Gynecomastia Surgery in Pune

What is gynecomastia?

Gynecomastia (also spelt gynaecomastia) is enlargement of the glandular breast tissue in a man. It shows as a rubbery or firm disc under and around the nipple, often with extra fat across the chest. It is common: one Indian surgical series notes a reported prevalence of up to 36% of men. It can affect one side or both.

It is different from pseudogynecomastia, where the chest looks full because of fat alone and there is no firm gland. The difference matters, because fat responds to weight loss and liposuction, while gland tissue usually needs to be removed. Our guide to chest fat vs gynecomastia explains how to tell them apart.

Common causes include:

• Hormone changes in puberty and again after about 50, when the balance between oestrogen and testosterone shifts.
• Weight gain, which adds fat and increases oestrogen production in fat tissue.
• Medicines and substances, such as some prostate and heart medicines, anabolic steroids, some bodybuilding supplements, alcohol and cannabis.
• Medical conditions such as liver disease, kidney disease, an overactive thyroid or, rarely, a hormone-producing tumour.

In many men no single cause is found. That is called idiopathic gynecomastia.

What are the grades of gynecomastia?

Surgeons often describe gynecomastia with the Simon classification, which looks at how much the chest is enlarged and whether there is extra skin. The grade guides the type of surgery.

Grade	What it means	Usual surgical approach
1	Small enlargement, no extra skin	Gland excision, with or without liposuction
2a	Moderate enlargement, no extra skin	Liposuction plus gland excision
2b	Moderate enlargement with some extra skin	Liposuction plus gland excision; skin often tightens, a small skin excision may be needed
3	Marked enlargement with clear skin excess	Gland and fat removal with skin removal, which means longer scars

Our article on gynecomastia grades and which surgery each needs covers this in more detail.

Who may benefit, and how is suitability assessed?

Gynecomastia surgery is usually considered when the enlargement has been present for a long time and is stable, you are in good general health, your weight is steady, and the chest bothers you in daily life. Many men describe avoiding fitted T-shirts, swimming pools or gym changing rooms.

At consultation your surgeon will:

1. Take a history: when it started, whether it is growing or painful, your medicines, supplements, alcohol and any steroid use.
2. Examine you: feeling for a firm gland behind the nipple, checking for skin excess and comparing both sides. The testes, thyroid and abdomen may also be examined.
3. Arrange tests if needed: blood tests for hormones, liver and kidney function, or an ultrasound if a lump is one-sided, hard, fixed or growing.

A lump that feels hard, is fixed to the skin, or comes with nipple discharge or bleeding needs prompt medical assessment before anything cosmetic is discussed.

What are the treatment options?

Surgery is not the only answer for every man. The right option depends on the cause, how long the enlargement has been present, and how much is gland, fat and skin.

Option	What it involves	When it may suit	Limitations
Watchful waiting	Review over months	Recent swelling in puberty	Long-standing gland rarely shrinks
Treat the cause	Change a medicine, stop steroids, treat a medical condition	When a cause is found	Older, fibrous tissue may remain
Weight loss	Diet and exercise	Mostly fatty chest (pseudogynecomastia)	Does not remove firm gland
Medicines	Specialist-prescribed tablets for recent, painful enlargement	Selected recent cases	Not a standard cosmetic treatment; side effects
Liposuction alone	Suction removal of fat through small openings	Fat-predominant chest	Firm gland is often left behind
Liposuction with gland excision	Fat removal plus cutting out the gland	Most grade 1-2 cases	Small scar at the areola edge
Excision with skin removal	Removes gland, fat and extra skin	Grade 2b-3, loose skin	Longer, visible scars

How is gynecomastia surgery performed?

The steps below are typical. Your surgeon adjusts them to your chest.

1. Markings: the areas of fat and gland are marked while you stand.
2. Anaesthesia: general anaesthesia, or local anaesthesia with sedation for smaller cases.
3. Tumescent fluid: a dilute solution of local anaesthetic and adrenaline is injected to reduce bleeding and discomfort.
4. Liposuction: fat is removed through openings a few millimetres long, and the chest is contoured so the edges blend with the surrounding area.
5. Gland excision: the firm gland behind the nipple is cut out through a small incision along the lower edge of the areola. A thin layer is left under the nipple so it does not sink.
6. Skin adjustment: if there is marked loose skin, a planned amount is removed.
7. Closing and dressing: the wounds are closed, a drain is sometimes placed, and a compression vest is put on.

Most men go home the same day once they are comfortable and walking.

How should you prepare, and what should you ask?

• Stop smoking for several weeks before and after surgery, because smoking slows healing.
• Share a full list of medicines and supplements. Blood thinners, aspirin and some herbal products may need to be paused, but only on medical advice.
• Stop anabolic steroids and bodybuilding supplements that contain hormones.
• Arrange for someone to take you home and stay with you for the first night.
• Keep a loose shirt that buttons at the front ready for the day of surgery.

Useful questions to ask at consultation:

• What grade is my gynecomastia, and is it mostly gland or fat?
• Will you use liposuction, gland excision or both, and where will the scars be?
• Is skin removal likely to be needed?
• What anaesthesia do you recommend, and where will the surgery be done?
• When can I return to work, drive and go back to the gym?
• How will you handle a complication, and how do I reach you after surgery?

What is recovery like?

Recovery varies with the extent of surgery. This is a typical pattern for liposuction with gland excision.

Time after surgery	What to expect for most patients
Days 1-3	Soreness, tightness and swelling. Rest, short walks, painkillers as prescribed. Vest on day and night.
Week 1	Bruising peaks and begins to fade. Desk work is often possible after 3-5 days. Avoid lifting your arms above shoulder height for heavy tasks.
Weeks 2-4	Swelling reduces steadily. Light exercise and walking increase. Keep wearing the compression vest as advised.
Weeks 4-6	Gym and heavy lifting are usually resumed gradually from about a month, after your surgeon checks you.
Months 3-6	Most swelling has gone and the new chest shape is clear. Firm areas soften.
12 months	Scars have usually faded to their final colour and texture.

You will be seen for follow-up around day 25 and as your surgeon advises.

What are the risks of gynecomastia surgery?

All surgery carries risks. For gynecomastia surgery they include:

• Bruising and swelling, which are expected and temporary.
• Haematoma (a collection of blood) or seroma (a collection of fluid) under the skin, which may need draining.
• Infection, usually treated with antibiotics.
• Contour irregularities, such as a dip under the nipple if too much is removed, or a remaining bump if too little is removed.
• Asymmetry between the two sides.
• Changes in nipple sensation, usually temporary; rarely permanent.
• Scars that stretch, thicken or darken, particularly in skin that is prone to keloids.
• Reduced blood supply to the nipple or areola, which is rare.
• Recurrence of fullness with major weight gain or continued steroid use.
• Risks of anaesthesia, including rare reactions and blood clots.

Call your surgeon promptly if one side becomes much more swollen or tight, you develop a fever, spreading redness or discharge from a wound, or you notice calf pain or breathlessness.

What affects your results?

Results depend on the grade, your skin quality, your age and how stable your weight is. Younger skin usually tightens well after the gland is removed; older or stretched skin may need removal to get a flat chest. Wearing the vest as advised, avoiding anabolic steroids and keeping a steady weight all help the result last. Some minor asymmetry is normal, as it is in every chest.

What affects the cost of gynecomastia surgery in Pune?

The cost depends on your plan, so a fixed price cannot be given before examination. The main factors are:

• Extent: one or both sides, the grade, and whether skin needs removing.
• Technique: liposuction alone, or liposuction with gland excision.
• Anaesthesia: local with sedation, or general anaesthesia.
• Facility: the hospital or day-care centre and the length of stay.
• Tests and medicines: blood tests, ultrasound if needed, and medicines after surgery.
• Compression garments and follow-up visits.

Health insurance usually does not cover cosmetic male breast reduction. Our guide to gynecomastia surgery cost in Pune explains each factor. Many men with a fatty chest and little gland also ask about liposuction, which may be enough on its own.