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Doctors at Smart Surgeons

Dr. Minnu Dev

Head of Cosmetic, Aesthetic & Regenerative Gynecology

MBBS, MS, FRM (Germany) Diplomate in Aesthetic & Cosmetic Gynecology & Lasers

A gynecologist with 9+ years of experience and has completed her MBBS from the prestigious Madras Medical College and an MS in Gynecology. She is specializes in cosmetic & regenerative gynecology, combining medical expertise with an artistic approach to enhance women's intimate health and aesthetics.

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Dr. Rajesh Vasu

Surgeon & Technical Advisor

MBBS, MS, MCh, FAS, FHRS, MRM

A super specialist with 20+ years of experience in plastic, reconstructive & cosmetic surgery. Received his degrees from most prestigious institutes of JIPMER Pondicherry (MBBS), AIIMS New Delhi MS General Surgery and NIMS Hyderabad (MCh Plastic Surgery)

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FAQs on gynecomastia treatment

What is gynecomastia? Is it different from chest fat? What is pseudogynecomastia?

Gynecomastia literally means female-like breast condition in men. The word is derived from 2 Greek words ‘gyne’ which means woman and ‘mastos’ which means breast.

Gynecomastia is a very common condition and the prevalence varies by age:

Newborns: Most newborns have small little breast tissue which can also express milk when pressed. This is due to maternal hormones estrogen, which is in the newborn immediately after birth. The condition slowly subsides naturally over few months as the baby grows
Adolescents: Can also have temporary gynecomastia and the prevalence ranges from 4-69% (a broad range), due to hormonal changes. The condition usually resolves on its own, as hormones settle with age
Adults: If gynecomastia continues in adulthood, is when people seek treatment. As the man ages the testosterone levels decline allowing estrogen’s effect to increase, causing gynecomastia. In one study, the prevalence of gynecomastia in the age group of 50 to 69 years is as high as 70%.

Gynecomastia should not be confused with pseudogynecomastia or excessive chest fat. In true gynecomastia there is development of the breast tissue, whereas a pseudogynecomastia is just excess fat deposition due to obesity or being overweight.

Here is a table of comparison between the 2 conditions:

HTML Table Generator

Feature	Gynecomastia	Pseudo-Gynecomastia
Definition	Enlargement of male breast tissue due to hormonal imbalance	Enlargement of the male chest due to excess fat deposition
Causes	Hormonal imbalance - increase in estrogen or decrease in testosterone	Obesity or significant weight gain leading
Breast Tissue	Present	Absent
Symptoms	There may be slight pain or tenderness or sensitivity in the chest area	Typically asymptomatic and painless
Treatment	Adults require surgical removal of the breast tissue. In adolescent age group it can resolve on its own	Can be reversed with weight loss. Liposuction or surgical fat removal can help in immediate results

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You can diagnose or differentiate between the 2 conditions at home as well if you suspect gynecomastia.

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What is the cause of gynecomastia?

Unlike pseudogynecomastia, true gynecomastia can have many different underlying causes:

Hormonal imbalance: In adolescents due to increase in estrogen there can be temporary gynecomastia which resolves as the child grows older. As men age, the testosterone levels reduce which reduces its counter-effect on the female hormone of estrogen causing gynecomastia.
Obesity: obesity can cause certain chemical changes in the testosterone hormone (aromitization) exacerbating hormonal imbalance
Liver disease: Most hormones in our body are metabolized in the liver. In liver disease this metabolization is affected which can in turn increase estrogen levels or cause overall hormonal imbalance
Thyroid disorders: can also affect overall hormonal imbalance causing gynecomastia
Medications: Certain medications like steroids, antidepressants, prostate cancer treatments and heart medications can also cause gynecomastia

In many men, a combination of the above factors can cause gynecomastia, most commonly declining testosterone and obesity.

A 20 years national registry Danish study revealed a marked increase in Gynecomastia incidence suggesting a change in the sex-streoid (estrogen, testosterone and progesterone) environment of the body.

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Can alcohol consumption cause Gynecomastia?

Yes, alcohol can cause or worsen gynecomastia through the following mechanisms:

Alcohol related liver damage hampering hormone metabolism: Estrogen is metabolized in the liver and it helps in tightly regulating this female hormone. Alcohol related liver damage hampers its ability to metabolize estrogen causing its levels to increase leading to gynecomastia
Alcohol related testicular failure: causes decline in testosterone level. When this is combined with liver damage, the result is an increase in estrogen and decline in testosterone leading to feminization, including gynecomastia and female-like fat distribution.
Estrogen-like chemicals in certain alcohols: like beer and wine contain phytoestrogens (estrogen derived from plant sources) which acts like an external estrogen causing or worsening gynecomastia.

Hence it is important that you avoid excessive alcohol consumption and maintain healthy BMI to avoid or control gynecomastia.

How do I check if I have gyno? How to self test for gyno? How to check gynecomastia at home?

You can detect gynecomastia at home with a pinch test:

Stand in front of a mirror in a well-lit area, and remove your shirt for a clear view.
Stand up straight with your arms relaxed at your sides.
Using your thumb and forefinger, gently pinch the area around the nipple (the areola). Focus on the tissue just beneath the areola.

If you feel a firm lump or a rubbery consistency beneath the areola, this may indicate the presence of glandular (breast) tissue, which is characteristic of true gynecomastia.

If the tissue feels soft and spongy without any distinct lumps, it may suggest pseudo-gynecomastia, which is typically due to excess fat rather than glandular tissue.

How do doctors diagnose gynecomastia? What are the types of gynecomastia?

Gynecomastia is diagnosed and classified based on Simon’s and Rohrich’s classification system. Gynecomastia is graded on the followin parameters:

The size of the breast tissue
Excess skin
Drooping of the breast, medically referred to as ptosis

The easiest way to classify and diagnose gynecomastia is as follows:

HTML Table Generator

Parameter	Grade 1	Grade 2	Grade 3	Grade 4
Breast tissue	Small enlargement (<250 grams)	Moderate enlargement (350-500 grams)	Severe Enlargement (>500 grams)	Severe Enlargement (>500 grams)
Excess Skin	Not present	Not present	Minor skin excess	Severe skin excess
Droopiness (Ptosis)	Not present	Not present	Grade 1 (mild drooping)	Grade 2 or 3 (severe drooping). Resembles female breasts
Treatment	Removal of breast tissue only	Removal of breast tissue & fat	Removal of breast tissue, fat & skin	Removal of breast tissue, fat, skin and reshaping

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Are there any tests needed to diagnose gynecomastia?

Not in all patients, but for some patients the doctor may order the following tests under certain conditions:

Blood testing for hormones (male hormone profile): Our surgeon may order this test to know the underlying cause, especially if there are other associated symptoms like female body fat distribution, unexplained weight gain due to thyroid issues, etc.
Sonography or CT scan (imaging) in case the surgeon suspects that it is not gynecomastia but a tumor.
Biopsy for the tissue removed during the surgery may also be ordered if the surgeon suspects that there is abnormality in the excised tissue.

In most cases though these tests are not needed, unless the patient insists on understanding the underlying cause.

How do men fix gynecomastia? How to remove chest fat?

Treatment of gynecomastia is surgical and the surgical approach is determined by the grade of gynecomastia. Gynecomastia surgery is performed under general anesthesia, hence testing for patient fitness is mandatory to perform the surgery.

Prior to the surgery:

The surgeon will take detailed clinical history & do clinical evaluation with respect to diabetes, heart conditions, blood pressure and obesity. The fitness of the patient for anesthesia is determined using ASA criteria
After the surgeon has passed you for the ASA assessment, he or she will prescribe a basic blood test commonly called a surgical profile, which includes tests like complete blood count, viral infection screen, sugar, bleeding and clotting time.

During the surgery

You will be asked to stay on fasting for 8 hours prior to the surgery. So if your surgery is scheduled at 8 am, you will be asked to not eat anything after 12 midnight.
On your arrival to the clinic, you will be asked to change into a sterile dress and would be made comfortable with your surroundings.
The anesthetist might also ask you basic questions about your health. The anesthetist is another doctor, who will give you general anesthesia and monitors all your health vitals during the surgery
Once you are comfortable, the surgeon will ask you to stand up and he will do the markings on your skin, to guide the surgeon during surgery. Don’t worry these markings go off with water very easily
Then you are taken into the operation theater by the surgical team, after which the anesthetist will give you anesthesia. He will first give you an induction anesthesia, which is a simple injection. You will be asked to count from 10 to 1 to check your consciousness
Once the anesthetist has ensured that anesthesia is properly induced, he will give a go ahead to the surgeon to start the surgery
The surgery time is usually around 1 hour
After the surgery the anesthetist will bring you out of anesthesia and check for your well being.
After the surgery, you are moved into the recovery room, where one of the team member monitors you

After the surgery

You might feel a little queasy or nauseous for sometime due to the effect of anesthesia. Need not worry, you will be fine as the anesthesia medicine wears off
The surgeon would be giving you some fluids through intravenous path so that your body is well hydrated
After monitoring you for 4 hours and checking your well being the surgeon will go ahead for discharge
The surgeon will prescribe you some antibiotics and painkillers for you and explain how to take these medications
You can then go back home for day’s rest

Do read our recovery section for more details on recovery.

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Do you need an attendant to accompany you for gynecomastia surgery?

Preferably yes, as it is not recommended to drive after gynecomastia surgery. Since the procedure is done under general anesthesia, we recommend getting an attendant who can be a friend or a family member, who can accompany after surgery.

You do not necessarily need an attendant while coming for the surgery, but an attendant should be there preferably to be with you after the surgery and to drop you till home.

Which doctor treats gynecomastia? Which medical expert specializes in gynecomastia?

Gynecomastia and pseudogynecomastia are treated by plastic surgeons. These surgeons are trained to treat this condition as they can give scarless results and are trained to remove fat and excess skin.

Plastic surgeons are super specialists, who have done their MBBS, followed by a masters in General Surgery (MS General Surgery), followed by a 3 years super specialization in plastic surgery (MCh Plastic Surgery).

Is gynecomastia surgery risky? Is gynecomastia surgery worth it?

The overall chances of having any complications from the surgery is only 1-5%, many of which are not life threatening and manageable:

HTML Table Generator

Risk/Complication	Description	How common?	Ease of Treatment
Hematoma	Accumulation of blood under the skin, leading to swelling and bruising.	Uncommon (1-10%)	Easy (May require drainage)
Seroma	Fluid accumulation under the skin after surgery.	Uncommon (1-10%)	Easy (Usually requires drainage)
Infection	Bacterial infection at the incision site or deeper tissues.	Rare (Less than 1%)	Variable (Antibiotics or surgery)
Scarring	Visible or hypertrophic scars, which can sometimes be thick or raised.	Uncommon (Varies ~5%)	Moderately easy (Scar revision or treatments like steroids)
Asymmetry	Uneven contour or shape of the chest after surgery.	Uncommon (Varies ~5%)	Difficult (May require revision surgery)
Contour irregularities	Uneven or wavy appearance of the chest due to irregular healing or fat distribution.	Uncommon (Varies ~5%)	Difficult (May require revision surgery)
Poor wound healing	Delayed or inadequate healing of the surgical site.	Rare (Less than 5%)	Varies (May require wound care or revision surgery)

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Now given these complications, is the surgery worth it?

A survey by realself found very high satisfaction rates for gynecomastia surgery with 93% patients claiming the surgery to be worth it.

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A scientific quality of life study found a significant increase in satisfaction and quality of life across all measured domains, particularly in social functioning and psychological health.

There are many surveys and studies done on Gynecomastia with very high patient satisfaction.

Given such high patient satisfaction and relatively much lower risks, makes Gynecomastia totally worth the cost and time.

Is gyno surgery painful? Is gynecomastia surgery painful?

The healing timeline for gynecomastia is as follows:

First Week

Pain and discomfort is typical in the first week
There might be some discharge from the surgery site which is also normal
Since you would be wearing compression garment all the time during the first week, you might take time to get used to wearing it
You might feel weakness and fatigue which improves after the first 2-3 days
You have to completely avoid all strenuous activities, including going to the gym. But you are encouraged to walk around to help in healing and reduce the swelling
You will be called for your follow-up appointment on the 5th or 7th day, in which your stitches will be removed

Second Week

The pain would have reduced significantly
Typically there is no more fluid drainage in the second week
You will experience less soreness and you will be able to sleep on your side
You are advised to continue wearing the compression garment in the second week as well to help reduce swelling faster
Strenuous exercise is still to be avoided

Third Week

Congratulations, you have made it this far. You can now resume your regular routine and also discontinue wearing the compression garment
Resume only mild exercise like running and mild jogging. Avoiding stains like weight lifting etc.

Sixth Week

This is the week you achieve complete normalcy. You can now go to the gym and do all the sets. No restrictions whatsoever

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What is the risk of scarring after gynecomastia surgery?

There will be some amount of scarring after the surgery. The degree of scarring depends on 3 factors:

Surgical technique: Techniques that utilize smaller incisions, such as the intra-areolar approach, tend to result in less visible scars. Conversely, larger incisions can lead to more pronounced scarring. Surgeons often aim to place incisions in less visible areas, such as along the edge of the areola, to minimize visible scarring
Genetic factors and keloid tendency: Some patients may have a predisposition to develop more prominent or raised scars, known as hypertrophic or keloid scars. If you have a history of such scarring in the past, you must share it with the surgeon so that you can openly discuss the pros and cons of the surgery for making an informed decision
Post operative care: Improper post operative care such as infection or strain on the surgical site can lead to more severe or pronounced scars

Getting your surgery done from a trained surgeon and following proper post operative care is important to reduce the risk of scarring.

Avoid activities that strain the incision site and cause stretching on the incision site
Discuss using scar management techniques (like silicone sheets or gels) with the surgeon
Massage the scar using the prescribed scar cream to flatten and soften the scars over time

What is the recurrence risk of Gynecomastia?

The recurrence risk of breast tissue in particular is less than 5%, particularly if the tissue is removed completely.

It is important to note that while the breast tissue might not recur, if you do not maintain a healthy weight, then the pseudogynecomastia will recur due to fat deposition.

Hence maintaining a healthy weight and regular exercise is important after the surgery, so that you can maintain the contours of your chest that were achieved after the surgery.

Can gynecomastia be prevented? Are there any lifestyle changes that can prevent gynecomastia?

Regular exercise and maintenance of health weight: Obesity is an important risk factor for gynecomastia and a direct contributor for pseudogynecomastia. Maintaining a healthy weight is the most important lifestyle change to prevent gynecomastia
Avoid alcohol: Alcohol has a multi-pronged effect on gynecomastia, hence avoiding excess alcohol and chronic drinking is very important
Testosterone enhancing foods: While a healthy balanced diet is necessary for overall functioning of the body, certain foods have an testosterone enhancing effect:
1. Food rich in omega 3 fatty acids such as fish and eggs
2. Food rich in magnesium and zinc such as green leafy vegetables,
3. Flavonoid rich foods such as berries & citrus food and cocoa (ensure you have the sugar free cocoa products for benefits)

Can gym reduce gynecomastia? Can gynecomastia go away with exercise?

Okay, first let’s get something out of the way - regular exercise is necessary for a healthy body. But, can it cause gynecomastia to go away? Unfortunately the answer is not a simple yes or no. While pseudogynecomastia will certainly improve with exercise and weight loss, true gynecomastia will not resolve, as the breast tissue will not go away with exercise.

An important thing to note is that true gynecomastia has an underlying hormonal cause leading to breast tissue development and female-like fat distribution in the chest area. While exercise can help in improving hormonal balance it does not resolve gynecomastia.

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Can you remove gyno yourself? Can gynecomastia go naturally? Will increasing testosterone naturally reduce gynecomastia?

We have covered earlier the role of balanced diet, exercise and maintenance of healthy weight to control gynecomastia and pseudogynecomastia. As mentioned earlier gynecomastia in adolescents can resolve on its own as the hormones settle with age.

In this section we will cover facts on natural and ayurvedic remedies on gynecomastia. As we can see in the below table the evidence levels for ayurvedic treatment is not strong enough. Ayurvedic treatments can be used as supportive therapy, but surgery is the only proper cure for gynecomastia.

HTML Table Generator

Remedy	Mechanism of Action	Scientific Evidence	Evidence Strength
Turmeric (Curcumin)	Curcumin in turmeric is believed to reduce estrogen levels and inhibit aromatase enzyme, which converts androgens to estrogens.	Some animal studies show anti-estrogenic effects; human studies are limited.	Moderate, mostly anecdotal
Ashwagandha (Withania somnifera)	Adaptogenic herb that may reduce stress and lower cortisol levels, potentially reducing gynecomastia triggered by stress-induced hormone imbalances.	Limited studies suggest hormonal regulation effects, but not specific to gynecomastia.	Weak, needs more research
Guggul (Commiphora mukul)	May support thyroid function and metabolism, helping to reduce body fat, which can contribute to gynecomastia.	Some evidence in metabolic health, but specific effects on gynecomastia are not well studied.	Weak, indirect evidence
Shatavari (Asparagus racemosus)	Traditionally used to balance hormones; may modulate estrogen levels and support overall endocrine health.	Limited scientific studies, primarily in women’s health; indirect evidence.	Weak, gender-specific studies needed
Green Tea (Epigallocatechin gallate - EGCG)	Contains catechins, which may help reduce estrogen production and promote fat loss.	Some studies suggest anti-estrogenic effects; however, specific data on gynecomastia are lacking.	Moderate, needs direct studies
Triphala	A combination of three fruits (Amalaki, Bibhitaki, and Haritaki) that may detoxify the body and support fat metabolism.	Limited evidence on hormonal effects; more research needed on gynecomastia.	Weak, anecdotal evidence
Fenugreek (Trigonella foenum-graecum)	May reduce estrogen levels and boost testosterone, potentially helping with hormone balance.	Some studies suggest effects on testosterone; specific evidence on gynecomastia is limited.	Moderate, needs targeted research
Nigella Sativa (Black Seed)	Contains thymoquinone, which may have anti-estrogenic and anti-inflammatory properties.	Limited animal studies; human studies are needed to confirm efficacy for gynecomastia.	Weak, preliminary findings only

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