When there is more than expected growth, hardness or sagging in the chest area, this can be both physically and emotionally disturbing for men. This condition, commonly called "gynecomastia", can lead to self-confidence problems in daily life and can even affect a person's choice of clothes. At this point, gynecomastia surgery comes into play and offers the opportunity to achieve a more balanced, masculine chest contour.
Gynecomastia is a medical term that refers to the growth of tissue in the chest area in men more than expected. The word "gynecomastia" is of Greek origin; "gyno" means woman and "mastos" means breast. Therefore, gynecomastia can be summarized as the enlargement of the male breast similar to the female breast. This growth can be caused by both adipose tissue and glandular (milk gland) tissue; most of the time it is a mixture of both.
In fact, all men have a small amount of breast tissue. Disturbances in the balance of hormones (especially estrogen and testosterone) or metabolic differences can lead to overdevelopment of this tissue. The causes of this hormone imbalance may include puberty, aging, use of certain medications, kidney or liver disease, alcohol and substance abuse. Sometimes there may be no clear cause.
For some men, this can cause a serious loss of self-confidence and sociocultural discomfort about their appearance. Some may tend to hide this growth to the extent that they avoid wearing t-shirts or swimsuits. The main purpose of gynecomastia surgery is to reduce this volume and create a flatter and more aesthetically pleasing male breast form.
Many people think, "I wonder if I am suitable for this surgery?" The general approach is this: If the growth in your chest area has reached a size that makes you uncomfortable, if you feel a tightness or discomfort in your chest even when closing the buttons of your shirt, or if you are hesitant to face the mirror at the gym, you may want to consider being evaluated by a specialist examination.
Persistent Gynecomastia: Especially in adolescents, this growth is often temporary and may resolve spontaneously when hormones stabilize. However, if there is still significant breast enlargement after the age of 17-18 and this causes psychological or physical discomfort, surgery may be an option.
Persistent Tissue Growth Outside of Weight Fluctuations: Some men may have fat accumulation in the chest area due to excess weight. If the chest area improves after weight loss, this may be called "pseudogynecomastia". Therefore, approaching the ideal weight with diet and exercise before gynecomastia surgery helps to understand whether the permanent tissue is really gynecomastia.
Healthy Individuals: People who do not have a risky health condition that cannot tolerate anesthesia, who do not have cardiovascular diseases or uncontrolled chronic conditions will have a more comfortable surgical process.
Smoking and Alcohol Use: Smoking in particular can prolong the healing process and cause scars to remain more prominent. For this reason, it is recommended to quit or minimize smoking and alcohol consumption before and after surgery, if possible.
The chest area has a different structure in everyone: Some patients have a predominance of adipose tissue, while others have more prominent hard glandular tissue. Therefore, surgical techniques are also planned individually. There are basically three main procedures: liposuction, direct excision (tissue removal) and a combination of both. In addition, there are endoscopic approaches, which are less common but can be used in certain cases.
Liposuction Techniques
Classic Liposuction: Excess fat is removed with the help of a small cannula. This method is more effective in soft and fat-dominated gynecomastia cases. For example, it is like shrinking a balloon by pulling the air out of an overfilled balloon with a tube. Thus, excess and contour defects on the sides of the chest can be removed.
Ultrasound Assisted Liposuction (UAL): In cases where the fat tissue is dense and fibrous, the fat is liquefied with ultrasound waves and then pulled out. This method may be more effective especially in areas with hard tissue. In a sense, if it is easier to spoon out butter that has been pre-heated and softened, it becomes easier to pull out hard fat tissue after liquefying it with ultrasound.
Excision (Tissue Removal) Techniques
Subcutaneous Mastectomy: If there is a significant amount of glandular tissue, this tissue is removed through a small incision under or around the areola (the dark ring around the nipple). Since the incision scar will be camouflaged by the folds of the dark color of the areola, it is usually not very noticeable from the outside.
Removal of Excess Skin: If gynecomastia is advanced and there is excess skin, larger incisions may be required to remove this excess skin. The aim is not only to reduce the breast, but also to allow the skin to gather without sagging.
Combined Method
In most patients, both liposuction and tissue removal methods are used together. Thus, it is possible to achieve a homogeneous thinning and shaping of the entire breast. While the hard tissue is excised, the surrounding fat tissue is shaped by liposuction.
Endoscopic Approach
In some mild to moderate cases, a camera system can be inserted through very small incisions to remove unnecessary tissue. Although this method may be preferred because it leaves minimal scarring, it is not suitable for everyone.
Proper preparation on the road to surgery is critical both for the operation to go smoothly and for the healing process to accelerate. Just like preparing our bag in an organized way before a long journey, some "preparation" steps are needed before surgery.
Examination and tests
A detailed physical examination by the doctor is the first step. The structure of your breast is examined, factors such as whether fat or glandular tissue predominates and whether there is sagging skin are evaluated.
If necessary, blood tests, hormone tests or imaging tests such as breast ultrasound may be ordered. The aim is to find out if there is a different underlying disease or hormonal disorder.
Medication and Supplement Regulations
Drugs with blood thinning effect (such as aspirin) or some herbal supplements (green tea extract, ginkgo, garlic pills, etc.) can be stopped some time before surgery. It is necessary to follow the doctor's recommendations carefully.
If there are medications you need to take on a regular basis, the doses or times of use can be reviewed.
Lifestyle Adjustments
Reducing or completely quitting smoking and alcohol consumption at least a few weeks before the surgery provides a great advantage in the healing process. Smoking can impair blood circulation, causing wounds to heal late and scars to remain more prominent.
In terms of nutrition, it is important that the body is in the best condition before surgery. Eating as healthy and balanced a diet as possible and drinking enough water will help you recover faster.
Practical Arrangements
It is important to have someone to accompany you on the day of surgery. A friend or family member who can drive you home from the hospital and help you around the house for the first few days will make you feel comfortable.
To be prepared for the day of surgery, it is helpful to have items you may need at home close by or positioned near your bed in advance.
Gynecomastia surgery is mostly performed under general anesthesia. In some mild cases, a combination of local anesthesia and sedation may be preferred, but this is more suitable for patients where small touches are sufficient. The duration of the operation varies between 1-2 hours on average, but this period may be longer or shorter depending on the surgical technique, the amount of excess skin and tissue structure.
Opening the Incision
The most commonly used incisions are made in the dark ring around the nipple (periareolar incision) or in the natural fold under the breast. The periareolar incision is often preferred as it helps to make the scars less visible.
If liposuction is planned, cannulas are inserted through holes of about a few millimeters and the fat tissue is removed.
Tissue Removal
If there is hard glandular tissue or excess skin, these tissues are removed using fine instruments. The shape of the breast is carefully corrected, like a sculptor carving marble.
Sometimes temporary drains may be placed because excess blood or fluid may accumulate during the operation. These drains are removed a few days after surgery.
Closure of the incision site
After the procedure is finished, the incisions are closed with cosmetic sutures. The breast area is then wrapped with a tight bandage or a special compression garment to reduce swelling and maintain the new contour.
Since everyone's body is different, the recovery period varies from person to person. However, in general, the first few weeks after gynecomastia surgery can be summarized as a period of "careful rest and care". Just as a planted seed needs time to germinate, patience is needed for the breast area to take its new shape and fully heal.
First week
Immediately after surgery, chest pain, mild bruising and swelling are normal. These are the body's healing response. Prescribed painkillers and anti-inflammatory drugs help to control these symptoms to a large extent.
A compression garment (a special corset or vest) is worn to support the chest and reduce possible edema. This garment is like a protective shield in the postoperative period. It both protects the shape and accelerates healing.
Strenuous activity, weight lifting or vigorous arm movements should be avoided for a few days.
Between 2-4 Weeks
Bruises usually start to disappear gradually during this period. Although a significant part of the swelling has gone down, it may take a few months to completely disappear.
As approved by your doctor, you can start light walking or low-paced exercises. This promotes healing by speeding up blood circulation.
After the stitches at the incision sites have completely healed, if necessary, silicone gel or similar topical products can be used to heal the scars faster.
Long Term Care
Exercises that tire the chest area (e.g. push-ups, bench press, etc.) can be gradually tried 4-6 weeks after surgery. However, you should definitely follow the instructions given by your physician.
The appearance obtained as a result of gynecomastia surgery is usually permanent. However, sudden weight gain and loss, hormone imbalance or the use of some special medications may cause growth in the chest area.
Proper Nutrition
A diet rich in protein, vitamins and minerals promotes cell repair and wound healing. Foods rich in vitamin C (oranges, kiwi, strawberries) and zinc (red meat, pumpkin seeds) in particular contribute to tissue healing.
Adequate rest and sleep
During sleep, the body repairs damaged tissues and cell regeneration accelerates. Sleeping 7-8 hours a night keeps the immune system strong and facilitates recovery after surgery.
Light Exercises and Improving Circulation
Not staying in the same position for a long time, getting up and walking from time to time increases blood circulation and allows the edema to dissipate faster. It is recommended to take short walks in the first weeks and then gradually return to normal activity with the doctor's approval.
Avoiding Smoking
The nicotine in cigarettes narrows the blood vessels, limiting blood flow to the tissues. This slows healing and increases the risk of complications. Therefore, smoking is largely discouraged before and after surgery.
As with any surgery, gynecomastia surgery has certain risks. Most of these are unlikely but should be considered when deciding on surgery.
Bleeding and Hematoma
Blood collection (hematoma) may develop in the area after the operation. In this case, an additional intervention or drainage may be required.
Avoiding heavy exercise and wearing the compression garment regularly for the specified period after surgery reduces this risk.
Infection
Inflammation (infection) may occur in poorly cared for wounds. Antibiotics or additional intervention may be required. Maintaining cleanliness and following dressing instructions minimizes this risk.
Scarring and Tissue Hardness
In gynecomastia surgery, scars are usually hidden around the areola or in the fold under the breast. In this way, they are not very visible from the outside.
However, in some people, scars may heal as hypertrophic scars or raised scars called keloids. This may occur due to genetic predisposition and may require scar treatment (laser, silicone cover, etc.).
In addition, stiffness, irregularity or asymmetry may occur in the tissues from time to time. These conditions can usually be corrected with massage or additional time. In rare cases, a second corrective procedure may be necessary.
Sensory Changes
Nerve endings can be affected during surgery, which can lead to temporary or permanent numbness/sensitivity changes in the nipple. This tends to improve over time, but it is also possible, although unlikely, that it is permanent.
Regrowth (Recurrence)
A treated gynecomastia can return if the hormonal imbalance persists or if the person gains excess weight. This is why it is important to maintain healthy living habits.
The tissue removed from the body after surgery does not grow back; however, if hormonal imbalance persists or if too much weight is gained with a high-calorie diet, fat and tissue growth may occur again. Substance abuse, certain medications or diseases that disrupt hormonal balance can also cause recurrence. Therefore, surgery solves the anatomical part of the problem, but if the underlying hormonal or metabolic problem persists, it is likely to grow again in the long term. Therefore, the postoperative period can also be considered as a starting point for establishing healthy living habits.
Gynecomastia surgery is an effective surgical procedure that helps to correct the proportions of the chest area, provide a more masculine contour and increase self-confidence. The breast tissue and skin of each man is different from each other; therefore, adopting a personalized approach is of great importance in both the choice of surgical technique and postoperative care.
Before entering this process, other factors that may cause gynecomastia (drug use, hormone disorders, obesity, etc.) should be reviewed, and the health status and expectations of the surgical candidate should be clarified. Then, careful planning and meticulous follow-up is required from preoperative preparations to the recovery period.
The results are usually quite satisfactory. In the postoperative period, the use of compression garments, regular check-ups, a healthy diet and an active life contribute to both the preservation of the new breast appearance and the holistic improvement of body health. Although this journey may seem like a short-term operation, it is actually a permanent investment that enables the person to make peace with himself/herself and to regain confidence in his/her body. Concerns are normal when deciding on surgery from time to time; the main thing is to overcome these concerns by integrating them with expert opinion and knowledge and to reach a result that improves the quality of life of the person.
Although gynecomastia surgery may seem like a complex surgery, it is a fairly routine procedure in experienced hands and the risk of complications is low. Nevertheless, before deciding on any surgical intervention, it would be best to weigh all the pros and cons, seek expert opinion and make this decision consciously. Knowing your own body and adopting a healthy lifestyle are the most important keys to positive results after surgery.
