About gynecomastia
True gynecomastia is proliferation of breast glandular tissue, distinct from pseudogynecomastia which is fat alone. Most patients have a mixture. The distinction matters because fat responds to liposuction and diet while gland responds only to excision.
This is the single most common reason patients present to us having had disappointing treatment elsewhere: liposuction was performed, the fat was removed, and the firm disc of gland behind the nipple remained — sometimes made more conspicuous by the surrounding fat being gone.
Our standard approach combines VASER-assisted liposuction to contour the chest with direct glandular excision through a small periareolar incision. Where there is significant skin excess, usually after major weight loss, skin tightening or excision is added.
Who this suits
- Persistent male breast enlargement present for more than twelve months.
- A firm, sometimes tender disc of tissue palpable beneath the nipple.
- Stable weight, where the enlargement has not responded to training or fat loss.
- Endocrine causes investigated and, where present, treated or excluded.
- Not currently using anabolic steroids or medications known to cause gynecomastia.
How the procedure is performed
- Clinical grading and, where indicated, hormonal workup and ultrasound to exclude a treatable cause.
- Tumescent infiltration and VASER-assisted emulsification of chest fat.
- Liposuction contouring of chest, axillary tail and upper abdomen for a continuous masculine line.
- Direct excision of the glandular disc through a small incision at the lower areolar border.
- Deliberate preservation of a thin layer of tissue behind the nipple to prevent a tethered, saucer-like depression.
- Skin excision or tightening in higher-grade cases with significant redundancy.
- Compression vest worn continuously for four weeks; excised tissue sent for histopathology.
What it achieves
- Flat, contoured, masculine chest.
- Permanent removal of the glandular component — recurrence is rare.
- Scar limited to the lower areolar border, where it is well camouflaged.
- Simultaneous contouring of the axillary tail and flanks.
- Substantial and well documented improvement in confidence and clothing comfort.
Recovery timeline
Individual recovery varies. These are the stages most patients pass through, and the ones we plan your follow-up around.
- Days 1–3
Compression vest worn continuously. Soreness comparable to a hard chest workout. Drains rarely needed.
- Days 5–7
Desk work resumed. Dressings reviewed; sutures usually dissolvable.
- Weeks 2–4
Swelling settling; contour emerging. Light cardio permitted from week two.
- Weeks 4–6
Vest reduced to daytime only, then discontinued. Upper body training resumed at week six.
- Months 3–6
Final contour; scar fading.
Cost
Grade dependent. Includes VASER, gland excision, compression vest, histopathology and one year of follow-up. Skin excision cases priced at the upper end.
Bands reflect the genuine variation in complexity between patients. Your firm quote is issued after examination and does not change afterwards. See our full price list for context across the catalogue.
Frequently asked questions
Not if the gland is properly excised, because glandular tissue does not regrow. It can recur if the underlying cause continues — anabolic steroid use being the most common — or if only liposuction was performed.
Only in pure pseudogynecomastia, where the problem is fat with no glandular component. That is a minority of patients, and it is why so many liposuction-only results are disappointing.
It follows the lower border of the areola where pigmented and non-pigmented skin meet, which camouflages it well. Most patients find it difficult to see by six months.
If the enlargement is recent, one-sided, painful or you are young, then yes — we investigate before operating. Long-standing bilateral gynecomastia in an otherwise well patient usually does not need extensive workup.
Continuously for four weeks, then daytime only for a further two. It has a genuine effect on the final contour, and compliance here is the variable patients most often underestimate.
