Male breast enlargement – clarifying the causes, regaining the contour

Many men avoid the swimming pool, tight shirts or group sports because of their chest. Yet an enlarged male breast is widespread: about one in four men is affected at some point in his life, on one or both sides. The good news: after careful assessment, the contour can be improved permanently in most cases.

Two forms that need to be distinguished

• True gynecomastia: The mammary gland tissue itself is enlarged. It feels firm, often like a disc directly beneath the nipple.
• Pseudogynecomastia (lipomastia): The enlargement consists predominantly of fatty tissue, usually in connection with body weight. It feels softer.

A mixed form is common. The doctor makes the distinction by palpation and ultrasound.

Possible causes

In many cases, no clear cause can be found. Known triggers include:

• hormonal changes – during puberty (often regresses on its own) and in older age
• medications and substances, such as anabolic steroids, certain hormone therapies, some gastric medications and psychotropic drugs
• diseases of the liver, kidneys or hormone-producing organs
• alcohol in larger quantities
• excess weight – especially in pseudogynecomastia

First clarify, then treat

Every operation is preceded by clarification of the cause: a discussion of medications and lifestyle habits, examination, ultrasound and – in true gynecomastia – a hormonal assessment, if necessary in cooperation with endocrinologists or your family doctor. If a cause can be eliminated, for example by stopping a medication after consulting a doctor, the breast may regress. If this does not help or the enlargement has existed for a long time, surgery is the reliable route.

The surgical options

• Liposuction: In pseudogynecomastia, suctioning the fatty tissue through a few very small access points is often sufficient.
• Removal of the glandular tissue: In true gynecomastia, the gland body is removed through a small incision at the lower edge of the areola. The tissue is then examined histologically.
• Combination: In most cases, both procedures are combined to create an even, flat transition to the chest wall.
• Skin tightening: Only with a large excess of skin, for example after major weight loss, is additional tightening necessary – with longer scars.

Procedure

1. Consultation and examination Palpation, ultrasound, clarification of medical history and possible causes.
2. Diagnostics hormone levels and further assessment if necessary.
3. Planning We decide on the technique, type of anesthesia and extent. Smaller procedures are possible under local anesthesia, larger ones under general anesthesia.
4. Surgery usually on an outpatient basis – you go home the same day.
5. Aftercare Compression vest, check-up after a few days, gradual return to everyday life.

After the procedure

In the first few weeks, a compression vest helps the swelling subside and helps the skin to settle. Office work is often possible again after a few days. You should avoid chest and upper body training, sports, sauna and intense sun for about six to eight weeks. Lymphatic drainage can promote the reduction of swelling. The final contour becomes apparent after around three months.

Costs and health insurance

In true gynecomastia that persists despite treatment of the cause, health insurers cover the costs in some cases – usually after an application and an expert assessment. Pseudogynecomastia is generally considered an aesthetic procedure and is self-paid. After the examination, you will receive an individual cost estimate.

Risks

Possible risks include bruising, secondary bleeding, seromas, infections, wound healing problems, unevenness of the contour, asymmetries, an inverted nipple as well as temporary or permanent sensory disturbances. Smoking increases the risk of healing problems. All points are discussed in detail before the procedure.

Liposuction: the procedure step by step
Preparation, day of surgery and healing – with illustrations

Frequently asked questions