Male Breast Reduction (Gynecomastia Surgery) Guide & Price

What is gynecomastia?

Gynaecomastia is a common medical condition that is seen in men of varying ages. It is the enlargement of breast tissue in men. It is not always clear why this occurs. However, some causes can include obesity, hormonal changes, certain drugs or certain medical conditions.
Before having surgery, patients should try and see if these causes may be the reason for the gynecomastia; you can read all about gynecomastia and its causes below.

It is important to check because patients may reverse it by stopping taking certain medications and drugs. It is also important to try to lose weight first before having surgery, as this may also be the cause. Ideally, patients should see their GPs to have some initial investigations to rule out cancer or endocrine problems. The GP can also make sure patients aren't having a medication-related gynaecomastia. It is especially important that if a patient has one-sided gynecomastia, they are checked out through the NHS before proceeding to cosmetic surgery.

What can a male breast reduction achieve?

Enlarged breast tissue can have a negative impact on a patient's self-esteem and be a source of emotional distress. Patients may feel that the excess breast tissue and excess skin in the chest area have given the chest more of a feminine look. As a result, patients may consider a breast reduction.

A male breast reduction procedure can help:

• Remove excess breast tissue.
• Remove excess skin in the chest area.
• Achieve a more masculine-looking chest.

In addition to physical changes, this procedure can help boost confidence.

How much does male breast reduction surgery cost?

The cost of male breast reduction surgery can vary between £4000 to £8000 in the UK. You can expect to pay around £5500 for the male breast reduction procedure. Many different factors could contribute to price variations, such as

• The complexity of the procedure for an individual's case
• Amount of hours required in surgery for each patient's case
• Surgeon's experience and specialities
• Hospital fees
• Anaesthetist expertise
• Additional combined procedure requirements, for example, the addition of liposuction (which is quite common to achieve a natural look)

In order for a patient to receive their tailored price adapted to their personal needs, they will need to be assessed by a surgeon during a consultation to ensure that the procedure can be done considering all their requirements. The personalised price will be all-inclusive and take into account all of the patient's needs. The tailored male breast reduction price will cover:

• Highly rated CQC hospital cost
• Surgeon's experience (BAAPS/BAPRAS)
• Anaesthetist time and expertise
• Any overnight stays that are required
• Follow-up appointments and aftercare

Like all cosmetic surgery consultations, male breast reduction consultations are free of charge, with no obligation to move forward with the procedure. A male breast reduction consultation allows patients to ask their questions, get to know the surgeon better and for the surgeon to be able to examine them and make them aware of the likely outcomes of their gynecomastia surgery.

Who are the ideal candidates for a male breast reduction?

Many men are unhappy with how their chest looks due to the presence of excess breast tissue. Male breast tissue enlargement, or gynecomastia, is a common condition. The most suitable male breast reduction candidates include men who:

• Have had no response to previous medical treatment.
• Have seen little to no improvement in their breasts after weight loss.
• Feel self-conscious and insecure because of their breast enlargement.
• Currently, have a stable breast size.
• Want an effective solution that will give long-lasting results.
• Are not currently suffering from any serious medical conditions.
• Have realistic goals.
• Have a healthy BMI of less than 30.

Both adult and adolescent men can develop breast enlargement. Adolescent men may also be suitable for this procedure. However, it is important to note that they are often at an age where the body is still developing. As a result, they may require another procedure after the first surgery.

Causes of gynecomastia

Gynecomastia is a condition that causes male breast tissue enlargement. This is a common condition, and at least a third of men will have symptoms at some stage of their lives. It can affect men of various ages, including teenagers. While it usually occurs in both breasts, it is also possible that it may only affect one. The cause of breast enlargement in many men often remains unknown. However, some causes include:

• Certain medications (e.g. for high blood pressure, heart disease, and prostate cancer).
• Some diseases (e.g. liver disease and some cancers).
• Certain drugs may affect breast tissue growth; if you're concerned about any medication you're taking and its effects, do speak to your GP.

Drugs and medications that may cause or exacerbate gynecomastia are:

Testosterone blockers: Bicalutamide, Flutamide, Finasteride, Dutasteride
Antihypertensive: Spironolactone, Amlodipine, Diltiazem, Felodipine, Nifedipine, Verapamil
Antiretrovirals: Saquinavir, Indinavir, Nelfinavir, Ritonavir, Lopinavir, Stavudine, Zidovudine, Lamivudine, Efavirenz
Hormonal: Oestrogen, Prednisone (male teenagers), Androgens (athlete abuse)
Antipsychotics: Lurasidone, Olanzapine, Ziprasidone, Amisulpride, Paliperidone, Risperidone, Sulpiride, Haloperidol, Chlorpromazine, Zuclopenthixol, Flupenthixol
Stomach protection: Cimetidine, Omeprazole 
Recreational: Cannabis, Amphetamines, Heroin, Methadone
Chemotherapy: Methotrexate, Cyclophosphamide, Carmustine, Etoposide, Cytarabine, Melphalan, Bleomycin, Cisplatin, Vincristine, Procarbazine

Hormone imbalance

The balance between the sex hormones testosterone and oestrogen can affect breast tissue size. All men have breast tissue, but in some cases, when the level of oestrogen compared to testosterone is too high, the body will increase the size of the breast tissue.

If this is the case, then a simple blood test can determine if there is an imbalance, and depending on the cause, can be treated with medication alone or in combination with male breast reduction surgery.

This imbalance is common during puberty, and the breast tissue size will often go down as the patient gets older without treatment. For older men, though, it’s normal for testosterone levels to drop. Offsetting the balance can lead to an increase in breast tissue size. It’s common for these patients to have male breast reduction surgery.

There are 4 different grades of gynecomastia. The more breast tissue an individual has, the higher the grade of gynecomastia. The classification of each grade is relative to the inframammary fold (IF). This is the line where the breast and the chest meet.

It is important to understand that sometimes, the enlargement of the breast can be because of excess fat and not excess breast tissue. When excess fat on the chest causes the male breast to increase in size, this is known as pseudo-gynaecomastia. Therefore, it is a good idea to try and lose weight first. This may reduce your breast size.  If weight loss does not help, patients may qualify as suitable candidates for surgery. If this is the case, the surgeon will be happy to consider patients for a breast reduction.

How is the male breast reduction procedure performed?

A male breast reduction procedure generally takes between 1 to 3 hours to perform. The use of general anaesthetic will ensure patients are asleep for the duration of the procedure. The procedure could be a day case, or the patient may need to stay overnight.

Consent form

Patients will first meet with the surgeon before the operation to sign a consent form. They will ask the patient to sign the form either at the preoperative assessment or on the day of the operation.

After the patient has given consent, the surgeon will use a marker to draw lines on the chest and discuss the goals of the surgery. In addition, the surgeon may ask for permission to take before and after pictures of the chest for medical records.

Anaesthesia

Before the procedure, the anaesthetist will have to administer an anaesthetic. The surgery can be done using a general anaesthetic or a local anaesthetic with IV (intravenous) sedation. This decision is met before surgery following a discussion with the surgeon.

Incisions

The technique BAAPS/BAPRAS surgeons choose to use for a male breast reduction procedure will depend on the amount of fat, excess breast tissue and excess skin.

Depending on the degree of breast enlargement, the surgeon may use liposuction, a breast tissue removal technique or a combination of both. If patients have a slightly enlarged breast, the surgeon may use liposuction alone to remove excess fat. If patients have more severe breast enlargement, the surgeon may use liposuction and a breast tissue removal technique to remove the excess breast tissue and/or skin. 

The greater the amount of excess breast tissue and skin patients have, the bigger the incision.

Liposuction 

If the surgeon chooses only to use liposuction, they will create various small incisions below the breast and under the armpit.

Periareolar incision

A common incision is the one drawn which is a 50% peri-areolar incision that can be extended onto the skin. Occasionally if a small amount of skin needs to be excised the surgeon will cut all the way around the nipple for a complete peri-areolar incision. . This requires the surgeon to make a cut around the whole areola, and a cut vertically down to the breast fold.

Anchor-T Incision

If patients have a large amount of excess breast tissue and skin, the surgeon may use an Anchor-T incision to perform the reduction.

Closing of incisions

Next, the surgeon will use absorbable sutures to close the incisions and will apply a dressing over your chest. Occasionally they may also place a drainage tube under the skin if there has been a very large reduction and the patient is planned to stay overnight. This will help to reduce swelling and bruising in that area.

Return to the ward

Finally, once the male breast reduction surgery is complete patients will return to the ward to recover from the anaesthetic. Patients will be able to return home on that day or the next day. Despite being able to return home, be aware the breasts will remain sensitive and tender for the next several weeks. Most surgeons will recommend the use of a compression garment for 6 weeks

What to expect during a male breast reduction consultation?

The BAAPS/BAPRAS surgeon will meet the patient for an initial male breast reduction consultation. This meeting can last between 15 minutes to an hour. The surgeon will use this time to talk about the patient's requirements and the surgery itself. They will discuss the following topics:

• The cause and degree of gynecomastia (male breast enlargement)
• The quantity and quality of the surrounding skin
• Personal goals for surgery
• Medications being taken (this includes prescription, over-the-counter and herbal medications)
• Smoke/Vaping or recreational drug use
• Past and current medical history
• Any personal or family history of breast cancer
• Any concerns or worries a patient may have.

After the surgeon has taken a full medical history, they will then examine the breasts and take some confidential photographs of the breasts.

What questions to ask during a male breast reduction consultation?

This consultation is the perfect opportunity for patients to ask any questions they may have about the procedure. It is therefore important that patients are as honest and candid as possible. This will help to ensure that the surgeon understands exactly what the patient wishes to gain from the procedure. Clear communication is vital in achieving the results that patients are happy with. To help, here are some questions patients may want to ask:

• Are these goals for surgery realistic?
• What surgical technique is appropriate?
• What will the final scars look like?
• Are there before and after photos available to view?  
• What are the risks and complications?

Although these are important questions to ask, it is strongly recommended that you spend some time thinking of and writing down questions prior to consultation This will help patients feel prepared for your consultation. Furthermore, it will help ensure patients get all the information they need to make a fully informed decision about the male breast reduction procedure.

What are the main risks and complications of a male breast reduction?

It is advised that patients familiarise themselves with the potential male breast reduction risks and complications. Doing this will help patients make a fully informed decision regarding the surgery. The surgeon will discuss all the male breast reduction risks and complications with patients during the consultation. These include:

Bleeding & bruising

Patients should expect to see some minor bleeding and bruising after the operation. This is a common and normal thing to experience after surgery, and it should settle down with time. In some cases, however, the bleeding can become more severe. Patients may notice that the chest will become very tight and swollen. If patients notice any heavy bleeding or sudden, painful swelling, they must contact a doctor as soon as possible.

Infection

A male breast reduction is an invasive surgical procedure. As with any surgery, it comes with the risk of infection. Even though most infections are mild, wound infections, patients must take them seriously if they occur. The surgeon will be able to treat the infection with some antibiotics.
In some rare cases, the infection may spread and become more severe if not treated early. Patients must, therefore, be aware of the signs of an infection, which can include:

• A temperature greater than 38°C
• Redness or swelling around the incision that is getting larger and beginning to spread
• Any foul-smelling discharge or pus that is coming from the drains or incision site
• An increasing amount of pain that does not reduce after taking painkillers.

Necrosis

If there is a disruption to the blood supply around the nipples or breast, it may damage the skin, fat or tissue around it. If the disruption is large enough, the area can lose blood supply. A loss of blood supply can lead to a condition called ‘necrosis’, whereby the affected area can die, leading to tissue death, nipple or skin loss. If this occurs, patients may need to have a small operation to remove the dead skin or tissue. This complication is infrequent but is much more likely to occur if patients are a smoker. This is why patients are advised to stop smoking and stop using all nicotine products for at least 6 weeks before and after surgery.

Seroma

In some patients, there may be a build-up of fluid under the skin. The medical term for this is a seroma, and it commonly occurs around the incision site. If it does develop after patients have had surgery, the surgeon may need to drain the fluid out from the seroma.

General surgical risks

All surgical procedures come with a general risk of complications. These include, but are not limited to:

• Reactions to tape, sutures, glues or injected agents
• Anaesthesia risks
• Blood clot formation
• Delayed wound healing
• Damage to underlying structures such as nerves or muscles.  

Changes in sensation

It is common to experience some minor changes in sensation in the breasts and nipples after the procedure. This may be an increase, a decrease or a tingling sensation, for example. This will often improve and resolve itself over time. However, the changes may become permanent if there is significant damage to the nerves in that area. In some rare cases, these can result in complete loss of nipple sensation.

Aesthetics

Patients should always keep in mind that they may be unhappy with the results of the surgery. It can be psychologically distressing if this occurs and so it is important to have very open discussions with the surgeon before surgery. Patients should be honest with themselves about how they would feel if the results did not come out as hoped before consenting to surgery.

This is one of the reasons why it is essential to choose the surgeon carefully. Patients should be honest and candid about what they would like to achieve. Choosing a highly experienced BAAPS/BAPRAS surgeon reduces the risk of this happening.

Asymmetry

Breasts are not 100% symmetrical, and surgery will not be able to guarantee this. Some patients may have more pronounced asymmetry following surgery.

Over/ undercorrection

It is possible that under or over-correction can occur. If too much breast tissue is removed, it can create an indent in the breast. This is known as dish deformity. For minor indentation, little intervention is needed, but when more pronounced, the surgeon may recommend additional surgery. Treatment options depend highly on each individual case.

Following extensive liposuction, the skin may need up to 12 months to tighten to its new breast shape (if the skin was not removed). In this period, patients might have loose skin in the area.

Scarring

As gynecomastia surgery requires the surgeon to use surgical incisions to be made, scars are unavoidable. If patients only have liposuction, there will be very minimal scars that may not even be visible. If the surgeon also has to remove some breast tissue, the scarring will be greater. The surgeon will tell you how best to look after the scars after surgery. Scars take 12 - 18 months to mature and become what they will look like for the rest of your life. In that time, normal cars can be red and raised for a time period. There is a small risk of developing abnormal scars (like keloid or hypertrophic scars), which can remain raised. If this happens, your surgeon will see you and offer you some treatment for these.
Patients will have the opportunity to discuss all of the above male breast reduction risks and complications with the surgeon during the consultation.

How to prepare for a male breast reduction?

Preparing for a male breast reduction can be easy as it is an elective procedure. This, therefore, gives patients time to get some things in order beforehand. Below, patients can find some tips that may help with male breast reduction preparation.

Food shopping

As patients will not be able to do any heavy lifting for a few weeks after surgery, be sure to do a big grocery shop before going in to have surgery. Patients may also want to cook some meals and put them in the freezer so that patients do not have to worry about cooking during their recovery.

Cleaning

Patients do not want to strain themselves cleaning and tidying whilst recovering. It may, therefore, be a good idea to clean the house, take the bins out and get the washing done before the operation.

Accessibility

Reaching for cupboard items may put a strain on the incisions around the breasts after surgery. It would be handy to put items like mugs, crockery and dry food on a low kitchen counter, where they are easy to reach.

Pets & children

Patients should ask family members and friends to help look after any young children or pets. It would be best if they had time to put your feet up and relax.

Driving

The surgeon will give instructions on when patients can start driving again. Usually, patients must wait between 5 days to 2 weeks before they can resume driving again. In any case, patients must arrange for someone to pick them up and take them home after the procedure.

Diet

It is important to maintain a healthy diet after surgery. Patients can do this by eating food that is high in protein and low in salt and sugar. Try to eat lots of fruits and vegetables and drink lots of water.

Sleeping

Patients may find it more comfortable to sleep propped up and on their back after the male breast reduction procedure. Patients should, therefore, make sure they have lots of extra pillows on their bed.

It's advised patients follow all the personalised advice that the BAAPS/BAPRAS surgeon gives.

What to expect after a male breast reduction

Knowing what is involved in the male breast reduction aftercare can help relieve any anxiety patients have. Patients will be able to return home on the same day of the procedure or the following day. The surgeon will arrange a post-operative appointment before patients leave the hospital. During this appointment, they will examine the chest, change any dressings and remove any non-dissolvable stitches.

Post-operative garment

Patients may be given an elastic pressure garment to wear after the procedure. Patients are advised to wear this day and night for the first few weeks following surgery. The surgeon will tell patients exactly how long they need to keep this on for. The breasts will be very sensitive for several weeks, and it may take a few months for them to settle completely. 

Showering & bathing

Patients may not be able to shower or bathe for 24 hours to a few days after surgery. Patients will also need to avoid using hot tubs, saunas and swimming pools for two to three weeks. The surgeon will give you specific time-frames for this.

Scar care

The surgeon may recommend some scar reducing techniques to help the healing of the scars. These can include:

Scar massage

The surgeon may or may not recommend that patients do a gentle scar massage after the incision has fully healed. Patients should wait until the scab completely disappears on its own, then use light cream, oil or scar gel to massage all areas of the scar.

Silicone sheets, gels or creams

Silicone has been clinically proven to help reduce the appearance of scars. Patients can use a gel, cream or some silicone sheets to apply over scars once the incision heals. If the surgeon advises patients to use this, they are advised to follow their specific instructions.

Protection from the sun

It is very important to keep scars out of the sun. Exposing scars to the sun may make them go darker. Usually, scars tend to be red and raised in the first few weeks after surgery. They will then change to purple in the following 3 months. From that point onwards, they fade to light lines and may eventually fade completely.

Returning to work

The type of job patients have will affect how much time needed to take off to recover. If the job involves a lot of physical activity, e.g. childcare or waitressing, patients will need to take at least 2 weeks off work. If patients have a desk job or a job that requires less activity, patients should take around 7 to 10 days off work.

In any case, patients should avoid even light household duties for at least 2 to 4 weeks.

Exercising

Although patients need to get plenty of rest after the procedure, they should take some short, like walks around the house as soon as possible. This helps reduce the risk of blood clots developing in the legs.

Regarding sports and exercise, patients should avoid all sports and exercises for the first 3 weeks after surgery. Even light, aerobic exercises might increase swelling in the breasts.

After 3 weeks, patients can continue to do light exercises such as cycling, but patients must not do any heavy lifting or contact sports. When 6 weeks have passed, patients can resume all kinds of sports and exercise.

Final results

As soon as the procedure is over, patients will see a difference in the size and shape of the chest. However, patients should keep in mind that it may take up to 12 months before they can appreciate the full results.

Remember to follow all the specific instructions the BAAPS/BAPRAS surgeon gives regarding male breast reduction aftercare. This will help patients achieve the best results possible from the surgery.

Your surgeon will not ask you for a GP referral if you want to have a male breast reduction consultation. They may, however, contact your GP practice to ask for a list of your medications and your medical history.

Some complex medical conditions may need a sign off from your doctor prior to having the male breast reduction surgery, but your Patient Care Adviser will let you know if this applies to you.

The results of your gynecomastia surgery should last a very long time. However, any major weight gain may reverse your results of the procedure and increase your breast size again. It is therefore important that you lead a healthy lifestyle after you have had your reduction. This will help you avoid gaining fat in your breasts. You should also be aware that certain drugs, medications and diseases can increase the risk of the breasts growing again.

Smoking, drinking alcohol and using recreational drugs are all things that can have a negative impact on your surgery and your recovery. Smoking, in particular, is harmful as it reduces the time it takes your wounds to heal. This puts you at a greater risk of developing an infection. You should, therefore, stop smoking and using all nicotine products at least 6 weeks before and after your surgery. It may also be helpful for you to reduce your alcohol consumption before and after your male breast reduction surgery.

All of the information found on our website is sourced from highly reputable experts, government-approved authorities and is widely used by healthcare professionals.

• https://www.nhs.uk/conditions/breast-reduction-on-the-nhs/ NHS
• https://baaps.org.uk/patients/procedures/6/gynaecomastia British Association Of Aesthetic Plastic Surgeons
• Understand.com Understand
• https://www.nhs.uk/common-health-questions/mens-health/what-is-gynaecomastia/ NHS

Our content is written by our Medical Quality Managers and Patient Care Advisers, all of who have medical backgrounds and training. Prior to publishing, all the information is reviewed by a surgeon specialised within the relevant field.