Gynecomastia Surgery in Ankara, Turkey

Gynecomastia is a common condition characterized by abnormal enlargement of breast tissue in men. This condition, which causes aesthetic concerns, can be corrected surgically. With gynecomastia surgery, excess fat and breast tissue are removed to give the chest area a flat and masculine form.

The surgical technique is determined according to the structure of the enlargement. If fatty tissue is predominant, liposuction is applied; if glandular (firm tissue) is dominant, surgical excision is preferred. If necessary, both methods can be used together. Incisions are usually hidden around the areola.

The procedure is generally performed under local or general anesthesia and takes approximately 1–2 hours. After surgery, the use of a special compression garment is recommended; this helps control swelling and supports skin adaptation. Patients are usually discharged on the same day.

The recovery process takes 1–2 weeks; physical activities such as exercise should be postponed for several weeks. After surgery, the chest achieves a flat, firm, and natural appearance. Permanent results are obtained and patients experience a significant increase in self-confidence.

What Is Gynecomastia Surgery?

Gynecomastia surgery is a procedure aimed at correcting the appearance caused by abnormal enlargement of breast tissue in men through surgical methods. Hormonal imbalances, weight gain, or certain medications may cause gynecomastia. The surgery is performed by removing excess fat tissue with liposuction, surgically removing the enlarged breast gland, or applying both methods together. The aim is to give the chest area a flatter and more masculine contour.

What are the causes of gynecomastia?

During our consultations with patients, the most frequently asked question is: “Did I cause this myself?” Most of the time, the answer is no. A very large portion of gynecomastia cases are structural conditions we call “idiopathic,” meaning the cause cannot be determined. However, there are also some triggering factors.

Some of these factors include:

• Hormonal fluctuations during puberty
• Decrease in testosterone levels with advancing age
• Excessive weight gain and obesity
• Chronic diseases such as kidney failure
• Liver function disorders
• Thyroid gland diseases
• Testicular tumors
• Pituitary gland disorders

Which medications trigger the development of gynecomastia?

In addition to medical causes, some substances taken externally may also disrupt hormonal balance and lead to breast enlargement. Especially in young men interested in bodybuilding, supplements used unconsciously to increase muscle mass are a serious risk factor. When these substances enter the body, they disrupt the hormone cycle and may enlarge breast tissue.

Substances that may predispose to gynecomastia include:

• Anabolic steroids
• Some antidepressant medications
• Blood pressure medications
• Some stomach-protective medications
• Medications used in prostate treatment
• Alcohol consumption
• Use of narcotic substances
• Some medications in the antibiotic group

What is pseudogynecomastia and how is it distinguished?

In our clinical practice, this is the most important distinction that changes the treatment plan. Pseudogynecomastia, as the name suggests, is not enlargement of the breast gland but excessive fat accumulation in the chest area. It usually progresses in parallel with general body fat. When touched, there is no firm mass; the tissue is soft and homogeneous. These patients may observe a noticeable reduction in their chest when they lose weight.

In true gynecomastia, however, the situation is different. Just behind the nipple, a disc-shaped or walnut-sized tissue that is much firmer than the surrounding fat tissue and has clear boundaries can be felt. This tissue is called “glandular” tissue. Even if the patient loses weight, this tissue does not melt away. On the contrary, as the surrounding fat decreases, this firm mass becomes more prominent and the nipple protrudes outward. In most of our patients, a “mixed type,” which is a combination of these two conditions, is observed; in other words, both fat increase and breast gland enlargement are present.

Which tests should be performed before surgery?

Gynecomastia should not be considered only as an aesthetic problem. Before lying on the operating table, we must ensure that there is no serious underlying health issue causing this enlargement. Therefore, we subject our patients to a detailed examination. If there is a hormonal disorder and surgery is performed without correcting it, there may be a possibility of recurrence.

• The routine tests we request are as follows:
• Total and free testosterone levels
• Estrogen level
• Prolactin hormone
• Thyroid function tests
• Liver enzymes
• Kidney function tests
• Breast ultrasonography
• Testicular ultrasound when necessary

Why is gynecomastia staging important?

Not every gynecomastia patient is the same, and a single surgical method cannot be applied to everyone. At this point, we categorize our patients using a system called the Simon Classification. This classification is based on the relationship between breast size and excess skin. The quality of the skin and the degree of sagging are the most fundamental factors determining the surgical technique and the resulting scar.

The stages of gynecomastia are as follows:

• Stage 1 (Mild enlargement, no excess skin)
• Stage 2A (Moderate enlargement, no excess skin)
• Stage 2B (Moderate enlargement, small amount of excess skin)
• Stage 3 (Significant enlargement, severe excess skin and sagging)

How did VASER Liposuction technology change the process?

In the past, gynecomastia surgeries were performed with rougher methods and the recovery process was more difficult. Today, thanks to VASER (Vibration Amplification of Sound Energy at Resonance) technology, we can achieve much more precise and comfortable results. VASER works by emitting ultrasonic sound waves. These sound waves target fat cells and gently detach them from their location.

The biggest feature that distinguishes this technology from classical methods is “tissue selectivity.” In other words, while the VASER probe melts fats, it does not damage nearby blood vessels, nerves, and connective tissue. As a result, bruising after surgery is much less, the risk of bleeding decreases, and recovery accelerates.

However, the truly revolutionary effect of VASER in gynecomastia surgery is its skin-tightening capability. Especially in patients with Stage 2B, where the skin is loose, VASER energy heats the skin from the inside and smooths it. This allows the skin to contract and enables us to obtain a flat chest without the need for an incision. Additionally, with this technology we can design a more athletic appearance called “High Definition,” where the shadows of the chest muscles are accentuated.

Is removing only fat sufficient?

We encounter this question very frequently. Many patients hope that the problem can be completely solved with liposuction alone. If the patient has only fat accumulation (pseudogynecomastia), yes, liposuction alone is sufficient. However, in the vast majority of our patients, there is also a hardened breast gland beneath the fat tissue:

Liposuction cannulas can suction fat, but they cannot break apart this hard, rubber-like glandular tissue. If the surgeon removes only the fat and leaves that hard tissue inside, the nipple will still appear protruding after surgery and the patient will not be satisfied with the result. In fact, because the fat is removed and the gland remains, the appearance may even worsen. Therefore, in the majority of gynecomastia surgeries, a combined approach is essential: first the fats are removed with VASER and the contour is corrected, then the remaining hard tissue is surgically removed.

How is gland excision (tissue removal) performed?

The removal of the breast gland is the most delicate part of the surgery. Our aim here is to remove that hard mass without leaving a scar and without disturbing the chest form. In current practice, we frequently prefer the “Pull-Through” technique. With this technique, we do not make large incisions on the nipple.

The procedure includes the following steps:

• The nipple is numbed
• A small entry hole is created
• The hard tissue is grasped with special instruments
• The tissue is fragmented and pulled out
• Minimal corrections are made if necessary

In this method, the surgeon’s experience is extremely critical. Scraping all the tissue completely is not correct. Because if you leave no tissue just beneath the nipple, when it heals the nipple collapses inward and a depression called “crater deformity” forms. This is an aesthetically undesirable appearance. Therefore, a thin layer of tissue must always be preserved as a protective cushion that will not disrupt the blood supply of the nipple and will allow it to remain upright.

Will there be scars after surgery?

The biggest factor causing male patients to keep their distance from aesthetic surgery is the concern: “Will it be obvious that I had surgery?” The greatest advantage of modern techniques is the ability to hide scars. In Stage 1 and Stage 2 patients where we use VASER liposuction and the pull-through technique, scars are almost nonexistent.

Entry points are usually hidden in the following areas:

• Armpit fold
• Inframammary fold
• Edge of the nipple

These holes are only 3–4 millimeters in diameter and when healed they appear like a faint mole. However, the situation is different in rare Stage 3 cases, where the breast sags like a female breast and the skin is very loose. In these patients, it is necessary to remove skin around the nipple to tighten the area. In this case, a circular scar may remain around the nipple. However, this scar also fades over time and is not very noticeable because it is placed along the color transition line.

How long does the surgery take and what is the anesthesia preference?

Although the duration of surgery varies depending on the scope of the procedure, it generally takes between 60 and 90 minutes. For patient comfort and to allow the surgeon to work comfortably, we prefer general anesthesia. The patient sleeps completely, feels nothing, and when he wakes up everything is finished. Local anesthesia and sedation may be considered only if a very limited, small fat removal procedure will be performed, but our standard approach is general anesthesia. Patients are usually discharged from the hospital on the evening of the surgery day or the next morning.

Is there pain after surgery?

One of the issues our patients fear most is pain. However, gynecomastia surgery ranks quite low on the pain scale. In other words, it is not a very painful surgery. Our patients usually describe the condition not as “pain” but as a feeling of “soreness” or “tightness.” It feels as if you worked your chest muscles in the gym for a long time and the next day your muscles feel stiff.

The reasons for this sensation include:

• Edema in the muscles
• Healing of the subcutaneous tissue
• Pressure of the compression garment
• Sensitivity of nerve endings

This process can be managed very comfortably with simple painkillers. It is normal to feel mild stinging when raising your arms or getting out of bed during the first few days.

Why is the use of a compression garment important after surgery?

Immediately after surgery, we put a special gynecomastia compression garment (in the form of a vest) on our patient. This garment affects the success of the result at least as much as the surgery itself. The function of the garment is not just to compress you; it ensures that the emptied subcutaneous space adheres to the chest wall. If the garment is not worn, body fluid or blood may fill the empty space (seroma or hematoma) and the skin may remain loose.

The rules for using the compression garment are as follows:

• Use day and night for the first 3 weeks
• Remove only while showering
• After week use only during the day
• Total duration of 6 weeks
• The garment should not create looseness
• It should not be excessively tight or loose

What happens during the recovery process?

When you return home, we recommend that you spend the first 3 days resting. This does not mean staying confined to bed; walking around the house is very beneficial for blood circulation. You just need to avoid movements that will strain your arms. Those who work at a desk can usually return to work on the 3rd or 4th day. Those working in physically demanding jobs should rest for about 1 week.

The stages of the recovery process are as follows:

• The first week is the period when swelling is most intense
• From the second week onward, bruises turn yellow and fade
• In the third week, tissue hardening begins
• By the fourth week, 60% of the swelling has subsided
• In the second month, tissues begin to soften

Why do I feel hardness in my chest?

Starting from the 3rd week after surgery, you may feel hardness or lumpiness in the surgical area when you touch it. This situation worries patients a lot, but it is a completely normal healing process. In medicine, we call this “fibrosis.” The body forms new connective tissue in that area to repair the treated site, which causes temporary hardness.

To reduce this hardness, the following should be done:

• Lymphatic massage application
• Manual deep tissue massage
• Consuming plenty of water
• Light stretching exercises

With regular massage, these hardness areas gradually disperse and the chest tissue returns to its completely soft, natural consistency within 3–6 months.

When can I return to sports?

For patients with an active sports life, this is a critical question. Rushing may disrupt internal healing and increase swelling.

The timeline for returning to sports is as follows:

• Light walking in the first week
• Brisk walking in the second week
• Lower body weight training in the fourth week
• Chest exercises and swimming in the sixth week
• Full-capacity sports in the eighth week

What are the risks of gynecomastia surgery?

As with any surgical intervention, gynecomastia surgery also has some risks, but these are rare in experienced hands and are manageable conditions.

Possible complications include:

• Hematoma (accumulation of blood under the skin)
• Seroma (accumulation of fluid under the skin)
• Infection
• Temporary loss of sensation in the nipple
• Asymmetry
• Skin irregularities
• Wound healing problems

Numbness in the nipple is common but usually temporary. As the nerves repair themselves, sensation returns within 3 to 6 months.

Does gynecomastia recur?

The best part of this surgery is that the results are permanent. Since the breast gland tissue is physically removed from the body, it is biologically impossible for that tissue to grow again. Since fat cells are also removed with VASER, it is difficult for fat accumulation to occur again in that area.

However, in some exceptional cases the appearance may change.

Situations that may trigger regrowth include:

• Excessive weight gain (such as 20–30 kg)
• Steroid use
• Use of strong hormonal medications
• Excessive alcohol consumption

If the patient maintains his weight and avoids substances that disrupt hormonal balance, the masculine chest form obtained will remain permanent for life.

What are the psychological effects of gynecomastia surgery?

As a plastic surgeon, the biggest change I observe after surgery is not in the chest but in the sparkle in the patient’s eyes and posture. Gynecomastia can cause serious loss of self-confidence, social isolation, and posture disorders (kyphosis) in men. Our patients may have avoided swimming for years, always worn loose T-shirts, or developed the habit of walking with their shoulders hunched forward.

When this burden is lifted after surgery, the patient’s self-confidence returns at an incredible pace. Not having to think “Which T-shirt will hide it?” anymore, not walking around the beach with a towel, and being able to stand upright are the greatest gifts this surgery offers. This is not only a physical correction but also a powerful psychological rehabilitation that allows a person to make peace with his body.