Gynecomastia: When Surgery Is the Right Choice—and When It Isn’t

Gynecomastia is an increase in breast volume in men. It is not a single diagnosis nor an automatic indication for surgery. During a consultation, Dr. García Ceballos, MD, FCCP, MRCS (England), with 25 years of experience in plastic, reconstructive, and cosmetic surgery, first determines whether the enlargement is glandular, fatty, or mixed, and whether there is an underlying cause that should be treated before considering surgical reduction.

Mallorca Medical Group conducts this evaluation in Palma de Mallorca. The purpose of this guide is to explain what you can expect from a thorough evaluation, not to promise a specific outcome. Each case is unique.

What It Is and What It Isn’t

There are two conditions that are often confused. In true gynecomastia, breast glandular tissue is present. In so-called pseudogynecomastia, the bulk of the volume consists mainly of fat, with no significant glandular tissue. Many patients have a mixed composition. This difference dictates the technique: fat can be removed with liposuction; glandular tissue cannot be removed by suction alone.

The enlargement may occur on one side or both, and may or may not be symmetrical. It can appear during puberty, in adulthood, or in association with a change in weight, a medication, or a hormonal imbalance. That is why the first visit does not begin with the scar—it begins with the medical history and physical examination.

When Not to Trade Right Away

Not all cases of gynecomastia require surgery. During adolescence, some cases resolve on their own without surgery, and it is advisable to undergo a period of observation as agreed upon with the patient’s treating physician. If a pharmacological, endocrine, or other medical cause is suspected, that cause must be investigated before removing tissue. Performing surgery without this step may leave the problem unresolved or increase the risk of recurrence.

Surgery is also not indicated when the patient is seeking a chest contour that their anatomy, skin, or current weight do not realistically allow, or when the motivation is not their own. A plastic surgeon must be able to say no. The Spanish Society of Plastic, Reconstructive, and Aesthetic Surgery (SECPRE) emphasizes that candidates must be healthy, emotionally stable, and understand the limitations of the procedure.

What Is Assessed During the Consultation

During a gynecomastia evaluation at Mallorca Medical Group, the following are reviewed:

• Degree of enlargement and whether glandular tissue, fat, or excess skin predominates.
• Position and size of the areola, and symmetry between both sides.
• Quality and elasticity of the skin on the chest.
• Medical history, medications, and, if applicable, tests ordered by the treating physician.
• The patient’s expectations regarding scarring, recovery, and possible outcome.

Based on this information, a decision is made as to whether a “wait-and-see” approach is appropriate, whether another specialist should be consulted first, or whether surgical reduction is a reasonable option. The clinic’s breast surgery page lists this procedure alongside other types of breast surgery, including cosmetic and reconstructive procedures.

Techniques: No One-Size-Fits-All Approach

When the indication is clear, the course of action depends on the severity:

• Predominantly fatty tissue. Liposuction through small incisions to reduce volume and refine the contour. This is not a substitute for excision if the gland is firm.
• Glandular component. Resection of the gland through an incision at the lower edge of the areola, often combined with liposuction.
• Excess skin. In advanced cases, it may be necessary to remove skin and reposition the areola. The scar is more visible and is explained before surgery.

Anesthesia may be local with sedation in select cases, or general when the procedure is more extensive. The hospital stay is typically outpatient or overnight, depending on the surgical plan and the team’s judgment. There is no standard duration or discharge procedure for everyone.

Recovery and Limits

In the first few days, there is swelling, discomfort, and, sometimes, bruising. A compression garment is recommended for the number of weeks specified by the surgeon—not according to a generic schedule found online. Intense physical activity and chest workouts should be resumed gradually. The areolar scar is usually well-concealed, but it is still a scar: it may widen, become discolored, or appear asymmetrical.

Risks include hematoma, seroma, infection, changes in nipple sensation, irregular contours, and the need for revision surgery. If the underlying cause persists, the swelling may return. None of this is addressed by a hastily signed consent form: it is discussed during the consultation, with ample time.

Dr. García Ceballos does not present gynecomastia as a defect that must be corrected at all costs. He presents it as a diagnosis that is sometimes observed, sometimes treated without surgery, and—when surgery is indicated—is planned to achieve a proportionate chest, not a dramatic transformation.

How to Request a Review

A consultation at Mallorca Medical Group is neither a free service nor a promotional offer. It is a medical evaluation. Anyone who would like to discuss their case can schedule an appointment at mallorcamedicalgroup.com or call 971 254 686. Camí Vileta 46C, 07011 Palma de Mallorca.