Gynecomastia: when surgery is an option and when it is not

Gynecomastia is an increase in male breast volume. It is not a single diagnosis and it is not an automatic indication for surgery. In consultation, Dr. García Ceballos, MD, FCCP, MRCS I England, with 25 years of practice in plastic, reconstructive and aesthetic surgery, first distinguishes whether the volume is glandular, fatty or mixed, and whether a cause should be treated before any surgical reduction is considered.

Mallorca Medical Group assesses this in Palma de Mallorca. This guide explains what a careful evaluation can offer. It does not promise a specific result. Every case is individual.

What it is and what it is not

Two situations are often confused. True gynecomastia involves breast gland tissue. In so-called pseudogynecomastia the volume is mostly fat, without relevant gland. Many patients have a mixed component. That difference changes the technique: fat can be addressed with liposuction; gland is not removed by aspiration alone.

The increase may affect one side or both, and it may be symmetrical or not. It can appear in puberty, in adulthood, or in relation to weight change, a medicine or a hormonal disorder. The first visit therefore does not start with the scar. It starts with the clinical history and the examination.

When not to operate first

Not every case of gynecomastia is operated. In adolescence, some cases settle without surgery, and a period of observation agreed with the patient’s doctor is appropriate. If a drug-related, endocrine or other medical cause is suspected, that cause is studied before tissue is resected. Operating without that step can leave the problem unsolved or expose the patient to recurrence.

Surgery is also not indicated when the patient seeks a chest that his anatomy, skin or current weight cannot realistically allow, or when the motivation is not his own. A plastic surgeon must be able to say no. The Spanish Society of Plastic, Reconstructive and Aesthetic Surgery (SECPRE) notes that the candidate should be healthy, emotionally stable and understand the limits of the procedure.

What is assessed in consultation

In the assessment of gynecomastia at Mallorca Medical Group, the surgeon reviews:

• Degree of enlargement and whether gland, fat or excess skin predominates.
• Position and size of the areola, and symmetry between sides.
• Quality and elasticity of the chest skin.
• History, medication and, if needed, tests requested by the relevant physician.
• The patient’s expectation against scar, recovery and a realistic result.

With that information the decision is observation, referral to another specialist, or a reasonable surgical reduction. The clinic’s breast surgery page places this procedure alongside the rest of aesthetic and reconstructive breast surgery.

Techniques, with no universal recipe

When the indication is clear, the approach depends on the grade:

• Mainly fat. Liposuction through small incisions, to reduce volume and refine contour. It does not replace resection if there is firm gland.
• Glandular component. Gland resection through an incision at the lower border of the areola, often combined with liposuction.
• Excess skin. Advanced grades may need skin removal and areolar repositioning. The scar is more visible and is explained before surgery.

Anaesthesia may be local with sedation in selected cases, or general when the procedure is more extensive. Stay is usually outpatient or one night, according to the surgical plan and the team’s judgement. Duration and discharge are not the same for everyone.

Recovery and limits

The first days bring swelling, discomfort and sometimes bruising. A compression garment is worn for the weeks the surgeon indicates, not for a generic calendar found online. Intense activity and pectoral training are resumed gradually. An areolar scar is usually discreet, but it is a scar: it can widen, pigment or remain asymmetric.

Risks include haematoma, seroma, infection, altered nipple sensation, contour irregularity and the need for a revision. If the underlying cause persists, volume can return. None of this is removed by a consent form signed in a hurry. It is discussed in consultation, with time.

Dr. García Ceballos does not present gynecomastia as a defect that must always be corrected. He presents it as a diagnosis that is sometimes observed, sometimes treated outside the operating room and, when surgery is indicated, planned for a proportionate chest, not a spectacular transformation.

How to request an assessment

A consultation at Mallorca Medical Group is not a free step and not an offer. It is a medical assessment. Anyone who wishes to review their case can request an appointment at mallorcamedicalgroup.com or call 971 254 686. Camí Vileta 46C, 07011 Palma de Mallorca.