Gynecomastia is enlargement of the breast tissue in men. As well as making the chest look larger, the breasts may sag or feel tender, and some men develop skin irritation under the breast fold. Many men feel self-conscious and avoid activities such as swimming.
Causes
- Hormonal imbalance: an increase in estrogen or a decrease in testosterone can enlarge breast tissue. This is common during puberty, when hormone levels fluctuate, and often resolves on its own.
- Medications: including anti-androgen drugs for prostate cancer, some antidepressants, cimetidine (for stomach ulcers) and some antibiotics.
- Obesity: excess body fat increases chest size, and fat cells convert androgens into estrogen, worsening the hormone imbalance.
True Gynecomastia vs Pseudogynecomastia
- True gynecomastia: enlargement of the firm glandular breast tissue behind the nipple. It usually needs gland excision.
- Pseudogynecomastia: enlargement caused mainly by fat. It often responds well to liposuction.
Most men have a combination of both. Before surgery, your doctor will examine you and may recommend tests to find the cause. A hard, one-sided or fast-growing lump should always be checked to rule out other conditions.
Treatment Techniques at Kamol Hospital
- Liposuction: small incisions and a thin tube (cannula) are used to remove excess fat from the chest.
- VASER (ultrasound-assisted) liposuction: ultrasound energy breaks up fat before it’s suctioned out. This is helpful for firmer, fibrous chest fat and larger volumes. See PAL / VASER Liposuction.
- Gland excision: firm glandular tissue is removed, usually through a small incision at the lower edge of the areola.
- Excision with skin removal: for severe gynecomastia with loose, sagging skin, excess skin is also removed, and the nipple may be repositioned.
- Combined technique: liposuction to remove fat, plus excision to remove glandular tissue. This is the most common approach.
Comparing the Techniques
| Liposuction / VASER | Gland excision | Excision with skin removal | |
|---|---|---|---|
| Best for | Mainly fatty chest | Firm tissue behind the nipple | Large chest with loose skin |
| Scar | Tiny entry points | Small scar at the edge of the areola | Longer scars on the chest |
| Recovery | Fastest | Short | Longer |
Who Is a Good Candidate for Gynecomastia Surgery?
A good candidate for a gynecomastia surgical procedure is typically a man who:
- Has developed breast tissue due to hormonal imbalances, certain medications, or obesity and is experiencing discomfort or embarrassment as a result.
- Has been diagnosed with gynecomastia by a medical professional and has no underlying medical conditions that would contraindicate surgery.
- Has realistic expectations for the surgery’s outcome and understands the procedure’s potential risks and benefits.
- Is in good physical health, does not smoke, and is at a stable weight.
- Has completed puberty. As the condition can be temporary in some cases, it is important to wait till breast development is finished.
- Understand that the surgery will leave scars, although they can be hidden in most cases.
Preparing for Surgery
The pre-operative routine for gynecomastia surgery typically includes the following steps:
- Initial consultation. Meet a board-certified plastic surgeon experienced in gynecomastia surgery. They will examine the breast tissue, discuss what you want to achieve, review your medical history, and arrange any tests needed to confirm you are a suitable candidate.
- Laboratory tests. Blood tests, an EKG or chest X-ray, and other tests as appropriate to confirm you are fit for surgery.
- Stop smoking. Your surgeon will likely advise stopping for at least four to six weeks before and after surgery to lower the risk of complications.
- Medication and supplements. You will be asked to stop certain medications, such as blood thinners, several weeks beforehand. Tell your surgeon about any supplements or herbal remedies you take.
- Pre-operative instructions. These cover when to stop eating and drinking, and what to wear on the day.
- Meeting the anaesthesiologist. You will discuss the type of anaesthesia to be used before the operation.
Follow these instructions carefully and attend every appointment beforehand — it makes a real difference to how smoothly the surgery and recovery go.
Surgical Techniques
We use several approaches, chosen according to the individual case:
- Liposuction. Removes excess fat from the chest through small incisions, using a thin cannula and suction. Suitable where the enlargement is predominantly fatty.
- Excision. Removes excess glandular tissue and skin through an incision. Used where there is a significant amount of firm breast tissue, which liposuction cannot address.
- Ultrasonic liposuction. Uses ultrasonic energy to break up fat before suctioning, which helps with larger volumes and denser tissue.
- VASER liposuction. Similar in principle, using VASER energy to emulsify fat before removal. Also suited to larger volumes.
- Combined approach. Liposuction together with excision, addressing both fatty tissue and glandular tissue. This is the appropriate approach for many patients, since most gynecomastia involves both.
The right technique depends entirely on your case, and your surgeon will recommend one after examination and consultation.
Post-operative Care & Recovery
The post-operative care for gynecomastia surgery is an important aspect of the recovery process. It is important to follow your surgeon’s instructions to ensure that the surgery goes smoothly and that you achieve the best possible outcome. Typically, the post-operative care for gynecomastia surgery includes the following steps:
- Pain management: You may experience pain and discomfort in the breast area for several days after the surgery. Your surgeon will provide you with pain medication to help manage the pain.
- Swelling and Bruising: After the surgery, the breast area is expected to experience swelling and bruising. These should improve within a few days and will continue to improve over the next few weeks.
- Wearing a Compression garment: Your surgeon may recommend wearing a compression garment to help reduce swelling and support healing. You will need to wear this garment for several weeks after the surgery.
- Rest and Recovery: You should take it easy for the first few days after the surgery. Avoid strenuous activities and heavy lifting for at least the first week after surgery.
- Follow-up Appointments: You must attend follow-up appointments with your surgeon to monitor your recovery and check the healing process. Your surgeon may also give you additional instructions on how to care for yourself after the surgery.
- Avoid smoking and alcohol: Your surgeon will advise you to avoid smoking and drinking alcohol, as they can slow down the healing process.
- Incision Care: You must care for the incision area, keeping it clean and dry. You must avoid showering for the first 24-48 hours and use only mild soap when showering.
It is important to remember that recovery time can vary from person to person. The swelling and bruising will take time to subside, but with proper care and following your surgeon’s instructions, you should be able to return to normal activities within a few weeks.
Risks and Complications
As with any surgical procedure, there are risks and complications associated with gynecomastia surgery. Some of the possible risks and complications include:
- Infection: An infection can occur at the surgical site and may require additional treatment.
- Hematoma or Seroma: Hematoma is a collection of blood outside the blood vessels, and seroma is a fluid collection. These can happen after surgery and may require additional treatment.
- Scarring: All surgeries leave scars, including gynecomastia surgery. However, most scars can be hidden in the underarms or around the areola.
- Numbness or Tingling: The nerves in the breast area may be damaged during the surgery, leading to numbness or tingling.
- Asymmetry: In some cases, the breast tissue may not be removed evenly, resulting in asymmetry between the two breasts.
- Changes in Sensitivity: Some men may experience changes in sensitivity in the breast area after surgery.
- Recurrence: In some cases, the breast tissue may return or grow again after surgery. This is rare but can happen if the cause of the gynecomastia is not addressed, such as hormonal imbalances.
- Unsatisfied results: In some cases, the patient may not be satisfied with the surgery’s results, which may require revision surgery.
It’s important to remember that most of these complications are rare and can be avoided by following your surgeon’s instructions and choosing a qualified and experienced surgeon. It’s also important to have realistic expectations and understand that the outcome of the surgery may not be perfect. Your surgeon will be able to provide you with more detailed information on the risks and complications of the surgery during your consultation.
Before & After for Gynecomastia Surgery
Why Choose Kamol Hospital in Bangkok for Gynecomastia Surgery
The mistake that ruins gynecomastia results is treating it as a liposuction case. Fat suctions out; glandular tissue does not. Remove the fat around firm glandular tissue, and you are left with a hard disc beneath the nipple that looks worse than what you started with — and this is the single most common reason men come to us for revision after surgery elsewhere.
- Every technique available: Liposuction, VASER, gland excision and skin removal, combined to suit your chest.
- Experience in chest contouring: Our plastic surgeons regularly perform male chest surgery, including top surgery.
- Discreet scars: Incisions are placed at the edge of the areola or in tiny entry points wherever possible.
- Medical assessment: The cause of gynecomastia is assessed before surgery, with a men’s check-up available.
- Hospital-level safety: A JCI-accredited hospital with an experienced anesthesia team.
- Support for international patients: Multilingual coordinators and Kamol Trip help you plan your stay in Bangkok.
Frequently Asked Questions (FAQs)
Will gynecomastia go away on its own?
Gynecomastia during puberty often resolves within a few years. If it’s caused by a medication, stopping or changing the medicine (with your doctor’s advice) may help. Long-standing gynecomastia in adults, especially with firm glandular tissue, usually doesn’t resolve without surgery.
Can exercise or weight loss get rid of it?
Weight loss can reduce the fatty part of a large chest, but it doesn’t remove glandular breast tissue. If firm tissue remains behind the nipples after weight loss, surgery is usually needed.
Is liposuction alone enough?
If the enlargement is mainly fat, liposuction or VASER alone may be enough. If there’s firm glandular tissue, it needs to be removed through a small incision. Most men need a combination of both.
Will I lose nipple sensation?
Temporary numbness or altered sensation around the nipple is common in the early weeks and resolves for most patients as the nerves recover. Permanent change is uncommon but possible, and more likely in extensive cases where more tissue is removed.
Can gynecomastia come back after surgery?
Recurrence is uncommon once the glandular tissue is removed. It’s more likely if you gain significant weight or if the underlying cause, such as a medication, steroid use or hormone imbalance, continues.
When can I go back to the gym?
Light activity is usually fine after a week. Chest exercises and heavy lifting are generally avoided for about 4–6 weeks.
Does Thailand have good surgeons for gynecomastia?
Thailand has an established plastic surgery sector, and chest contouring in men is performed routinely here by Thai board-certified plastic surgeons, many with additional overseas training. Because the technique overlaps with masculinising chest surgery, centres doing high volumes of gender-affirming work often have particular depth in it. Verify board certification and check that the facility is an accredited hospital rather than a small clinic.
Is it worth travelling to Bangkok, Thailand for this?
Gynecomastia surgery is rarely covered by insurance even though the distress it causes is real, so patients are usually paying out of pocket wherever they go — which makes the cost difference against Australia, the UK, or North America meaningful. Allow around ten days to two weeks in Bangkok, Thailand for suture removal and a wound check before flying. Many patients combine it with liposuction of the flanks or abdomen in the same operation for a better overall chest and torso contour.
How long should I stay in Bangkok after gynecomastia surgery?
Plan to stay in Bangkok for about 5–7 days. This allows for a follow-up check before you fly home. Wear your compression garment while traveling. Kamol Trip can arrange accommodation close to the hospital.
