Gynecomastia surgery has a long healing time, but it can improve the overall quality of life in eligible candidates.
Gynecomastia surgery is breast reduction surgery for cisgender men and other people assigned male at birth (AMAB).
Gynecomastia is a condition marked by “excess” breast tissue in AMAB folks, resulting in the appearance or presence of a fuller chest, explains Jonathan Kaplan, MD, MPH, plastic surgeon at Pacific Heights Plastic Surgery in San Francisco.
A plastic surgeon can create a flatter chest with enhanced pectoral contours by removing breast tissue, fat, and skin from the area.
The procedure can be performed on one or both sides of the chest, usually in the same operation.
Gynecomastia surgery is a cosmetic, elective procedure.
It’s often considered by individuals who are after a particular flat-chested aesthetic, or who experience gender dysphoria, body dysmorphia, or shame around the appearance of their chest.
It is not mandatory for people who have excess chest tissue. Every person is unique. Every person’s chest shape and size are different.
Yes, there are a few different types of gynecomastia surgery. Some of the more common procedures include:
Liposuction involves removing the fat in the chest tissue from the chest cavity. Here, the gland tissue is left intact.
“Liposuction on its own is really only an option for people with good skin elasticity and minimal glandular tissue,” explains Christopher Hess, MD, a nationally recognized plastic surgeon based in Fairfax, Virginia.
The main benefit of this option is that the scar left behind will be minimal.
Excision involves making larger incisions in the affected area.
The overall pattern, length, and location of the incisions depend on your chest size and the desired result.
“Excision is necessary in order to actually remove the firm glandular breast tissue,” says Ashley Steinberg, MD, a plastic and reconstructive surgeon based in Houston.
Surgeons typically use a combination of liposuction and excision to remove as much of the unwanted tissue and fat as possible, Hess says.
Sometimes the weight and heft of excess breast tissue can cause the tissue to sag, pulling the nipple downward. This can stretch the skin around the nipple (areola), resulting in an enlarged appearance.
Here, gynecomastia surgery may also involve resizing and repositioning the nipple. This procedure is more invasive and will require additional healing time.
Anyone who has some degree of gynecomastia is eligible for surgery, says Kaplan.
Beyond that, people generally must meet the requirements associated with any elective surgery.
- not having a blood disorder
- not taking immune-suppressing medication
- not using nicotine and tobacco products in preparation for surgery and until recovery is complete
- managing any underlying health conditions
- being able to take the prerequisite time off of school, work, or other obligations to heal
- having one or more people who can be caretakers during your recovery
Can trans men or transmasculine folks get gynecomastia surgery instead of top surgery?
The short answer: Usually not.
Typically, trans men and transmasculine folks who have experienced puberty as the sex they were assigned at birth — developing breasts and beginning menstruation — are not candidates for what’s generally known as gynecomastia surgery.
By definition, gynecomastia surgery is used to treat gynecomastia in people assigned male at birth.
However, trans boys and transmasculine folks who started puberty blockers or testosterone therapy or both before going through “female puberty” but still developed excess breast tissue may be a candidate. (This occurrence is rare, but it is possible).
Trans men and transmasculine folks in the former category do have options for removing unwanted breast and chest tissue.
The main difference between top surgery and gynecomastia surgery is in the name — the procedures themselves are quite similar.
Popular top surgery techniques include:
- Minimal scar
Mainly by understanding exactly what recovery entails.
No doubt, gynecomastia surgery can be life changing for the folks it’s designed for.
“The surgery opens up options for more fitted clothing and the opportunity to enjoy many activities with greater freedom and ease, which can result in increased confidence and improved self-image, and even more fulfilling relationships with themselves, friends, family, and co-workers,” explains Hess.
But the recovery journey is a long(ish) one. You need to be prepared not to work or exercise as long as required.
“Patients also need to understand the possible risks and complications so that they can have reasonable expectations,” he says. “Individual results vary and depend on the patient’s overall health and genetic makeup.”
During your initial consultation with your clinician, they will discuss your options for intravenous sedation and general anesthesia. They can help you determine which method best suits your needs and comfort.
When you arrive for your procedure, your clinician will administer the medication you agreed on. This will help you remain calm and comfortable during the procedure.
If your procedure includes liposuction, your clinician will make several small incisions in the affected area. They will then insert a thin hollow tube called a “cannula” through each incision and move it back and forth. This helps loosen the excess fat, which is removed via vacuum suction.
If your procedure includes excision, your clinician will make several larger incisions in the area. The exact pattern, length, and location of the incisions vary from person to person, procedure to procedure. Your clinician should give you an idea of the depth and degree of these incisions during your initial consultation.
The risks associated with any invasive surgery are associated with gynecomastia surgery, too, says Kaplan. “Namely, bleeding and infection at the incision site.”
Prolonged numbness, fluid buildup, and skin color irregularities are also possible, according to Hess.
Risks that are specific to gynecomastia surgery are rare but possible, Kaplan says. “There is some risk of a sunken appearance of the nipple or loss of the nipple altogether.”
Sometimes people also lose sensitivity in their nipples.
“Usually, nipple sensitivity and sensation returns a few weeks or months after surgery, but some people will permanently lose sensation following surgery,” says Hess.
Gynecomastia is typically an outpatient surgery.
In most cases, “once the patient has recovered from anesthesia, they’re able to return home with a responsible caretaker that same day,” says Hess.
You may experience symptoms commonly associated with anesthesia, such as:
- feeling groggy, confused, or foggy
- generalized muscle aches
Pain and discomfort around the surgical site are also common, says Hess. Your clinician may prescribe medication to help manage these effects.
“Typically, patients return to work after 1 to 2 weeks,” he says. “But they wear a compression vest for at least a month.”
A compression vest can help minimize discomfort, protect the surgical site, and reduce swelling.
“Patients should avoid soaking or swimming for at least 2 weeks and avoid any vigorous physical activity or exercise for at least 1 month following surgery,” says Hess. It can take up to a year for a surgical scar to fully mature.
“Many surgeons recommend sun avoidance, scar massage, scar cream, and/or fractionated laser treatments to help minimize the appearance of the scar,” he adds.
“Selecting a properly trained and qualified surgeon will greatly increase your chances for a successful and safe operation,” says Hess.
So how do you find a surgeon? If you have a primary care physician, start there. They may be able to make a referral.
If you have insurance, you may find it helpful to reach out to your insurer and ask about potential coverage.
If your plan covers the surgery, ask for a list of in-network providers. If your plan doesn’t cover the surgery, you can still ask for a list of recommended providers.
If neither of the above options applies to your situation, Google search “gynecomastia + [your city]” to get a sense of nearby providers.
Take your time reviewing their websites and reach out to any that stand out to you. Most surgeons offer free consultations, so take advantage of this opportunity to ask any questions.
It’s not cheap.
Gynecomastia surgery costs an average of $4,239, according to the most recent statistics from the American Society of Plastic Surgeons.
That amount doesn’t include the price of anesthesia, general operating costs, or other expenses associated with surgery (like transportation, accommodations, household expenses during recovery, and the like).
So this figure is probably on the low end of what it will ultimately cost.
You might wonder, is gynecomastia surgery covered by medical insurance? Although it depends on your insurance plan, elective and cosmetic procedures like this are typically not covered.
Is scarring a given after gynecomastia surgery?
Yes and no.
“You will have a scar,” says Steinberg. “There’s really no way to get around that.”
But most people won’t have visible scars, according to Kaplan.
“Most procedures can be done through the lower half of the areola with great cosmetic results and hidden scars,” explains Kaplan.
Will you be able to see your pec muscles after gynecomastia surgery?
Following gynecomastia surgery, there is less breast tissue “hiding” the pec muscle beneath.
So, yes, you will typically be able to see the pec muscle after surgery.
However, the surgery doesn’t add pec muscles.
If you want to increase the appearance of your chest muscles, you’ll need to incorporate chest-strengthening exercises once your clinician gives you the go-ahead to resume strenuous physical activity.
How soon can you work out or go to the gym after gynecomastia surgery?
It depends on the exact surgery an individual undergoes. However, 4 weeks is a good general guideline, says Steinberg.
Some experts may recommend that you stay away from traditional “chest day” exercises for longer than that, so be sure to talk with your clinician before you begin any exercise or workout regimen.
Is gynecomastia common?
More than you might guess.
“Gynecomastia is a common condition that affects up to two-thirds of adolescent males and up to 25% of men over 50 years of age,” says Hess.
What causes gynecomastia?
There are several causes. “Typically, the excess tissue is usually a result of a hormone imbalance,” says Hess.
“It can also be caused by steroid use or general increase in skin laxity in older age,” adds Kaplan.
Gynecomastia surgery removes unwanted, excess breast tissue, chest fat, and skin in AMAB folks.
The surgery has a relatively long healing time, but it can improve the overall quality of life in eligible candidates. If you think that’s you, talk with a healthcare professional to learn more and discuss your options.
Gabrielle Kassel (she/her) is a queer sex educator and wellness journalist who is committed to helping people feel the best they can in their bodies. In addition to Healthline, her work has appeared in publications such as Shape, Cosmopolitan, Well+Good, Health, Self, Women’s Health, Greatist, and more! In her free time, Gabrielle can be found coaching CrossFit, reviewing pleasure products, hiking with her border collie, or recording episodes of the podcast she co-hosts called Bad In Bed. Follow her on Instagram @Gabriellekassel.