Gynaecomastia (Male breast reduction)

What is Gynaecomastia

Gynaecomastia is when the male develops breast, there is both a shape and comfort issue or causes sensitivity pain or embarrasment. Gynaecomastia serves to remove this tissue and give a flatter shape to the chest.

The decision is yours but you should discuss this with a plastic surgeon. We will also discuss your expectations and what is surgically possible. Gynaecomastia is considered a medical procedure and a rebate is available. Before your appointment to see Dr Mahajani, make sure that your referring doctor arranges blood tests for gynaecomastia and an ultrasound of the breasts and bring the test results with you. This will help save you time and more appointments.

When to have an operation for gynaecomastia

To some extent, many boys develop gynaecomastia during puberty. It also goes away in may boys by the time development is complete. Sometimes the surgery is done before growth is complete because of symptoms or other concerns such as embarrasment. Other times we can wait till growth is complete. Gynaecomastia may also be due to medical conditions and the work up for gynaecomastia includes blood tests and ultrasound. Some cases of gynaecomastia are reversible. This is seen in bodybuilders who have used steroids. The steroids should be stopped and hormone levels checked and if the gynaecomastia has not gone after the hormone levels are normal, then surgery is required. A number of medical condtions cause gynaecomastia ( hormone producing tumours like in the liver or testicles ) and these are to be investigated and treated first. There are pro's and con's for this operation and will be discussed with you - see the section on risks and complications. 

Before the operation

Discuss any queries regarding the operation and post operation requirements with Dr Mahajani and his staff. Any fee enquiries please discuss with the practice administration. Do not smoke 2 weeks before the operation to 3 months after the operation. Stop any medications you have been advised to by the anaesthetist. Go to your anaesthetic appointment. We will give you the name of your anaesthetist so you can make contact with them. We will give you your operation date and time. The day before operation you will come for a mark up where the nipple position is determined and the operation is discussed. Please bring the completed consent form with you. The practice will also advise you about garments to wear after the operation.

What does the operation involve

The operation is done under general anaesthetic or occasionally under sedation anaesthesia. Incisions are made around the areolar breast junction. The nipple and areolar are kept attached to the blood supply. Then using these incisions the breast gland tissue is removed. The tissue is sent for histology. The operation is smetimes aided with the assistance of liposuction to help feather the contours of the gynaecomastia excision and make the contour as smooth as possible.

After the operation

Dressings are applied and you are admitted to the ward. You may be allowed to go home the same day. There are drains in each breast and stockings on the legs to prevent deep vein thrombosis. Pain relief is given and you rest in hospital for 1-2 days. Drains and stockings are removed before discharge or the next day in the rooms. Upon discharge, you will be given pain relief medication, antibiotics and instructions to come back for dressings

After the operation and returning to normal activities

We would like you to rest for 1-2 weeks. It is common to be tired. The pain in general decreases over 2 weeks. You will come for dressings and reviews and histology is given to you. The support garment is worn for 6 weeks. You can return to work after 1 week for an office job and 2 weeks for other jobs. You can drive after 1 week but be careful with seatbelts. After 6 weeks, you can return to normal activities. There is a review at 6 weeks and 3 months.

Surgery Expectations, Risks and Complications

For most people the operation is a safe and straightforward procedure. We would however like you inform you of what to expect along with risks and complications.


The operation does produce a scar around the areolar, and where liposuction ports are placed. This scar is red up to 12 months but then settles down. In some people the scar may thicken or stretch. These scars are permanent but over time the majority do lighten. Whislt we attempt to make scars as fine as possible, scars in these areas can thicken and we cannot predict how scars will manifest. In this area on the chest near the areolar, scars can also distort the shape of the nipples so they may look a little oval rather than round.


Generally heal over 2 weeks but can take longer. They tend to settle down finally at the 6 week mark and the scar matures thereafter.

Incisions can get infected and usually only requires antibiotics to treat. Occasionally stitches that infect need removal. We will help manage your dressings. Rarely some wounds break down and the patient needs a revision of this. Infections that require more than antibiotics like severe necrotic infections requiring surgery are very rare.


Both breasts are always different. The operation is designed to make the breasts as symmetrical as possible but there may be some minor asymmetry between side to side. Mostly this is not significant or noticeable and it rarely needs any correction. Sometimes a little tissue remains behind or regrows and this may need surgery to fix this at a later date.

Bleeding and swelling

It is unusual to have significant bleeding but if you do bleed, we may be required to stop the bleeding and or give a transfusion. There are drains which help indicate this. After the operation, the breast swells before it settles down. It takes usually 6 weeks to 3 months to completely settle.

What shape will I be and particular issues with gynaecomastia?

The operation is designed to make the chest flat. How flat is flat is variable from patient to patient and the contour depends on the amount of tissue we see in the operation. Sometimes after the operation, the nipple may sink in and whilst we make every attempt to prevent this, it may be that the surgery results in a sunken in nipple and needs a revision later on. This may also be due to secondary scar tissue that develops after the operation and pulls the nipple towards the chest. On the otherhand, insufficient tissue may be removed and need removal later. Sometimes to keep the nipple contour, we preserve a small cuff of tissue under the nipple and this has the potential to grow causing a recurrence of the gynaecomastia.

Numbness and pain

In the breast skin and areolar, numbness may occur. This usually resolves over weeks or months. Occasionally it is permanent but doesnt interfere with function. The nipple may lose erectile or sexual sensativity. Pain lasts 1-2 weeks and settles down after this over a 6 week period in most people but can take longer. In some patients, nerves can be irritated and cause pain that is very severe or longer to resolve. This is unexpected but occasionally occurs. If this happens, our practice will help you to manage this where we can.

There may be injury to the blood supply to the nipple or the areolar and whilst this is most rare, parts or the whole of the nipple areolar complex may be lost necessitating nipple areolar reconstruction. So far this has not been seen in Dr Mahajani's practice.

Liposuction can cause its own problems like contour abnormalities, bruising, skin discolouration. In theory but so far not encountered, injury to structures deeper to the chest wall. This again is very rare and probably more theoretical.

In general it is the shape of the chest after gynaaecomastia that is mostly encountered with some scar revisions or the removal of small residual amounts of gynaecomastia that is encountered after the operation.

Other complications

General complications from any anaesthetic include, sore throat, chest infection, deep vein thrombosis, irritation from dressings, rare complications from anaesthetic ( your anaesthetist will discuss ) .

Realistic expectations from a gynaecomastia

It is important for your expectations to be realistic. We will try as far as possible , within the constraints of your physical health and the state of the breasts to help you achieve your goals. The surgeon cannot guarantee all expectations ( especially size and shape) and nor can guarantee the longlasting effect as the ageing process continues and there may be weight fluctuations, hormone issues and recurrence of the gynaecomastia. Very uncommonly, gynaecomastia regrows for some unknown reason and revisional surgery is required. This is most unusual however and more commonly, if a person puts on weight or loses weight, this will affect the breast size and shape, or if the patient is a bodybuilder, and continues to take steroids, it will recur. Whilst we attempt to give the patient the chest contour they wish for , for no fault of anyone, it may not result that way and it may not be able to be fixed. The practice will always try and help where humanly possible.