Gynaecomastia – when male breasts become a burden

Gynaecomastia is the enlargement of the male breast gland and is a widespread phenomenon. It is estimated that up to 40–50% of all men are affected at some point in their lives. Particularly in adolescence or with increasing age, visible breast development can occur, which is often felt to be unpleasant or distressing. Gynaecomastia frequently leads to reduced self-esteem, avoidance of showing one's body and social withdrawal.

Medically, gynaecomastia is a benign increase in male breast glandular tissue. It must be distinguished from so-called pseudogynaecomastia, in which breast volume is caused by increased fatty tissue.

In true gynaecomastia, there is an increase in glandular tissue, usually caused by hormones. The cause is a shift in the balance between oestrogens and testosterone in favour of the female hormone. Pseudogynaecomastia, on the other hand, often occurs with excess weight and is caused by fat accumulation.

A medical assessment is important if the enlargement occurs on one side only, is painful or changes. Palpable lumps or discharge from the nipple should also be investigated.

Hormonal fluctuations are the most common cause of true gynaecomastia. During puberty, but also in older age, oestrogen can become relatively dominant over testosterone. Certain illnesses such as cirrhosis of the liver, kidney failure or hormone-producing tumours can also be triggers.

Medications can also play a role – including psychotropic drugs, blood pressure medication or anabolic steroids. Alcohol abuse, chronic drug use and the use of steroids are also associated with the development of gynaecomastia. Last but not least, genetic predisposition can play a role.

Diagnosis begins with a physical examination, in which palpable tissue below the nipple can be detected. A soft, painless fat pad suggests pseudogynaecomastia, while a firm, glandular lump suggests true gynaecomastia.

This is supplemented by ultrasound examinations, blood tests to determine hormone status and, if necessary, a mammogram. These examinations help to identify the cause and make a well-founded decision about therapy. If conservative measures are not enough or the gynaecomastia significantly affects well-being, surgery may be recommended.

In many cases, weight loss or a change of medication is enough to bring about an improvement. Hormone therapy may also be an option if there is a clear endocrinological cause.

If this does not lead to the desired result, or if the gynaecomastia is pronounced with glandular tissue, surgery makes sense. Two methods are used: liposuction and removal of the glandular tissue (through a small incision at the edge of the areola). The two are often combined. Depending on the findings, the procedure can be performed under local or general anaesthesia.

The procedure is carefully prepared, including informed consent, photo documentation and, if necessary, laboratory values. On the day of surgery, the incision is planned individually depending on the method. As a rule, a crescent-shaped incision is made at the edge of the areola.

The operation usually takes one to two hours. After removing fatty and glandular tissue, a compression vest is put on to stabilise the tissue and support healing. It should be worn consistently for several weeks.

The first days after the procedure should be quiet and without physical strain. Sport is possible again after about four to six weeks. Good scar care supports wound healing.

Successful gynaecomastia surgery significantly improves body image and self-confidence. Many patients report a new body image and an improved quality of life. Clothes fit better, and sport and visits to the swimming pool become a matter of course again.

Possible risks include scarring, minor asymmetries or temporary changes in sensation. In rare cases, a revision may be necessary. If body weight remains stable, the result is usually permanent.

Before the procedure, smoking, alcohol and blood-thinning medication should be avoided. A balanced diet and exercise promote healing.

After the operation, rest is important. The compression vest should be worn continuously to support an optimal result. Sport and heavy physical work should be avoided for four to six weeks. The scars should be protected from UV radiation and treated with special care products.

Costs vary depending on the practice, method and effort. In Vienna, the average total cost is between €3,000 and €5,500. This usually includes consultation, surgery, anaesthesia, aftercare and check-ups.

Health insurance may cover the costs if there is a medical indication. This includes pain, psychological distress or hormonal disorders. Detailed documentation and an application are required.

Gynaecomastia is a common and treatable phenomenon. Anyone who suffers from its appearance should seek a medical assessment. Surgical correction is safe and effective and can significantly improve self-image.

Contact Dr. Handl's practice – gynaecomastia treatment in Vienna
Further information, individual advice and appointments: gynaecomastia treatment with Dr. Handl in Vienna

Is the result permanent? Yes, if your weight remains stable, the effect is usually long-lasting.

When can I work again? Depending on your job, after a few days to two weeks.

Will there be visible scars? The scars are usually small and inconspicuous.

How long does healing take? Healing takes about six to eight weeks.