Case Study 23: Gynecomastia Surgery for Enlarged, Sagging Male Breasts

Case summary

• Patient: 54-year-old man from the UAE

• Procedure: gynecomastia surgery (male breast reduction)

• Surgeon: Prof. Dr. Suleyman Tas, Prof. Dr. Suleyman Tas Clinic, Istanbul

• Goal: a flatter, firmer and more masculine chest

The patient's concerns

This patient was bothered by enlarged, sagging breasts. Gynecomastia is common: it affects a large proportion of men at some point in life and becomes more frequent with age. Beyond appearance, it often causes self-consciousness about wearing fitted shirts, swimming or exercising in public.

What causes gynecomastia?

Gynecomastia is the enlargement of breast tissue in men. It can result from:

• Hormonal changes, particularly an imbalance between oestrogen and testosterone, which increases with age

• Medications, including some heart, prostate, psychiatric and anabolic steroid treatments

• Weight gain and obesity, which add fatty tissue (pseudogynecomastia) and raise oestrogen levels

• Underlying medical conditions, such as liver, kidney or thyroid disorders, which should be excluded before surgery

In older men, skin laxity often adds sagging to the enlargement.

What was done

Surgery is tailored to what makes up the enlargement:

• Liposuction removes the fatty component through tiny incisions and contours the chest. Ultrasound- or laser-assisted systems can help the skin retract.

• Gland excision removes the firm glandular tissue behind the nipple, which liposuction alone cannot remove, through a small incision at the lower edge of the areola.

• Skin tightening or reduction is added when there is significant sagging or excess skin.

In this case the enlarged tissue was reduced and the chest was recontoured to create a flatter, masculine shape. Learn more on the body contouring page.

Result

The patient's chest is flatter and more masculine, with improved contour and firmness, restoring his confidence in clothing and during physical activity.

Recovery

Most patients return to normal daily activities within a few days and to desk work within a week. A compression vest is worn for four to six weeks, and strenuous activity and weight training are avoided for several weeks. Swelling settles gradually over three months.

Frequently asked questions

Can gynecomastia go away without surgery?

Adolescent gynecomastia often resolves; long-standing adult gynecomastia, particularly with glandular tissue, rarely does.

Will gynecomastia come back after surgery?

Removed gland does not regrow, but weight gain, steroids or certain medications can cause new enlargement.

Are there visible scars?

Scars are small and placed at the edge of the areola and in natural creases, becoming very discreet.

Next step

See more on the case studies page or contact Prof. Dr. Suleyman Tas Clinic for a consultation with Prof. Dr. Suleyman Tas.

Does gynecomastia come back after surgery?

The gland tissue that is removed does not grow back. Significant weight gain, anabolic steroid use or a hormonal problem can change the chest again.

When can I train again?

Light activity after about two weeks and chest training usually after six weeks, with a compression vest worn during the first weeks.

Are the scars visible?

The incision follows the lower edge of the areola, where the change in colour hides it. When loose skin also has to be removed the scar is longer, and that is planned with the patient before surgery.

Is the operation covered by insurance?

Sometimes, when true glandular gynecomastia is documented and causes symptoms. Purely aesthetic chest contouring is not covered, and the rules differ from country to country and between policies.

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About the author

Prof. Dr. Suleyman Tas is a European Board-certified plastic, reconstructive and aesthetic surgeon based in Istanbul with over 20 years of experience, author of Rhinoplasty in Practice (CRC Press) and founder of the Closed Atraumatic Rhinoplasty Course. Read verified patient reviews or book a consultation.

This article is for general information and does not replace an individual medical consultation.