Management and Surgical Treatment of Gynecomastia

Gynecomastia affects a substantial proportion of males across the life span, arising from an imbalance between oestrogenic and androgenic activity that drives benign proliferation of glandular and adipose breast tissue. Initial assessment involves a thorough history, physical examination and targeted biochemical testing to exclude endocrine or systemic causes, followed by classification into severity grades to inform treatment. In mild or pubertal cases, reassurance, weight management and observation often suffice, whereas persistent discomfort or psychosocial distress may warrant pharmacotherapy with selective oestrogen receptor modulators or aromatase inhibitors. Surgical intervention is reserved for long-standing, high-grade or refractory gynecomastia and aims to restore chest contour and alleviate psychological burden. Contemporary practice employs liposuction, open subcutaneous mastectomy or combined techniques—frequently enhanced by ultrasound or endoscopic assistance—to minimise scarring and optimise symmetry. Treatment algorithms integrate grade, tissue composition and patient preference, achieving high satisfaction and low complication rates on a global scale.

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Management and Surgical Treatment of Gynecomastia publication trend

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Technical terms

Gynecomastia: Benign enlargement of male breast tissue characterised by proliferation of glandular and adipose components.

Simon’s classification: Grading system for gynecomastia severity based on breast prominence and skin redundancy (Grades I–III).

Liposuction: Minimally invasive technique that removes excess adipose tissue using a suction cannula.

Subcutaneous mastectomy: Surgical excision of glandular breast tissue beneath the skin while preserving the nipple–areola complex.

Endoscopic subcutaneous mastectomy: Minimally invasive glandular resection performed via small lateral incisions under endoscopic guidance.

Selective oestrogen receptor modulator (SERM): Agent that blocks or modulates oestrogen receptors in target tissues (for example, tamoxifen).

Aromatase inhibitor: Drug that inhibits conversion of androgens to oestrogens, reducing oestrogen-driven breast tissue proliferation.

References

1. Gynecomastia: physiopathology, evaluation and treatment. Sao Paulo Medical Journal (2012).
2. Incidence of Complications for Different Approaches in Gynecomastia Correction: A Systematic Review of the Literature. Aesthetic Plastic Surgery (2022).
3. Pediatric endoscopic subcutaneous mastectomy (pesma) with liposuction in adolescents with gynecomastia. Surgical Endoscopy (2022).
4. Gynecomastia: A systematic review of pharmacological treatments. Frontiers in Pediatrics (2022).