Gynaecomastia (Enlarged Male Breast Tissue): Treatment Options | Newcastle NSW
Gynaecomastia is enlarged male breast tissue. The surgery to reduce it is also known as male breast reduction surgery. In my practice I see it across a wide age range, and 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 a mix of both, and some also have loose skin once the tissue is reduced. What is actually present in the chest is what decides which operation is appropriate.
This page is a short overview of the treatment options, with a link out to a dedicated page for each one. If you want to understand how I grade gynaecomastia and match it to an operation, there is a separate detailed article on my grading system.
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Understanding the cause comes first
Gynaecomastia has more than one cause. It can be hormonal, related to certain medications or agents, related to weight, part of normal puberty or ageing, or have no clear cause at all.
A few points I discuss with every patient:
- Pubertal gynaecomastia is common and frequently settles on its own. In an adolescent, surgery is not the first consideration, and observing for stability is usually the right path.
- Where a driver such as a medication, an anabolic androgenic steroid, or a hormonal cause is still active, that is treated first. Surgery does not change an ongoing cause, so where the driver continues, the changes can return.
- Any medication change is made under medical guidance. Patients should not stop a medication on their own.
Investigating the cause is part of the workup before any decision about surgery, and where indicated this is coordinated with your GP.
Matching treatment to your chest
The distinction between glandular tissue and fat matters, because it changes the operation. Liposuction (suction assisted lipectomy) removes fat. It does not remove a firm glandular disc, so where a gland is present, gland excision is often needed as well. Where the fullness is fat without a firm gland (pseudogynaecomastia), liposuction (suction assisted lipectomy) may be enough on its own. Where there is significant loose skin at the higher end of the range, a skin-reducing procedure may be needed.
You do not need to work out your own grade before coming in. I assess this at consultation. If you would like the detail, my gynaecomastia grading system article explains how each grade maps to an operation.
Treatment options
Each option below has its own page covering the technique, recovery, and complications in full.
BB grade 1: gland excision only
Removal of the glandular disc through a small scar at the lower edge of the areola, for a firm gland without significant excess fat. Recovery is relatively short and a compression garment is worn. The main risk to be aware of is haematoma, a collection of blood in the cavity left after the gland is removed. Read more: gland excision only for gynaecomastia.
Disclaimer: Results vary, surgery has risks, seek second opinion. Operation performed by Dr Beldholm.
BB grade 2: VASER liposuction (ultrasound assisted lipectomy) only
VASER liposuction (ultrasound assisted lipectomy) for a chest that is mostly fatty, with no significant firm gland. This has the mildest recovery of the options, with bruising and swelling that settle over time, and a compression garment is worn. The main risks here are contour irregularity and asymmetry, rather than haematoma. Read more: VASER liposuction (ultrasound assisted lipectomy) for gynaecomastia.
![Patient 2021-7009 Pseudo-gynaecomastia with Small Amount of Gland [BB grade 2b] Before & After 12 Months Post Surgery - Side](https://beldholm.com.au/wp-content/uploads/2025/03/DrBB_Website_3_-_Patient_2021-7009_-_Gynaecomastia.jpg "Gynaecomastia (Enlarged Male Breast Tissue): Treatment Options | Newcastle NSW 5")
Disclaimer: Results vary, surgery has risks, seek second opinion. Operation performed by Dr Beldholm.
BB grade 3: VASER liposuction (ultrasound assisted lipectomy) with gland excision
A combined approach for a chest with both a firm gland and a fatty component. The VASER liposuction (ultrasound assisted lipectomy) treats the fatty component and the excision removes the disc. As with gland excision, haematoma is the main risk to be aware of. Read more: VASER liposuction (ultrasound assisted lipectomy) with gland excision for gynaecomastia.
Disclaimer: Results vary, surgery has risks, seek second opinion. Operation performed by Dr Beldholm.
BB grade 4: crescent lift
Where the nipple sits low and needs elevating, a crescent of skin is removed above the areola to lift it, alongside reducing the tissue. This adds a scar above the areola and carries a specific risk of areolar distortion. Because the skin takes time to retract, I usually reassess the result at six to twelve months, and a second stage is sometimes considered. Read more: crescent lift for gynaecomastia.
Disclaimer: Results vary, surgery has risks, seek second opinion. Operation performed by Dr Beldholm.
BB grade 5: mastectomy with free nipple graft
The largest operation, for significant tissue and skin excess, where the nipple is removed and replaced as a graft. Recovery is the longest, the graft is protected with a bolster dressing, and the chest wall scars can extend across the sternum. The risks specific to this operation include partial or complete graft loss, loss of pigment in the nipple, and altered nipple sensation. Read more: mastectomy with free nipple graft for gynaecomastia.
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Risks and recovery
Each of these is a surgical procedure and carries risk. None of them is minor. Haematoma is a notable one across the operations that involve excision, and the other risks include seroma, contour irregularity, asymmetry, changes in nipple sensation, scarring, and recurrence. Recovery takes time. A compression garment is usually part of it, and return to the gym and to exercise is staged rather than immediate. Results vary between patients, and the detail differs by operation, which is why each treatment page covers its own recovery and complications in full.
How the decision is made
Whether surgery is appropriate, and which technique, is a clinical judgement made for the individual. It follows a history, an examination to tell gland from fat, and the appropriate workup to identify or exclude a cause. Where the history or examination warrants it, that workup includes blood tests and sometimes imaging or a specialist opinion.
Before a consultation you will need a referral from your GP, and suitability is determined only at that consultation. If you are considering male breast reduction surgery, the starting point is an assessment, not a decision that has already been made.
About Dr Bernard Beldholm
I have been performing gynaecomastia surgery for more than 15 years, and male chest surgery is a significant part of my practice rather than an occasional case.
Most men who come to see me are less worried about surgery itself than about what the chest looks like afterwards. That is a reasonable thing to focus on. Gynaecomastia surgery has recognisable ways of going wrong. Liposuction (suction assisted lipectomy) on its own leaves a firm glandular disc behind, because it removes fat and not gland. Taking too much tissue from directly behind the nipple leaves a dished or hollow contour that is difficult to correct later. Working to one default operation, whatever the chest in front of you, produces both.
So the operation has to be chosen rather than applied. I use VASER liposuction (ultrasound assisted lipectomy) where the fullness is fat, gland excision where there is a firm disc, both together where both are present, and a skin-reducing operation where there is genuine skin excess. At the far end of that range I perform mastectomy with free nipple graft for men with significant skin excess after major weight loss. The grading system on this website exists for exactly this reason. I built it because the published classifications did not map cleanly onto the operation I would actually perform, and it sets out which operation suits which chest.
I also assess what caused the gynaecomastia in the first place, including where anabolic androgenic steroids are part of the history. I raise this clinically, not to make a judgment. It matters because an ongoing driver changes both suitability and the chance of the tissue returning.