Male breast enlargement – first the cause, then the contour

Because of their chest, many men avoid the swimming pool, tight shirts or group sports. 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. After careful assessment, the contour can be improved in many cases.

Two forms that must be distinguished

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

A mixed form is common. The distinction is made by palpation and ultrasound.

Possible causes

Often no clear cause is found. Known triggers include:

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

Assess first, then treat

Every operation is preceded by clarification of the cause: a conversation about medication and lifestyle, an examination, ultrasound and – in true gynaecomastia – a hormonal assessment, if necessary in cooperation with endocrinologists or your GP. If a cause can be eliminated, for example by stopping a medication after consulting a doctor, the breast may regress. If that does not help, or if the enlargement has existed for a long time, an operation may be considered.

The surgical options

• Liposuction: In pseudogynaecomastia, suction of the fatty tissue through a few very small access points is often sufficient.
• Removal of the glandular tissue: In true gynaecomastia, the gland is removed through a small incision at the lower edge of the areola and then examined histologically.
• Combination: Both techniques are usually combined to create an even, flat transition to the chest wall.
• Skin tightening: Only with a large excess of skin, for example after considerable weight loss, is additional tightening necessary – with longer scars.

Process: preparation, procedure, aftercare

Smaller procedures are possible under local anaesthesia; larger ones are performed under general anaesthesia. We decide on the place of the procedure during the consultation.

1. 01before the procedureAssessment and planning

   Palpation, ultrasound, medical history, hormone levels if necessary; deciding on the technique, type of anaesthesia and extent.

2. 02day of surgeryProcedure

   Liposuction and/or gland removal, usually on an outpatient basis – you go home on the same day.

3. 03weeks to monthsAftercare

   Compression vest, check-up after a few days, gradual return to everyday life and training.

In the first few weeks, the compression vest supports the reduction of swelling and helps the skin to settle. Lymphatic drainage can promote the reduction of swelling.

Health insurance

In the case of true gynaecomastia that persists despite treatment of the cause, cost coverage by health insurance may be possible in some cases; please clarify this before treatment. Pseudogynaecomastia is generally regarded as an aesthetic procedure and is paid for privately. After the examination, you will receive an individual cost estimate.

Risks

Possible risks are bruising, secondary bleeding, seromas, infections, wound-healing problems, unevenness of the contour, asymmetries, an inverted nipple and temporary or permanent sensory disturbances. Smoking increases the risk of healing problems. We discuss all these points in detail before the procedure.

Frequently asked questions