GYNECOMASTIA

Gynecomastia is the enlargement of glandular breast tissue in men, a condition that can appear at any stage of life: during infancy, adolescence, or adulthood. It is estimated to affect between 40% and 60% of men at some point in their lives, although it often goes undiagnosed.

This condition can be unilateral (affecting only one breast) or bilateral (both), and its origin varies: hormonal imbalances, use of certain medications (such as antihypertensives, anabolic steroids, or some antidepressants), consumption of substances such as marijuana or alcohol, or simply a genetic predisposition. In many cases no specific cause is identified and it is called idiopathic gynecomastia.

It is important to distinguish true gynecomastia — which involves glandular tissue — from pseudogynecomastia, which consists solely of fat accumulation without a glandular component, more common in overweight men. The surgical treatment differs in both cases.

Surgical time ranges from 1 to 2 hours, depending on the degree of the condition and the technique used.

Consultation Process

During the initial consultation, I will perform a detailed physical evaluation of the breast tissue to classify the degree of gynecomastia and determine whether there is a predominantly glandular, adipose, or mixed component. We will review your medical history, current medications, and relevant background together.

I will explain in detail the available treatment options: liposuction alone (for cases of pseudogynecomastia or predominantly adipose component), glandular excision through small periareolar incisions (for firm glandular tissue), or a combination of both techniques for mixed cases.

We will review photographs of previous results and discuss realistic expectations based on your specific anatomy. We will also address the impact this condition may have on quality of life and the importance of making this decision from a place of emotional balance and complete information.

Surgical Technique

The technique depends on the type and degree of gynecomastia:

For pseudogynecomastia (fat): Conventional or ultrasound-assisted liposuction (VASER) is performed through minimal 3-5 mm incisions in the axillary or periareolar region. This technique is effective, has a fast recovery, and leaves virtually invisible scars.

For true gynecomastia (glandular tissue): A semicircular incision is made at the lower border of the areola (periareolar incision), through which the glandular tissue is directly removed. This incision heals very well due to the difference in pigmentation between the areola and surrounding skin.

For mixed cases or high-grade gynecomastia: Liposuction is combined with glandular excision. In advanced cases with significant skin excess, repositioning of the nipple-areola complex or additional skin resection may be necessary.

Step-by-Step Procedure Description

The procedure is performed under general anesthesia or sedation plus local anesthesia, depending on the degree of the condition. Once the patient is anesthetized, I infiltrate tumescent solution into the areas to be treated to reduce bleeding and facilitate tissue removal.

In cases requiring liposuction, I insert thin cannulas through tiny incisions and remove adipose tissue with controlled movements. For the glandular component, I access through the periareolar incision and excise the breast tissue en bloc, preserving a retroareolar button of tissue to avoid excessive nipple retraction.

At the end, sutures are placed in the internal planes and skin, and compressive dressings are applied. In some cases, a small drain is left for 24-48 hours to prevent fluid accumulation.

Pre-surgical Tests

A complete blood count, PT, PTT, platelets, creatinine, blood glucose, electrocardiogram, and chest X-ray are required. In patients over 40 or with cardiovascular risk factors, additional tests may be requested. A hormonal profile (testosterone, estrogens, prolactin, FSH, LH) is also recommended to rule out endocrinological causes that may require medical management prior to surgery.

Recovery Timeline

Day 1 - Day 3 (First days): Mild to moderate pain, swelling, and bruising in the operated area. A chest compressive garment or binder is applied and must be worn continuously. Relative rest, avoid abrupt arm movements.

Week 1: Progressive improvement in pain. Swelling remains present. You may resume sedentary and office activities. Continue with prescribed antibiotics and analgesics.

Weeks 2-3: Notable reduction in swelling. Most bruising disappears. The periareolar scar begins to consolidate. Light physical work may be resumed.

Month 1: Results begin to be appreciable. Light cardiovascular exercise may be initiated. The compressive garment is worn mainly at night.

Months 2-3: Residual swelling subsides almost completely. Results are clearly visible. Normal physical exercise may be resumed, including chest activity with caution.

Months 3-6: Definitive result consolidated. Scars continue to mature and become increasingly less visible.

Post-operative Care and Recovery Leave

Surgery is usually performed on an outpatient basis, with no need for hospitalization. The patient returns home the same day with detailed care instructions. Work leave is approximately 5 to 7 days for office work, and 2 to 3 weeks for physical or arm-movement-intensive jobs. The use of the compressive garment is essential during the first 4 to 6 weeks to ensure optimal results and reduce inflammation.