This excess of the mammary glands can be due both to a high volume of the mammary glandular component, and to a greater fatty component. The hormonal changes that originate in the adolescent stage mean that, between the ages of 12 and 22, Gynecomastia is quite frequent, although it usually reverses naturally and spontaneously.

There is no common cause known as the origin of Gynecomastia, although it is known that some medications and drugs have a direct relationship with this overdevelopment of the male breast. Certain medical problems may also be associated, such as excess prolactin in the blood (hyperprolactinemia) or excess estrogen in the body (hyperestrogenism) derived from a metabolic pathology or consumption after undergoing estrogen treatment. In the latter case, a distinction is made between  Pseudo-Gynecomastia  (accumulation of fat develops in the shape of a breast) and the  Gynecomastia  (if they develop true breasts). Pseudo-Gynecomastia can also occur in cases of obesity.

To a greater or lesser degree, Gynecomastia affects more than 50% of men, making it the most common breast pathology in males. A fairly common problem that is still little talked about; and of which its possible medical solutions are not well known. Its permanence over time is what can be unsightly when an adult male has an excessive breast augmentation that deforms his silhouette. The  breast reduction procedure  It is a very useful surgery in patients who are concerned about their appearance, since a well-contoured, firm and flat chest is achieved.

Surgery for the correction of Gynecomastia (reduction mammoplasty in men) is recommended for patients of any age, healthy and without other previous pathologies, who present emotional stability. In overweight or obese patients who had not previously tried to lose weight through some type of diet or physical exercise, surgery could be discouraged. Likewise, it may be inadvisable in cases of patients with addiction or excessive consumption of hashish or alcohol. Since, as in the case of anabolic steroids, their excessive consumption can cause Gynecomastia, the previous recommendation is that this type of patient modify their habits first and check if their breast size decreases. The surgical procedure may consist of removing fat and glandular tissue from the breasts, although sometimes it may be necessary to remove excess skin. A firm and elastic skin that manages to adapt to the new contour of the chest will ensure a better result.  

In the first consultation, you will receive information about the intervention, and the surgeon will take a medical history. In the consultations prior to the Gynecomastia intervention, a breast examination, the measurement of certain parameters and the general state of health, and the taking of photographs are necessary. Possible causes of Gynecomastia will be sought, such as impaired liver function, use of medication containing estrogen, or use of anabolic steroids. If a medical problem is suspected as the cause, we will refer you to the appropriate specialist. In extreme cases we may recommend a mammogram.

This will not only rule out the small possibility of breast cancer, but will reveal the composition of the breast. Once we know how much fat and how much glandular tissue the breast contains, we can choose the appropriate surgical technique. The breast examination together with the age and history will serve to request other complementary tests (analytics, electrocardiogram, ultrasound, etc.) before the operation. The measurements will help to decide the technique to use and the photographs will serve to evaluate the result.

It is important that you say if you have any major illness; if you are a smoker; if you take any medication; or if you are allergic to any medication or product. Our advice is that you should ask anything you doubt. It is important that you tell your surgeon what your expectations are, so that he or she can explain if they can be met or if there are limitations to them.

The Preoperative

Like any aesthetic operation that requires surgery, for a Gynecomastia, a preoperative period is necessary that the surgeon will indicate in consultation (analytics -blood tests and electrocardiogram-, special care, as well as the reading and signing of the Informed Consent). You will be given instructions on how to prepare for surgery and what to do with any medication you take or need.

Being the intervention under general anesthesia, you must comply with the prescribed fasting of solids and liquids during the 6 hours prior to the intervention. It is important that you have a family member or companion who can take you home when you are discharged, and who, if necessary, can help and care for you during the postoperative period. Smokers should stop smoking for a minimum of one to two weeks prior to surgery and during recovery, as smoking decreases circulation and interferes with healing. For the success of the treatment it is essential that you follow our instructions.

The operation

Once the patient who will undergo the Gynecomastia corrective surgery is asleep, the surgical field is sterilized and the operation is carried out. Your surgeon will inform you of the usual and extraordinary measures taken into account for your safety during the Gynecomastia intervention, as well as during the medium and long-term postoperative period.

The surgeon will choose the product and the technical and human means that he considers best for his patients. Surgery for Gynecomastia is generally performed as an outpatient, but in extreme cases, or in those with special medical or social conditions, with a one-day hospital stay. The surgery usually lasts about an hour and a half. However, in special cases it can last longer. The correction of enlarged breasts in men can be performed under general anesthesia, or in some cases under local anesthesia and sedation. You will be awake, relaxed, and pain-free. More extensive corrections may require general anesthesia, allowing the patient to sleep through the entire operation. We will discuss with you which option is the most recommended in your case, and why.

If glandular excess is the primary cause of breast augmentation, it must be removed with a scalpel. This procedure can be performed alone or with liposuction. In a normal treatment, the incision is made in an inconspicuous area; on the edge of the areola. Working through this incision, excess glandular tissue, fat, and skin are removed. In more severe cases, the removal of excess tissue can lead to larger incisions and scars, but it is not common. If liposuction is used to remove excess fat, the cannula is usually inserted through the existing incisions.

If the Gynecomastia consists fundamentally of an excess of fatty tissue, we use Liposuction to remove it. A small incision is made, less than 1 cm in non-visible areas, and with the help of a hollow cannula attached to a vacuum pump, the fat is broken up and suctioned out. You may feel a vibration or friction during the procedure, but no pain. In extreme cases of severe Gynecomastia, when large amounts of fat are removed, the skin may not fit well with the new body contour. In these cases, the excess skin may have to be removed –skin resection- to allow the remaining skin to readjust correctly to the new breast contour. Sometimes a small drainage tube is left in to remove excess discharge from the wound. Subsequently, the chest is bandaged so that the skin adapts correctly.

The Postoperative

After the corrective operation of the  Gynecomastia, whether the excision was with a scalpel or with a  Liposuction, you will feel some discomfort a few days after the surgery. However, the discomfort can be controlled with medication. In any case, you must be accompanied by a responsible adult for a day or two, who can help you with whatever you need. It will be swollen for some time - in fact, you may wonder at first if the treatment has been effective. To help reduce swelling you will wear an elastic garment for some time.

Although most of the swelling will subside within a few weeks, it may take three months or more for the final result of the surgery to become apparent. In the meantime, it's important to get back to normal. You should gradually recover and return to your usual activity when you feel well, which could be one to two days after surgery. If there are sutures, they are removed one to two weeks after the procedure.

We will advise you to limit your physical activity at first, avoiding heavy exercises or sudden movements for three weeks. In general, it will take about a month before you can return to normal physical activity. You should avoid exposing your scars to the sun for at least six months. Sunlight can cause permanent pigmentation changes in the skin, causing scars to darken. If sun exposure is imperative, use sunscreens. The results of the procedure are significant and permanent. If your expectations are realistic, the changes will be good and you'll be happy with your new look.