Gynecomastia — the enlargement of male breast tissue — affects an estimated 30–50% of men at some point in their lives. Despite being so common, it remains a source of significant embarrassment and psychological distress for many. The good news is that it is well understood and highly treatable.
What Causes Gynecomastia?
The condition is caused by an imbalance between oestrogen and testosterone. During puberty, this imbalance is temporary and resolves in most young men within one to two years. In adults, causes include hormonal changes associated with ageing, certain medications (including anabolic steroids, some antidepressants, and medications for heart conditions), liver or kidney disease, and occasionally, tumours of the testes or adrenal glands. In many cases, no specific cause is found — this is called idiopathic gynecomastia.
Pseudo-gynecomastia vs True Gynecomastia
It is important to distinguish between true gynecomastia — where actual glandular breast tissue enlarges — and pseudo-gynecomastia, which is simply fat accumulation in the chest area. True gynecomastia feels firm, almost disc-like, directly beneath the nipple. Pseudo-gynecomastia is soft and distributed more broadly. Treatment differs significantly between the two, so accurate diagnosis is essential.
Diagnosis
A thorough clinical examination is usually sufficient to diagnose gynecomastia. Blood tests to assess hormone levels, liver and kidney function, and sometimes an ultrasound or mammogram may be requested to rule out underlying causes and confirm the tissue composition. A biopsy is rarely needed but may be recommended if there is any concern.
Non-Surgical Options
If an underlying cause is identified (such as a medication), addressing it can lead to gradual resolution. Weight loss helps significantly in cases with a large pseudo-gynecomastia component. However, in true gynecomastia, particularly if it has been present for more than one to two years, the glandular tissue rarely responds to non-surgical measures.
Surgical Treatment
Surgery is the definitive treatment for true gynecomastia. The procedure involves removal of the glandular tissue through a small incision at the edge of the areola, often combined with liposuction to contour the surrounding fat. The result is a flat, masculine chest contour. Surgery takes approximately one to two hours under general or local anaesthesia with sedation. Recovery involves wearing a compression vest for four to six weeks. Most patients return to desk work within a week and exercise within four to six weeks.
Results and What to Expect
Results are long-lasting. The glandular tissue removed does not grow back, and as long as the underlying cause is addressed, recurrence is uncommon. The incision scar, positioned at the lower edge of the areola, becomes nearly invisible in most patients within six to twelve months.
Dr. Vicky Jain is a board-certified plastic and reconstructive surgeon with over 17 years of clinical experience across cosmetic and reconstructive surgery in Mumbai. Learn more about Dr. Jain →