Gynecomastia is a feminine chest contour from excess gland and/or fat in the male breast. Pseudogynecomastia is mainly fat; true gynecomastia contains firm, palpable gland. The grade-based plan on our gynecomastia page follows that split.
Medicine before surgery
Fullness that persists after puberty is common; hormonal disease, drugs (spironolactone, some steroids, anti-androgens), tumour and liver disease still sit in the differential. Active endocrine pathology is investigated first. Surgery removes diagnosed tissue; it does not treat the underlying disease.
Choosing technique
Liposuction may suffice when the grade is mainly fatty. Gland is excised through the areolar border (periareolar); combined with fat this is the most common plan. Advanced grades may need limited skin tightening. The aim is a flat, masculine chest wall and a natural areola position — not a ‘breast reduction’ aesthetic.
Grade and the technical spectrum
In clinic we separate fat-predominant (pseudogynecomastia), gland-predominant and combined forms. Simon-type grading also counts skin excess: early grades may keep millimetric scars; advanced grades discuss periareolar or limited skin excision. The aesthetic is a flat thoracic wall, not the pillars of a female reduction.
Anabolic steroids, cannabis and some anti-androgens can stimulate gland. If surgery is done before the substance is stopped, recurrence risk rises. That conversation is indication, not moralising.
Recovery
Most patients go home the same day. A compression garment controls oedema and dead space. Seroma is described on the male chest; it is caught early. Desk work within days; heavy chest training and bench press are deferred for weeks. Temporary areolar sensory change may be described; lasting numbness is less common.
Asymmetry, residual gland (‘puck’) and rare haematoma belong on an honest list. The gym does not ‘melt the chest’ when the tissue is gland.
In short
Gynecomastia is a medical diagnosis first, contour surgery second. Gland does not vanish with exercise; fat may reduce with weight. Examination makes the distinction.
