?

Patients with gynecomastia alone would have considerable trouble getting their surgery covered by health insurance. If their gyno is caused by other medical conditions, it’s more likely to be covered by insurance as a medically necessary procedure rather than a purely cosmetic one.

Is male breast reduction surgery safe?

Gynecomastia surgery is one the most widely performed male cosmetic surgeries in the US.

Performed by a board-certified plastic surgeon with enough experience, the procedure is incredibly safe.

If the surgeon you’re interested in seeing is board-certified, it’ll be clearly noted on his/her website.

If he or she is experienced enough to do the job, there will be PLENTY OF RECENT before and after photos on their website. PLENTY & RECENT.

Is male breast reduction surgery painful?

No. You’ll feel no pain during gynecomastia surgery due to the local or general anesthesia.

Pain afterwards can be easily managed by pain medication.

Does gynecomastia come back after surgery?

Results of a well done gynecomastia surgery are virtually permanent in most cases. But there are factors that could cause it to return, such as continued drug, medication, or marijuana use (if these were the causes of gynecomastia in the first place), as well as if the cause was adrenal or pituitary problems that weren’t handled before surgery.

How to find and pick a gynecomastia surgeon

NO GOOD SURGEON GIVES DISCOUNTS ON THEIR SURGICAL WORK

Botox and fillers, sure, occasionally, but surgery, NEVER.

Look for a board-certified plastic surgeon in your area with the most (and best) before and after photos on their website.

Assume these photos are best-case scenarios and that your results will generally match what you see in those shots, 9 out of 10 times.

Do the BEFORE photos match your current physique? If you’re a bodybuilder, look for a surgeon who’s done surgery on people like you.

You want “after” photos that look natural and like there was no surgical work done in the first place: Symmetrical breasts, left and right; correctly sized and shaped areolas that are still a full natural circle, no visible indentations or recesses, scarring that is virtually imperceptible and isn’t a raised ridge.

A RealSelf profile with the doctor’s answers to a lot of patient-submitted gyno questions is at least an indication that gyno is one of their more commonly performed procedures.

Surgeons have specialties, you want a surgeon whose specialty either is or at least includes gynecomastia surgery.

Will gynecomastia surgery leave scars?

Every time an incision is made in the skin, a scar is formed. Every time. But the scars left by a good gynecomastia surgeon will be virtually imperceptible from a few feet away.

Done wrong, yes, these scars can absolutely end up as a red, puffy, raised ridge of tissue that is obvious to anyone looking. Look at your surgeon’s before and after photos, paying particular attention to scarring. 

A good surgeon will conceal these in the natural contours of the chest and around the areola. And they will not be prominent at all.

How visible the scars ends up also depends to some degree on you and how well you care for the incision sites.

After surgery, good hygiene and proper wound care, wearing sunscreen, not smoking, and avoiding direct sun exposure will all help make your scars less visible. 

What to expect in a gynecomastia consultation

When it comes time for your personal consultation, your surgeon is going to look you up and down and ask you loads of questions: your medical history, your goals and expectations for the procedure, what meds or drugs you’re currently taking, and how long you’ve had the condition.

They take photos of your chest, and do testing to try and find out what’s causing the gynecomastia. Then they’ll talk about risks and possible complications.

Anesthesia is another hot topic. Your surgeon will usually already have determined what anesthesia needs to be used pretty much after simply looking at you, since only the lower and less pronounced grades of gynecomastia can be treated under local anesthesia.

Before you head in for this consultation, you should at the very least have perused their website in full, seen them in any YouTube or Instagram videos they’ve put out, Googled their reviews—don’t be alarmed by a few bad reviews, but look at the trend and majority consensus.

Surgeons have a hard enough time pleasing everyone and some even have sites dedicated to their demise. Take these with a grain of salt but if too many grains accumulate, move on if it no longer feels right.

You want results you can see in before and after photos, and you want a surgeon you can connect with as you would a good friend.

A good friend who is going to put you under and stab at you with cannulas only a few inches from your heart (relax, gyno surgery is incredibly safe and goes nowhere near vital organs. This isn’t a BBL, a surgeon would have to try very hard to make it dangerous, but poor-looking, aesthetically displeasing results are something a bit more common and you should watch out for them.)

Their conversation style, demeanor, and willingness to understand your position and preferences is important.

You’ll feel under pressure to at least some extent just by visiting, and your surgeon should help relieve this pressure through their personality, understanding and attention to your concerns.

If you leave feeling rushed, not understood, like you couldn’t confide in them, uncertain of your outcomes, or not cared for, that should be the last time you visit. Look elsewhere for a surgeon that meets the above criteria.

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V. Gynecomastia Surgery: Procedure

What happens in gynecomastia surgery?

In a gynecomastia surgery, liposuction alone is used to remove the excess fatty tissue (but not the breast gland tissue) from the breast mound, or, a mastectomy is done to remove the breast gland tissue, with liposuction done to remove the fatty tissue. This is a minimally invasive treatment that requires only small incisions, but is usually done under general anesthesia unless the condition hasn’t advanced beyond about a Grade I or II.

How long does gynecomastia surgery take?

Gynecomastia surgery typically takes an hour or two.

What anesthesia is used for gynecomastia surgery?

Mild cases of gynecomastia such as Grades I and II, may be treatable under local anesthesia, or local anesthesia and IV sedation.

However, if you find yourself actively searching for a surgeon to treat your gynecomastia—meaning it has evolved to the point of causing serious physical or mental anguish—it’s likely your gynecomastia has advanced to a state beyond what would be treatable under local anesthesia, and would require general anesthesia.

To reduce the cost of gynecomastia, ask if you can have the surgery done under local anesthesia. That cuts out a huge cost—about $4,000 depending on where you live or go to for surgery—associated with general anesthesia, as well as hospital fees.

Local anesthesia will reduce the cost of your surgery, but is not always an option. That is your surgeon’s call, and if you have advanced gyno, even second- and third-opinions will advise you do the procedure under general anesthesia.

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VI. Gynecomastia Surgery: Recovery

How long does it take to recover from gynecomastia surgery?

Recovery after surgery depends on what was done in surgery (liposuction, mastectomy), and who your surgeon was. Recovery after gynecomastia surgery is a brief and usually uneventful one to three days. 

Three days after surgery, you should be able to return to work and your social activities.

Five or six weeks after surgery, you’ll likely be able to hit the gym again.

These are approximate timeframes for a typical gynecomastia surgery patient; your surgeon will give you a recovery timeframe specific to your case.

How long should I wear a compression vest after gynecomastia surgery?

After gynecomastia surgery, most patients are advised by their surgeon to wear a compression vest for 6 to 8 weeks after surgery in order to help the skin retract and to prevent the unwanted accumulation of fluid at the treatment site, causing what is called a seroma.

Popular New York gynecomastia surgeon, Dr. Jonathan Lebowitz from the Long Island Gynecomastia Center says the compression garment is put on immediately post op, and is “used for a total of about 6 weeks, sometimes a little bit shorter for those that just need the gland removal, and sometimes a little bit longer for those patients who need a lot of fat and glands to be removed.”

(A seroma is simply the collection of fluid (serum) that builds up beneath the skin surface. Seromas may go away on their own, but always let your surgeon know what is occurring, and contact them rapidly if it is large or painful, red and warm, tender, swollen, emitting pus of any kind, or if you have either a high fever or a rapid heart rate (tachycardia). They can drain (aspirate) it for you, and prescribe any antibiotics or medication if indicated. Medication alone will not make it go away any faster, its purpose is to treat or prevent infection. Diuretics aren’t advised either. Always contact your surgeon.)

How do you reduce swelling after gynecomastia surgery?

Swelling after surgery can last four to six weeks, with the majority of swelling disappearing within the first several days of surgery. Wear a compression vest and massage the treated breast tissue with your hands or a roller—your surgeon will show you how.

References:

  1. U.S. National Library of Medicine, “Breast enlargement in males,” reviewed 11 Oct 2018
  2. SIMON, BERNARD E. M.D.; HOFFMAN, SAUL M.D.; KAHN, SIDNEY M.D. CLASSIFICATION AND SURGICAL CORRECTION OF GYNECOMASTIA, Plastic and Reconstructive Surgery: January 1973 – Volume 51 – Issue 1 – p 48-52
  3. ASPS Recommended Insurance Coverage Criteria for Third-Party Payers 
  4. Gynecomastia.org; “Gynecomastia: Information, Treatment, and Support
  5. Breastcancer.org, “The Risk Factors for Male Breast Cancer,” last modified 29 Sept 2016, 08:19
  6. NIH study confirms risk factors for male breast cancer, 19 February 2014
  7. American Cancer Society, “Risk Factors for Breast Cancer in Men,” last revised 27 Apr 2018 
  8. Goldman RD. Drug-induced gynecomastia in children and adolescents. Can Fam Physician. 2010;56(4):344-345.
  9. American Board of Cosmetic Surgery, Gynecomastia Surgery Guide
  10. Mayo Clinic, Enlarged breasts in men (gynecomastia); Oct. 02, 2019
  11. Goldman RD. Drug-induced gynecomastia in children and adolescents. Can Fam Physician. 2010;56(4):344-345. 
  12. Lemaine V, Cayci C, Simmons PS, Petty P. Gynecomastia in adolescent males. Semin Plast Surg. 2013;27(1):56-61. doi:10.1055/s-0033-1347166

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