Gynaecomastia (Enlarged Male Breast Tissue): Treatment Options
Gynaecomastia is enlarged male breast tissue. It presents differently from one man to the next. Some men have a firm disc of glandular tissue behind the nipple. Others have mostly fatty fullness. Many have both, and some also have loose skin or a nipple that has dropped. What is actually in the chest decides the operation, not the other way round.
This page is a short guide to the five operations I perform for gynaecomastia. Each has its own page covering who it suits, the operation, recovery, risks and cost.
The cause comes first
Gynaecomastia can be hormonal, related to a medication or agent, related to weight, part of normal puberty or ageing, or have no clear cause. Three points apply to every patient:
- Pubertal gynaecomastia is common and frequently settles on its own. Surgery is not the first consideration in an adolescent.
- Where a driver is still active, it is addressed first. Surgery does not change an ongoing cause, and where the driver continues, the tissue can return.
- Any medication change is made under medical guidance, usually with your GP. Do not stop a medication on your own.
The causes of gynaecomastia article covers the workup in detail.
Five operations, matched to the chest
I grade each side of the chest separately on what is present: gland, fat, skin and nipple position. The BB grading system article explains how each grade maps to an operation. The short version is below.
BB grade 1: gland excision only
A firm disc under the areola with little fat and no loose skin. The disc is removed through a short incision at the lower edge of the areola.
Day procedure, about 1 hour, no drain, no garment. Main risk: haematoma.
BB grade 2: VASER liposuction (ultrasound assisted lipectomy) only
A soft, fat-only chest with no firm disc. Fat is removed through small ports.
Day procedure, about 1 hour, no drain, compression vest for 4 weeks. Main risks: contour irregularity and asymmetry.
Read more: VASER liposuction (ultrasound assisted lipectomy) for BB grade 2 gynaecomastia
BB grade 3: VASER liposuction (ultrasound assisted lipectomy) with gland excision
A firm disc with fatty fullness around it. Liposuction (suction assisted lipectomy) alone would leave the disc behind, so both are done in the one operation.
About 2 hours, drains, compression garment. Main risk: haematoma.
BB grade 4: crescent lift with gland excision
A nipple that has dropped a little on skin that still springs back. A crescent of skin above the areola is removed to lift the nipple up to 2 cm, and the gland and fat are treated through the same incision.
Scar along the upper edge of the areola. Skin retraction reassessed at 6 to 12 months.
BB grade 5: mastectomy with free nipple-areola graft
Loose skin with poor elasticity, or a nipple well below the chest muscle, often after major weight loss. The tissue and skin are removed through an incision across each side of the chest and the nipple is replaced higher as a graft.
One night in hospital, drains, bolster dressings for 10 days. Permanent chest scars, and the nipple loses its sensation.
Read more: mastectomy with free nipple-areola graft for BB grade 5 gynaecomastia
Not sure which grade you are?
You do not need to work it out before you come in. If you want a head start, download the five grades guide: what each BB grade looks like and the operation that matches it.
Cost and Medicare
Medicare items 31525 and 31526 apply to gynaecomastia surgery where the criteria are met, and the out-of-pocket cost depends on the operation and your health fund. The gynaecomastia surgery cost guide sets out the fee structure for each grade.
Before you book
Every one of these is real surgery with real risks, including haematoma, seroma, asymmetry, changes in nipple sensation and scarring. Recovery takes weeks, and return to the gym is staged. Results vary between patients.
A GP referral is needed before consultation, and whether surgery is appropriate, and which operation, is decided only at that consultation. The recovery and complications articles cover the general picture. Each treatment page covers its own.
Book a consultation online
I examine both sides, grade each one, and tell you which operation applies. Bring your referral and a list of your medications.
About Dr Bernard Beldholm
I am a Specialist General Surgeon and a Fellow of the Royal Australasian College of Surgeons (FRACS). I have performed gynaecomastia and body contouring surgery for more than 15 years, and men who have lost a large amount of weight make up much of my practice.
I publish in the peer-reviewed literature, teach other surgeons, and host the Body Contouring Podcast. My rooms are in Lorn, near Maitland in the Hunter Valley, and I operate at Maitland Private Hospital, which has an intensive care unit.
