It depends on what’s causing the fullness. If it’s mostly fat, called pseudogynecomastia, liposuction alone can work. True gynecomastia is firm glandular tissue behind the nipple, which liposuction usually can’t remove. That needs direct excision through a small incision at the edge of the areola, usually combined with liposuction. Many men have both. A medical check should come first, because hormones, medications, or supplements can be the cause.
Which type do you have
| Type | What it feels like | Usual approach |
|---|---|---|
| Fatty (pseudogynecomastia) | Soft, evenly spread | Liposuction |
| Glandular | A firm, rubbery disc behind the nipple | Excision of the gland |
| Mixed | Firm center with soft fullness around it | Excision plus liposuction |
| With excess skin | Sagging chest skin, often after major weight loss | Excision with skin removal |
Why a medical check comes first
Gynecomastia can be caused by a hormone imbalance between testosterone and estrogen, and that has causes worth finding:
- Medications, including some for blood pressure, prostate conditions, and heartburn
- Anabolic steroids and some bodybuilding supplements
- Marijuana and alcohol
- Liver or kidney disease, or thyroid problems
- Rarely, tumors that produce hormones
In teenagers, it often resolves on its own. A new, one-sided, hard lump should be checked by a doctor before cosmetic surgery is considered, since breast cancer can occur in men, though rarely.
What surgery involves
Most gynecomastia procedures are outpatient. Liposuction uses small incisions. Gland excision uses a short incision along the lower edge of the areola, placed where the color changes so the scar blends. The goal is a flat, natural chest contour without a hollow under the nipple, which is why only the right amount of tissue is removed.
Recovery
- A compression vest for several weeks
- Desk work often within about a week
- No heavy chest workouts, like bench press or push-ups, for several weeks
- Swelling settles over months, and the final contour shows gradually
Insurance
Gynecomastia surgery is usually considered cosmetic. Coverage is uncommon and depends on your plan’s criteria. The practice is cash-pay and does not bill insurance; financing is available.
How Mafi MD approaches it
Gynecomastia surgery at Mafi MD is performed by Dr. Parham Mafi, MD, FACS, a board-certified plastic surgeon, at the practice’s AAAHC-accredited surgery center in Fresno. Your consultation includes an exam to tell glandular tissue from fat and a review of medications and history before recommending surgery.
Frequently asked questions
- Can exercise get rid of gynecomastia?
- Exercise reduces fat, not glandular tissue. If the firm disc remains after weight loss, it won’t respond to training.
- Will it come back?
- Removed gland tissue doesn’t grow back, but steroids, some medications, or weight gain can cause new fullness.
- Is the scar noticeable?
- The areola incision usually blends well because it follows the edge of the darker skin.
Medically reviewed by Parham Mafi, MD, FACS, board certified by the American Board of Plastic Surgery, Fellow of the American College of Surgeons, and a member of The Aesthetic Society and the American Society of Plastic Surgeons. Gynecomastia surgery is performed at the AAAHC accredited surgery center at Mafi Plastic Surgery in Fresno, California.
This article is general education, not a treatment recommendation. Whether you need excision, liposuction, or both depends on an in-person exam. Call (559) 890-6500 to schedule a consultation.
Sources
- Braunstein GD. Clinical practice. Gynecomastia. N Engl J Med. 2007;357(12):1229-1237.
- American Society of Plastic Surgeons. Patient information on gynecomastia surgery.