Gynaecomastia surgery in London

Gynaecomastia is enlargement of the breast gland tissue in men. It feels like a firm or rubbery disc under and around the nipple, on one or both sides, and can be tender when it first develops. It is common: a European Academy of Andrology guideline puts prevalence at between 32% and 65% of men, depending on age and how it is measured. It is benign and is not considered a pre-cancerous condition.

It is most common at three stages of life: in newborn babies, during puberty, and in men over 50 as hormone levels change. Pubertal gynaecomastia usually settles on its own.

Gynaecomastia or pseudogynaecomastia?

Chest fullness is not always gland. Pseudogynaecomastia is enlargement caused by fat alone, usually with weight gain. Many men have a mix of both. The difference matters, because fat responds to weight loss and liposuction, while gland tissue does not shrink with diet or exercise and usually needs to be cut out.

Grades

Surgeons grade the chest by size and whether there is excess skin: small enlargement without extra skin; moderate enlargement with or without a little extra skin; and marked enlargement with loose, drooping skin, often after major weight loss. Grade guides technique and the scars involved.

Surgery may suit men aged 18 and over whose chest enlargement has persisted, whose underlying causes have been checked, and who are at a stable weight. Suitability is decided at consultation with your operating surgeon.

See your GP first if

• the enlargement is new, growing quickly or painful;
• there is a hard lump, especially on one side only, or a lump that feels fixed;
• there is nipple discharge or bleeding, or skin dimpling or a rash;
• you have noticed a lump in a testicle, or other symptoms such as low sex drive or erection problems.

Your GP can check for causes and may arrange blood tests or a scan. Male breast cancer is rare, but these signs need assessment.

Common causes

• Hormone changes: during puberty and after 50, the balance between oestrogen and testosterone shifts.
• Excess weight: fat tissue converts some testosterone to oestrogen, and adds fat to the chest.
• Medicines: examples include spironolactone, finasteride and dutasteride, anti-androgen treatments for prostate cancer, some antipsychotics, digoxin, and some medicines for stomach ulcers, HIV and fungal infection. Do not stop a prescribed medicine without talking to your doctor.
• Anabolic steroids and drugs: anabolic steroids, some bodybuilding supplements, cannabis and heavy alcohol use.
• Health conditions: including thyroid, kidney or liver disease, and problems with the testicles.
• No cause found: in many men, no specific cause is identified.

You may be a good candidate if

• the enlargement has lasted a year or more, or is long-standing from puberty;
• any medical cause has been treated, and any steroid use has stopped;
• you have tried weight loss where relevant, and the gland remains;
• you are in good health, a non-smoker or willing to stop, and at a stable weight.

The NHS rarely funds gynaecomastia surgery, usually only for long-standing cases where other treatments have failed and there is considerable pain or distress.

The technique depends on how much of the enlargement is gland, how much is fat, and whether there is excess skin. Many men need a combination.

Gynaecomastia surgery usually takes 1–2 hours. It is most often done under general anaesthetic, although smaller cases may be done under local anaesthetic with sedation. Many men go home the same day or after one night.

Consultation

At your consultation at 15 Harley Street, London, your surgeon will ask about when the enlargement started, medicines, supplements, steroid, cannabis and alcohol use, and any symptoms that suggest a hormonal cause. They will examine your chest to judge gland, fat and skin, and may recommend blood tests or a scan before surgery. You then have at least 14 days to reflect before you give consent.

On the day

1. Your surgeon marks the chest while you are standing.
2. Tumescent fluid, containing local anaesthetic and adrenaline, is injected to reduce bleeding.
3. Liposuction removes fat and blends the chest into the armpit and upper abdomen.
4. If needed, the gland is removed through an incision at the lower edge of the areola, leaving a thin layer under the nipple to avoid a hollow.
5. Removed gland may be sent for analysis.
6. The incisions are closed with dissolving stitches, a drain is occasionally used, and you wake in a compression vest.

1. Days 1–3

   Rest at home. Swelling, bruising and tightness are normal; pain is usually moderate and controlled with regular tablets. Wear the compression vest day and night.

2. Week 1

   Most men return to desk-based work after 3–7 days. Walking is encouraged. First wound check.

3. Weeks 2–3

   Driving is usually possible once you can wear a seatbelt comfortably and make an emergency stop. Avoid heavy lifting and strenuous exercise for at least 3 weeks. Manual work may need 2–3 weeks off.

4. Weeks 4–6

   Build up cardio and lower-body training. Chest and upper-body weights usually resume at 4–6 weeks, starting light. The vest can usually be reduced to daytime or stopped, as advised.

5. 3 months

   Most swelling has gone and the chest looks flatter. Some firmness under the nipple is normal and softens with time.

6. 6 months

   The final contour is visible. Scars at the areola edge fade and are usually hard to see.

Gland tissue that has been removed does not grow back, so for most men the result is long-lasting. The chest is noticeably flatter once swelling settles, and fitted shirts and swimming are often the first things men notice.

Gynaecomastia can return if the cause returns: significant weight gain, anabolic steroid use or certain medicines can stimulate any remaining tissue. Weight gain after liposuction adds fat to the chest and elsewhere.

Results depend on skin quality. Younger skin usually retracts well after liposuction and gland removal; in older men or after large weight loss, some looseness may remain, and a skin reduction may be needed later.

Surgery is not the first step for everyone.

• Watchful waiting: gynaecomastia during puberty usually settles on its own, and recent enlargement from a medicine may improve once it is changed under medical supervision.
• Treating the cause: stopping steroids, treating a hormonal or thyroid problem, or reviewing medicines with your doctor.
• Weight loss and exercise: can reduce pseudogynaecomastia considerably, though they will not remove gland tissue.
• Medication: in some recent, tender cases, a specialist may consider medicines. They are most likely to help early, before the tissue has become fibrous.
• Compression shirts: can flatten the chest under clothing.

If you have lost a lot of weight and have loose skin on the chest as well as elsewhere, our guide to body contouring after weight loss may help.

At iQonic, gynaecomastia surgery costs from £4,250 when liposuction alone is needed, and from £5,250 when the gland is also excised. Larger cases with skin removal are quoted individually. For comparison, the NHS estimates private male breast reduction in the UK at between £3,500 and £5,500, excluding consultations and follow-up care.

What changes the price:

• whether gland excision is needed as well as liposuction;
• the amount of tissue and any excess skin;
• whether nipple or areola reduction is added;
• anaesthetic type and hospital stay.

Your written quote is valid for three months. For payment options see our pricing and finance page, and to plan your consultation see how the process works.

Your consultation is with the consultant who would operate. Check any surgeon on the GMC register.