what is gynecomastia?
Very simply put, gynecomastia is breast tissue in men. This is not fat, it is actual breast tissue. It can be due to many different causes, some of which are temporary (see puberty hormonal changes). When you have actual breast tissue, you cannot remove it with weight loss or liposuction. You need to cut it out. I usually see it as a genetic issue or from people who have done steroids.
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Hormonal changes during puberty, which often resolve on their own
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Aging, where natural testosterone levels decline
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Medications, such as certain anti-androgens, anabolic steroids, some antidepressants, and heart medications
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Health conditions, including liver or kidney disease, thyroid disorders, and tumors affecting hormone levels
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Substance use, including excessive alcohol, marijuana, or certain drugs
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Obesity, as excess fat can increase estrogen production and mimic breast enlargement
what are the surgeries done to fix it?
Surgery to fix gynecomastia is usually a combination of direct excision- cutting out the breast tissue- with liposuction of the area. Just like with women’s breasts, breasts are a combination of breast tissue and fat. The fat usually extends out into the axilla / armpit area, so that area is liposuctioned as well.
When doing gynecomastia surgery, some men are droopy or have large areola. You can see breast lifts and areola reduction (which is a circumareolar or donut scar that is 360 around the areola) performed at the same time.
Published Aesthetic Journal article on Innovative Surgical Concept for Gynecomastia
This was a study in the August 2025 Aesthetic Surgery Journal. The title is long, so bear with me, “Innovative surgical Concept for Simon’s Grade IIb Gynecomastia: A Systematic Integration of Circumareolar Mastectomy, Interlocking Suture, Inframammary Fold Detachment, and Waterjet-Assisted Liposuction for Superior Long term Outcomes.”
So what is the study?
They looked at 95 patients (176 breasts). The volume of the tissue was less than 250 grams. Their assessment was that there was skin redundancy and an enlarged areola diameter, making it Grade IIb. They had a procedure which combined
- Circumareolar Mastectomy. (This was done through a lateral approach at the areola to preserve the neurovascular supply in the upper inner areola).
- Circumareolar interlocking suture (This is the suture technique I use when doing a periareolar mastopexy. It is a “wagon wheel” pattern made famous by Dr. Hammond, and it helps keep the scar from elevating.) Their goal was a diameter of the areola of 2-3 cm.
- Inframammary fold detachment
- Liposuction
These patients interestingly had a stay in the hospital for 2.75 days (study was done in Germany). They found a complication rate of 7.7% with no complete nipple areola necrosis. Areolar diameter was significantly decreased postop. At 1 year, 71% of patients were very satisfied with scarring. Body positivity was improved for chest and nipple. Nipple sensation was preserved in 88% of cases.
My thoughts on gynecomastia surgery
I love this surgery. If your issues is just fat, then I can just do liposuction. If you have actual breast fibrous tissue, which I can feel on exam or document using my new Clarius ultrasound in our clinic, then you have to have direct excision of the tissue. In essence, you need a mastectomy. I always pair this with liposuction to contour and blend the surrounding areas.
I liked this study, but I don’t like scars that go 360 around the areola. I find those scars are more visible, and interestingly for most of my gynecomastia patients, when I remove the breast tissue behind the areola, the stretched puffiness of the areola goes away. In English, I find the areola size shrinks when we remove the tissue behind it, so I don’t need to do a surgery to make the areola smaller.
I had a patient with gynecomastia on one side, and when I removed the breast tissue the areola became smaller and matched his non-gynecomastia side perfectly. The goal with this surgery is for you to have your top off, with minimally or not visible scars.
I do put a scar at the areola, but it is usually just the bottom half of a semicircle. It heals beautifully. If we found we need to do an areola reduction, I wouldn’t do it until I see how your tissue retracts and shrinks on its own.
I liposuction broadly, and I think I my liposuction is likely doing a “disruption” of the inframammary fold.
If you have breasts as a man, it can be psychologically tough. You may dress differently- compression shirts, layered clothing, not taking your shirt off at the beach. If you have true breast tissue, 1% of all breast cancers occur in men. Gynecomastia surgery is a great surgery to address it all. I do 3D Vectra imaging to help assess the volume of your breast tissue. Also I use the Clarius ultrasound to see if it is fat or breast tissue.
My page on GYNECOMASTIA
Medical Reference
The information provided on this website is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider for any questions regarding your health or medical condition.
