An enlarged male breast is more common than many assume. It can occur on one or both sides and affects men of all ages. For treatment, one distinction is decisive, because it determines the entire approach: does the enlargement consist of fatty tissue or of glandular tissue?
Gynaecomastia or pseudogynaecomastia
In pseudogynaecomastia (also lipomastia) there is exclusively increased fatty tissue. Glandular tissue is not enlarged and therefore does not need to be removed.
In true gynaecomastia, an increase in mammary gland tissue is added to the fatty tissue. It lies directly behind the areola and cannot be suctioned off because it is firm. It has to be removed surgically.
Which of the two forms is present is determined by the examination. Palpation alone is not sufficient for this.
Clarification before the operation
Before a procedure, the cause must be clarified. Two examinations are required for this:
- a hormone status by an endocrinologist
- an ultrasound of the testicles
The ultrasound serves to rule out malignant causes. Gynaecomastia can be the first sign of a condition that needs to be treated first. Please bring both findings to the consultation.
Treatment of pseudogynaecomastia
If only fatty tissue is present, liposuction is sufficient. Only small incisions are needed, through which the cannulas are introduced.
First a tumescent solution is applied. It liquefies the fat and makes it suctionable. It is then removed through fine suction cannulas. The incisions are so small that hardly anything can be seen of them later.
Treatment of true gynaecomastia
Here, suction is performed first exactly as described above. In the same procedure the glandular tissue is then removed: a crescent-shaped incision at the lower edge of the areola provides access to the glandular body, which is then removed.
The scar runs at the transition between the areola and the skin. It hardly stands out there because it lies on a natural colour border.
Procedure and stay
The operation is performed under general anaesthesia. A stay of one night is recommended; in principle the procedure is also possible on an outpatient basis.
Drains are usually not necessary. If they are, only mini-drains are placed and removed again on the day of discharge. With an outpatient approach, a mini-drain is removed the following day at the practice.
After the operation
For six weeks you wear a compression vest day and night. It serves two purposes: it prevents an accumulation of fluid in the wound area (a seroma), and it ensures that the skin adheres more quickly to the pectoral muscle underneath. This reduces the cavity created during suction.
Avoid sport and heavy physical work for as long as the vest is worn.
What are the risks of the operation?
Contour irregularities. If too much glandular tissue is removed directly behind the areola, a dip can form there and the areola can appear pulled in. For this reason, a thin layer is deliberately left in place.
Seroma and post-operative bleeding. Wound fluid can collect beneath the lifted skin. The compression vest counteracts this. Larger seromas have to be drained by needle, and post-operative bleeding can make a further operation necessary.
Sensation in the nipple. The access lies at the edge of the areola. An altered sensation in the first weeks is common, a permanent reduction possible.
Wound healing and infection. Rare but possible. Nicotine impairs blood flow and thus wound healing.
Asymmetry. Both sides are rarely equally pronounced before the operation and do not heal identically. Small differences remain possible.
Recurrence. If the cause persists — a hormonal disorder, a triggering medication, anabolic steroids or marked excess weight — tissue can form again. This is why the clarification comes before the operation, not after.
Are there alternatives to the operation?
Treating the cause. If the gynaecomastia is due to a hormonal disorder or a medication, it can recede once the cause is treated. This is the actual reason for the clarification beforehand — an operation that bypasses the cause does not solve the problem permanently.
Waiting during puberty. Gynaecomastia in adolescence often recedes on its own within one to two years. It is worth waiting before an operation — Dr. Özdemir operates on gynaecomastia from the age of 18.
Weight loss for pseudogynaecomastia. If the enlargement consists mainly of fatty tissue, losing weight changes the finding. With true glandular tissue, however, it does not help — glandular tissue does not respond to diet and exercise.
Doing nothing. If the finding has been clarified and is harmless, and you are comfortable with it, there is no medical reason to operate.
Why there are no before-and-after pictures
You will not find before-and-after photos on this page, and Dr Özdemir does not show any during the consultation either. Initial findings, tissue proportion and body build differ too much for another patient's result to say anything about yours. Instead, after the examination you receive an honest assessment of your own findings.
