What is gynecomastia surgery, and is it right for you?
The number of male plastic surgery patients is going up, and gynecomastia surgery (male breast reduction), in particular, is on the rise
It wasn't that long ago that celebrities passed off their plastic surgery as, "Oh, I'm drinking more water." Flash forward a decade or so, and John Cena is one of the many public figures who are talking openly about procedures they've had – Cena, for his part, had a hair transplant. There's been a definite "societal shift in attitudes towards plastic surgery," said Josef Hadeed, MD, FACS.
The more people talk about their own plastic surgery and post about it on social media, the more comfortable new patients are with seeking out plastic surgery procedures for themselves. We're realizing how transformative – for confidence, well-being and appearance – the right procedure can be for a patient. And with that, more men are getting plastic surgery than ever before. In 2024, 7 percent of all plastic surgery patients were men, representing a 1 percent increase over 2023, according to the ASPS Plastic Surgery Statistics Report.
"Men are starting to be more comfortable with talking about plastic surgery, or at least with seeking it out, because men want to look and feel just as good as women do," said Dr. Hadeed.
And as more men are becoming interested in plastic surgery, one procedure in particular is gaining attention. Gynecomastia surgery, also known as male breast reduction, experienced the sharpest growth of any procedure among male patients, who got 11 percent more gynecomastia surgeries in 2024 than in 2023. The second-fastest-growing cosmetic surgery among male patients was cheek implants, which saw a 3.6% year-over-year increase.
"It's the male and their chest," said Gregory Greco, DO, FACS, adding that there's the classic image of a man puffing out his chest with pride, and then there's the embarrassment that patients often talk about around their gynecomastia.
Gynecomastia – the medical term for male breast enlargement – can make the chest look more pronounced, and "with the highest-grade gynecomastia, it does look like men have breasts," said Dr. Hadeed. "Gynecomastia can be a cause of concern for a lot of guys who don't want to take their shirt off at the pool or the beach, or they're just very self-conscious about it even when they wear T-shirts."
This condition can be caused by a variety of different factors, including hormonal shifts with puberty or age, anabolic steroids or marijuana or alcohol use. And it can look different on different patients. For some, growth of glandular breast tissue creates a firm nodule behind the nipple, while others might experience fatty tissue growth that can resemble sagging breasts.
"For lack of a better term, it's the 'man boob,' which is lax skin and fatty tissue," said Dr. Greco.
Patients who have lost substantial weight, including on GLP-1s, might wind up with sagging skin on the chest.
"The gynecomastia patient often has two shirts on – they're always hiding their chest – [but] shirts don't hide it well," said Dr. Greco. "I think we're at a place where people can comfortably walk into a [plastic surgery] office where they see other patients like themselves, and they can have these procedures done. There's a comfort level."
It's born of other patients' openness about plastic surgery and made easier by how much easier it is to learn about the range of procedures that plastic surgery offers – ones that can make a real difference to a patient's quality of life and confidence.
Gynecomastia "can affect men at any point [in their lives], and [gynecomastia surgery] is definitely one procedure that is starting to become more out there for men, where men are starting to learn more about it," said Dr. Hadeed, explaining that men with gynecomastia are realizing, "they don't have to live with it. There's actually options available for them."
Male breast reduction "is a transformative procedure for pretty much every guy who has the procedure done," said Dr. Greco. "Anecdotally and patient-reported outcomes prove, too, that patients are usually very happy with this decision. They can wear their clothing comfortably and proudly, and there's a self-confidence that comes with it. I personally had a mother complain that her son never puts his shirt on anymore – he walks around the house constantly with his shirt off."
What is gynecomastia?
Gynecomastia is male breast enlargement that can be caused by an increase in glandular or fatty tissue, and may also include skin laxity or sagging in the area. Gynecomastia might be caused by hormonal shifts, certain medications, anabolic steroids or marijuana or alcohol use, and it can happen at any age.
"Often it's idiopathic, [meaning] we just don't know why it happens," said Dr. Greco.
Some plastic surgeons are also seeing a new cause: "Patients who have been on GLP-1s are noticing more saggy skin," said Dr. Hadeed.
That can cause a shift in the look of their chest.
"We're seeing so many people with hanging breasts secondary to massive weight loss, especially with GLP-1s," said Dr. Greco.
What is gynecomastia surgery?
Gynecomastia surgery creates "a more toned look, restoring what the chest is supposed to look like in a man, with a muscular shape and a tightened look," said Dr. Hadeed. "The whole goal of gynecomastia surgery is to take a more feminine-looking chest and restore it to a more masculine-appearing chest – that's really the whole purpose behind doing the procedure."
Standard gynecomastia surgery usually involves removing excess glandular tissue that's several centimeters beneath the breast, using liposuction to remove excess fatty tissue or removing excess skin that might be causing sagging in the area.
What can you expect during gynecomastia surgery?
There are a few different ways surgeons can perform this procedure, and their choice ultimately depends on the type of gynecomastia a patient has, which can sometimes be diagnosed with a physical exam and sometimes with an ultrasound.
Firm nodules caused by glandular breast tissue growth "typically have to be treated with an excision – we make a small incision [in the shape of] a half-moon around the brown portion of the nipple, and we can excise (remove) the tissue that way," said Dr. Greco. "Commonly, it's done in conjunction with some liposuction to kind of feather out the area" for a natural-looking result.
This fatty tissue caused by breast tissue growth is often treated with "liposuction alone – it's more than enough to take care of it," said Dr. Greco.
In Dr. Hadeed's practice, sometimes fat that has been liposuctioned from the chest is strategically injected back in and placed in the pectoral muscles "for some men – not everybody – who want a more muscular, more athletic look."
While reinjecting fat during gynecomastia surgery is not a mainstream procedure, Dr. Hadeed has been providing it for a couple of years now and finds that it can make the pec muscles look bigger and more defined.
"I do think it makes a noticeable difference in terms of what the chest looks like afterwards," said Dr. Hadeed. "It's that Superman chest."
When there's looseness of the skin, which could look like sagging or hanging breasts, that might be caused by significant weight loss, including on GLP-1s, "a lot of times those guys will need excision (removal) of the skin," said Dr. Hadeed, adding that sometimes the nipple might need to be removed and reattached during the procedure.
Options for mild laxity might look different.
"Sometimes we see guys where maybe the skin's a little bit loose – they may not necessarily need skin excision, but rather skin tightening with devices," said Dr. Hadeed.
The best candidates for skin-tightening devices, Dr. Hadeed explained, have "a very mild degree of skin laxity" and are okay with devices that give them "some degree of movement" on their lax skin, but he tells patients not to expect complete removal of laxity or sagging. With plasma skin tightening devices, for example, Dr. Greco estimated that patients "can probably expect 30 to 50 percent improvement in the area."
What is the typical recovery from gynecomastia surgery?
Again, it depends on the surgery you had, but with a "simple cut under the areola, you're talking about going back to work within a few days, and for more severe cases, sometimes it's two to three weeks before going back to work," said Dr. Hadeed. "As far as working out and going to the gym, depending on what procedure they had, it could be anywhere from a couple of weeks to sometimes a couple months before they can start working out, doing upper body exercises."
After surgery, patients can expect to wear a compression garment for "a bare minimum of six weeks, although a lot of times our patients voluntarily wear it for a longer period of time, just because it's a security blanket – they feel more comfortable in it," said Dr. Hadeed.
With simpler incisions, patients might shower two days after their surgery, and "there's very minimal care involved, other than proper scar management with silicone taping and massaging," said Dr. Hadeed. Patients who had larger incisions – for removal of significant excess skin, for example – might be sent home with drains that can stay in for about five to seven days.
Does gynecomastia come back after surgery?
No, gynecomastia should not come back after surgeries in which the cause of gynecomastia was diagnosed and treated, but there are exceptions.
"If you have a patient who uses anabolic steroids and you left glandular tissue behind, it could actually recur," said Dr. Greco. "If it's fatty tissue, it doesn't usually recur, unless there's massive weight gain."
Does gynecomastia surgery leave scars?
Any time you make an incision in the skin, you will have a scar, and the scars associated with gynecomastia surgery can vary from patient to patient, depending on the type of procedure.
Plastic surgeons will do their best to make scars as inconspicuous as possible, taking into account the placement of their incisions. For example, incisions made around part of the nipple "tend to camouflage pretty well, they're really not that noticeable," said Dr. Hadeed.
Removing excess skin from the chest can require a relatively larger incision, which can be made along the pec line. This can mean, "without a doubt, a scar that goes straight across your chest, so it's basically in the shape of where the pec muscle is – we kind of design it so it falls in that area, at the lower edge of the pec muscle," said Dr. Greco. "On some people, especially if they don't shave their chest, it looks wonderful, and on other people, it's visible."
Often, scars placed in the natural folds of the chest – curved so they follow the pec muscle – "tend to heal pretty well," said Dr. Hadeed. "You can see the scars, but you don't notice them that much."
Some patients are okay with a scar if it means reshaping their chest, while others might opt for skin-tightening devices that don't leave scars – even though their results aren't as significant as what you can get from surgery. These devices might also be used in conjunction with liposuction to remove fatty tissue from the area (liposuction can leave a smaller scar than skin excision).
It's important that your plastic surgeon talks with you about your tolerance for post-op scarring, explained Dr. Greco. And it's equally important to go only to a board-certified plastic surgeon qualified to perform gynecomastia surgery. You can use the ASPS Find a Surgeon tool to locate board-certified plastic surgeons near you.
To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.
