Besides the size growth of breast tissue, there may also only be increased fat present. If that is the case, this indicates a “false gynecomastia (pseudogynecomastia, lipomastia). Mostly, however, is a mixed form, so there is breast tissue and increased fat.
Most often true gynecomastia occurs in puberty (65%). During puberty, a young man’s hormone production in the testes begins. In addition to testosterone, the precursor hormon of estrogen -estradiol- is also produced. Often the estradiol raises faster than the testosterone concentration, thereby increasing existing breast tissue and, finally, a gynecomastia. After completing puberty, the breast usually reduces back to normal size although this may sometimes fail, despite normal hormone levels.
There are several causes that lead to the development of gynecomastia:
- physiological causes (at birth, at puberty, in old age)
- gynecomastia after massive weight loss
- disease-related causes (Gonad tumors, thyroid disorders, etc.)
- gynecomastia can be caused by taking medication and drugs (anabolic steroids, cytotoxic drugs, etc.)
- unknown causes
In 80% of patients with gynaecomastia vera and/or pseudogynecomastia there is unfortunately no medical explanation.
Men who notice the growth of their breasts should therefore consult a doctor, who should first clarify all the possible causes of a disease-related gynecomastia. This is essentially a detailed medical history and a specific blood test for the collection of the hormone status. Once pathological causes can be excluded, surgical correction can proceed.
The removal of the breast glandular tissue in true gynecomastia in Austria is paid for by the health insurance companies because men with breast glandular tissue, though much less than in women, can have breast cancer.
A correction surgery involves the removal of the breast glandular tissue and the existing fat. This is usually done together. Fat in the neighboring regions almost always has to be extracted for aesthetic reasons so that a smooth transition is ensured. This surgical step is often omitted, which leads, from an aesthetic point of view, much to be desired.
Unfortunately again, this part of the operation is generally not covered by the health insurance.
Of course, the severity of the gynecomastia is subject to strong individual variations, and the person concerned ultimately determines to what extent it interferes with their appearance and whether they wish for surgical correction.
1. What is a gynecomastia?
A true “gynecomastia” (gynaecomastia vera) refers to the presence of breast tissue in men. In addition, there may also only be increased fat present. If that is the case, this indicates a “false gynecomastia” (pseudogynecomastia, lipomastia). Mostly, however, is a mixed form, so there is breast tissue and increased fat.
2. What causes the development of gynecomastia?
There are several causes that may lead to the development of gynecomastia: physiological causes, after massive weight loss and disease-related causes. Gynecomastia can also be caused by taking medication and drugs and other unknown causes. Unfortunately in 80% of the cases, both gynaecomastia and pseudo gynaecomastia, there are no medical explanations.
3. How many men are affected by gynecomastia?
In 50% of all men breast tissue can be found behind the areola. 1-2% of those affected have seen enlarged breasts.
4. Why do bodybuilders often suffer from a gynecomastia?
Bodybuilders often take anabolic steroids to support muscle increase . These are hormone-like substances that are similar to testosterone or its precursors. The way how gynecomastia develops in bodybuilders by anabolic steroids is relatively simple: the body tries to compensate for the increased testosterone levels and therefore increases the production of estrogen, which stimulates the growth of breast glandular tissue.
5. What surgical methods are there?
With small development and young age, the removal of the breast glandular tissue alone might often be enough. Additionally, if there is surplus of skin and more fat present, this must also be removed. Almost all patients require liposuction in the neighboring regions to improve contours and, in this sense, provide for an aesthetically pleasing result.
6. Can gynecomastia occur again after intervention?
If the complete removal of breast tissue can be achieved during surgery, a recurrent is ruled out. It is different with the fat: since not all fat cells can be removed, a new increase in breast size especially in case of weight gain of more than 5kg is unfortunately possible.
7. Does the health insurance cover the costs for the surgery?
The removal of the breast glandular tissue in true gynecomastia in Austria is paid for by the health insurance companies because men with breast glandular tissue, though much less than in women, can have breast cancer. Any necessary completing liposuction is unfortunately rarely covered.
8. What complications can occur?
Medical risks can include infection and bleeding, however; if surgery is properly performed, both are extremely rare. Aesthetic complications include asymmetry, steps and wrinkles and unsightly scars. Aesthetic complications can almost always be completely corrected.
9. Where are the scars after gynecomastia-surgery?
In less severe cases, the scar is small semicircle at the bottom of the areola to the border of the surrounding skin. In more severe cases, the scar runs around the areola. In severe cases the incision must be further extended laterally, the scar stretches out a few centimeters over the areola area.
10. When is one “operational” after gynecomastia surgery?
This depends largely on the extent of the operation (if tightening or a complementary liposuction is necessary). In general, it is back to normal after 7-10 recovery days.
11. Should I wear compression garment after the operation?
If concomitant liposuction was performed, the wearing of compression garment for the duration of 4-6 weeks is recommended. The compression underwear reduces bruising and supports the tissue to allow the skin to adjust to the new, reduced volume ratios better.
12. What are the long-term results after gynecomastia surgery?
Keep weight fluctuations less than 5 kg and long term results in general are excellent.
The first consultation takes up to 30 minutes and costs EUR 180. For consultations lasting longer than 30 minutes EUR 250 will be charged. All other consultations are free of charge.
If you purchase the Enzyklopaedia Aesthetica book “Gynäkomastie” (Gynaecomastia) ( EUR 34.90 ) the first consultation is free of charge! You can purchase the book during your first visit in the ordination or order it online.
Surgical preparation for performing the procedure under local anesthesia
For public health reasons, a blood test (so-called “small laboratory blood”) is necessary, including HIV and hepatitis A, B, C as well as a mammography and ultrasound. If you are insured in Austria and the procedure is medically indicated, there are no additional costs.
Surgical preparation for performing the operation under general anesthesia
The surgical preparation includes a blood test (so-called “complete blood count”), chest X-ray, mammography, ultrasound and a surgical release by a general practitioner or internist. If you are insured in Austria and the procedure is medically indicated, there is no additional cost. The same applies to the OP-release by an internist or general practitioner, who holds a contract with the usual social security institutions in Austria. When you choose your own doctor the insurance will cover about 50% of the cost.
Hospital stay – a day clinic or outpatient (no overnight)
EUR 700 – 1.500, – depending on duration of operation and hospital
Hospitalization – inpatient (overnight)
EUR 900 – 3.500,- depending on duration of operation, number of nights, room type (suite, single, triple) and hospital
If the surgery is performed under general anesthesia, an anesthesiologist is needed for surgery. The cost of anesthesia varies depending on the duration of the operation and is between EUR 300 – 800. An average cost of EUR 500-700 is to be expected.
Depending on the complexity and scope of the operation, there is a surgical fee of between EUR 1.200-5.000. On average a fee of EUR 2.800-3.500 is to be expected.
Visits are included in the surgical fee.
When Liposuction has been performed it is recommended to wear compression underwear. The compression garment eases bruising, supports the tissue and the skin adjusts better to the new, reduced volume. Depending on the make and design costs are between EUR 90-150.
Check-ups are included in the surgical fee.
Gynecomastia surgery should always be performed in an ISO-certified operating room of a hospital.
For a period of 14 days before the operation, clotting drugs (aspirin, Marcoumar, vitamin E, etc.) should be avoided as this can delay blood clotting. Also alcohol and sleeping pills should be avoided as far as possible, because they reduce the coagulating ability of the blood and thus increase the risk of bleeding. The consumption of cigarettes should be reduced to a minimum as much as possible. Nicotine has a vasoconstrictive effect, which can lead to impaired wound healing.
For surgery under local anesthesia, the following tests should be conducted:
- Preoperative complete blood count including blood type, HIV and hepatitis A, B, C
For surgery under general anesthesia, the following additional tests are needed:
- Lung X-ray and ECG
- Complete blood count, blood type, HIV testing and hepatitis A, B, C
- Surgical release by a general practitioner or internist
Please note that the results may not be over 10 days old at the time of surgery. Please bring the X-ray and all the findings for surgery.
For the smooth processing of admission, please arrive at the hospital at least 2 ½ hours BEFORE the surgery and be six hours sober at the time of surgery. After completing the admission formalities you will be placed in your room. At your request, you will receive an infusion which reduces your thirst.
In a gynecomastia surgery under general anesthesia there will be a hospital stay of up to two nights.
- OP-date plan
- OP-date set (take vacation, compensatory time or sick leave, arrange for child care if necessary, etc.)
- Two weeks before the surgery, complete the necessary preoperative exams (mammography, ultrasound, blood lab, X-ray, ECG, surgical release)
- A preoperative interview will take place the day before the surgery. It will assess the findings, discuss final details, sign the consent form and choose the appropriate compression garment. An instruction sheet will be given to you by the assistant to complete and bring to the hospital. Planing of the 1st follo-up visit.
Arrive at the hospital 2.5 hours before surgery to complete admission formalities. If requested, an assistant can accompany you to help shorten the time before the surgery.
- Discharge from the hospital usually happens one to threa days after surgery. Please do not drive yourself. Take a taxi or let yourself be picked up.
- At home, relaxation and recovery should be in order. Avoid strenuous activities
- 1st Follow-up Visit (about 5-7 days after surgery) Change of bandages
- 2nd Follow-up Visit (approximately 10 days after surgery): Removing the stitches
- 3rd Follow-up Visit (approximately 20 days after surgery)
- 4th Follow-up visit (approximately 30 days after surgery)
- Further follow-up visits will take place one, two and six months after
- Final follow-up control after one year