Sydney

Gynaecomastia Surgery

Gynaecomastia is glandular tissue. Pseudogynaecomastia is fat sitting on the chest without gland enlargement. They can look similar from the outside but need different treatment, since fat responds to liposuction and to weight change while glandular tissue does not.

Plenty of men have both. The distinction is made by examination, sometimes with imaging, and it matters for three reasons. It determines whether surgery would involve excision, liposuction or both. It determines whether losing weight would help at all. And it determines Medicare eligibility, because the relevant item specifically excludes enlargement due to obesity. Ask which you have rather than assuming, since the answer changes the plan substantially.

Sometimes. Gynaecomastia that appears during puberty resolves without treatment in a large proportion of boys, often within one to two years. Gynaecomastia caused by a medication or substance may settle if the cause is stopped under medical supervision. Long-standing gynaecomastia in adults is much less likely to resolve.

This is why both time and cause matter before surgery is considered. Operating on an adolescent whose gynaecomastia would have settled anyway means unnecessary surgery and permanent scars. Where tissue has been present for years it becomes fibrotic and is unlikely to disappear on its own. Medical treatment is also occasionally appropriate depending on the cause, which is a discussion for your GP or an endocrinologist rather than something a surgical consultation should pre-empt.

Yes. Gynaecomastia can be a sign of an underlying condition, so the cause should be considered before surgery rather than afterwards. Recognised causes include hormonal conditions, thyroid, liver and kidney disease, certain medications, anabolic steroids, and in uncommon cases tumours.

Your GP can arrange the relevant examination and blood tests and refer on to an endocrinologist where appropriate. This matters because surgery removes the tissue without addressing why it grew, and because a treatable cause may make surgery unnecessary. Separately, a firm or hard lump on one side, particularly if it feels fixed, or comes with skin or nipple changes or discharge, needs prompt medical assessment. Breast cancer in men is uncommon but it does occur, and it should not be assumed to be gynaecomastia.

Yes, and it is worth being straightforward about it. Anabolic steroid use is a recognised cause of gynaecomastia, and continuing to use them after surgery can cause tissue to regrow. Surgeons are not there to judge, and an accurate history leads to better advice.

If you are using or have used anabolic steroids, say so at consultation. It affects the assessment of the cause, the timing of surgery and the likelihood of recurrence afterwards. Some men are advised to stop and allow time before surgery is considered. Steroid use also carries broader health effects worth discussing with your GP independently of any surgical plan. Recurrence is listed among the recognised risks of this operation, and continued use is one of the clearer reasons it happens.

It depends on whether the enlargement is glandular, fatty or both. Surgery usually involves liposuction, surgical excision of the gland, or a combination of the two. It is performed under general anaesthetic given by an accredited anaesthetist at an accredited facility, and typically takes around two hours.

Where gland is removed, a small incision is made at the border of the nipple so the scar sits at a natural junction in the skin. Where liposuction is used, incisions of three to five millimetres are made to admit the cannula. The area is wrapped afterwards and you are placed in a compression garment. Drains are sometimes inserted and removed the following day, and an overnight stay in hospital is usual.

Sometimes. Item 31525 covers mastectomy for gynaecomastia, with or without liposuction, where the breast enlargement is not due to obesity and is not proportionate to body habitus, and where sufficient photographic evidence demonstrating the clinical need is documented in your patient notes.

Two details are worth knowing. The item is a mastectomy item, meaning it covers removal of glandular tissue, so liposuction alone does not attract this rebate. It is also a unilateral item, claimed per side. The obesity exclusion is the criterion that most commonly rules men out, which is another reason the distinction between glandular tissue and chest fat matters so much. The schedule fee is $606.60 with a benefit of 75 per cent, so a rebate is a contribution rather than payment, and it is a hospital-only item. Surgery performed purely to improve appearance attracts no rebate. Ask whether the item applies to you and get the answer in writing before booking.

If a significant part of your chest volume is fat rather than gland, weight change will affect the result and reaching a stable weight first is generally worthwhile. If the enlargement is glandular, losing weight will not remove it, however much you lose.

This is the most common source of frustration among men who have spent years training and eating carefully without the chest changing. Glandular tissue does not respond to exercise. Weight stability before surgery also gives a more predictable result, since fluctuations afterwards can alter the chest contour, and weight is relevant to surgical risk as well. If weight is something you want to address, your GP is the right starting point, and it need not delay a consultation to find out what you are actually dealing with.

Reported risks include bleeding and haematoma, infection, fluid collection under the skin, wound healing problems, changes in nipple sensation, asymmetry between the two sides, contour irregularity, poor scarring, recurrence, anaesthetic complications, and the possible need for further surgery.

Contour problems deserve particular mention, because removing too much tissue directly behind the nipple can leave a visible depression that is difficult to correct afterwards. Some asymmetry is normal, since most men start with two sides that already differ. Recurrence is possible, particularly where an underlying cause continues. Tell your surgeon about all medications and supplements, including anything bought online. If you develop increasing pain, spreading redness, fever or rapid swelling on one side after surgery, contact the practice rather than waiting.

Most swelling settles within about two weeks. You can usually return to work after one or two weeks if the job is not physically demanding. Heavy lifting and vigorous exercise are avoided for six weeks. A compression garment is worn as instructed while you heal.

Arrange for someone to drive you home from hospital. Sleeping on your back with your head elevated is generally more comfortable early on, and smoking and alcohol should be avoided while healing. Returning to gym training too early is a common cause of problems, chest work especially, so follow the timeline you are given rather than going by how you feel. The final chest contour takes months to settle, so judge the result then rather than at six weeks.

Scars depend on the technique used. Liposuction leaves small scars of a few millimetres. Gland excision leaves a scar at the border of the nipple, where the change in skin colour and texture helps conceal it. Larger reductions involving skin removal leave longer scars.

Scars look at their worst in the first few weeks, then flatten and pale over the following months, with most continuing to change for around 12 to 18 months. Keep healing scars out of the sun, which takes some thought if you are often shirtless through an Australian summer. If you have a history of thickened or keloid scarring, raise it before surgery rather than after. Ask to see the planned incisions marked out beforehand so you know where they will sit.

A GP referral is essential to see A/Prof Bish Soliman for any type of surgery. Where the procedure is performed to improve appearance rather than for a recognised clinical indication, the Medical Board of Australia’s cosmetic surgery guidelines apply, including a cooling-off period of at least seven days after informed consent.

Those guidelines also require a referral from an independent medical practitioner, at least two pre-operative consultations with one of them in person with the surgeon who will operate, and assessment for psychological conditions using a validated screening tool. Patients under 18 require independent evaluation and a cooling-off period of at least three months, which is particularly relevant here given how often gynaecomastia appears during puberty and settles on its own. Where the surgery meets the criteria for a Medicare item, the position differs. Ask which pathway applies to you at your first appointment.