Gynecomastia is a medical condition generally referred to as “man-boobs”. It is a common issue that many men face. Gynecomastia is the enlargement of the chest area which often might resemble a woman’s breast. It can be either due to the breast gland tissue being enlarged or due to the accumulation of fat tissue (often termed as pseudo-gynecomastia). Mostly it affects both the breasts, but sometimes Gynecomastia may be present unevenly on either breast.

There are various reasons that can cause Gynecomastia. Here are some of them:

1. Primary (physiological) Gynecomastia: Generally, physiological gynecomastia can be observed in boys hitting puberty. In this case, it is referred to as primary Gynecomastia and generally affects the age group of thirteen to seventeen. This may happen due to hormonal imbalance. There are chances that the secretion of Estrogen, often termed as the female-hormone (present in males in smaller quantities) might surge during puberty. This results in gynecomastia in teenagers or adolescent boys.

2.Secondary (pathological) Gynecomastia: In case of middle-aged men, Secondary (pathological) Gynecomastia can be observed. The secretion of testosterone decreases as a man ages thus increasing the amount of estrogen in the body. This causes hormonal imbalance. This hormonal imbalance results in secondary Gynecomastia. Men with issues like liver cirrhosis, kidney issues, thyroid, cardiovascular issues, use of excessive anabolic medications taken by bodybuilders, etc. are more prone to secondary Gynecomastia.
Although noticed primarily in boys and men, it is also sometimes seen in infants who still have their mother’s estrogen present in their body. However, this is temporary and the enlarged part wanes away after a few weeks.
Excessive use of alcohol and drugs like marijuana, opium, etc. often results in Gynecomastia.

Another reason for the enlargement of the chest in men is obesity. This causes the accumulation of fat in the chest area altering the appearance of the chest. This is often termed as Pseudo-gynecomastia.

Gynecomastia generally feels like a rubbery mass below the nipple area. A general swelling can be noticed bilaterally, or in certain cases unilaterally as well. This swelling may or may not be even. It is often painless. 
However, some tenderness or sensitivity can be observed in the particular area. If you notice any of these signs, you must visit a doctor at the earliest. When you consult a doctor, you might be asked to run a few tests or go for a mammogram to rule out any chances of male breast cancer.

Gynecomastia surgery is a surgical procedure that can cure primary or secondary Gynecomastia. The surgery involves the extraction of excess glandular tissue and fat. The Cosmetic Surgeon will also contour the chest to match the patient’s physique proportionately. More details on how Gynecomastia Surgery is performed will follow in the section “What Happens During The Procedure?”.

Dr Shree Harsh of Pinnacle Cosmetic Clinic, Lucknow, lists the following criteria for an ideal Gynecomastia surgery candidate:

1. The candidate must be a male who is above 18 years of age suffering from Gynecomastia.
2. The candidate is overall physically healthy.
3. The candidate is suffering from psychological distress due to Gynecomastia.
4. The candidate must be a non-smoker or must quit smoking for a brief period before the surgery, according to the doctor’s instructions.

It is also necessary for the candidate to have practical expectations from the surgery. Often having unrealistic expectations from the Gynecomastia surgery can lead to disappointment later. 
Although this condition is not grave enough to cause harm to the life of an affected person, it can cause tremendous psychological distress that is associated with being perfect physically.

Gynecomastia procedure is not just a cosmetic procedure. It is a surgery that is resolving a medical issue which affects not only the patient’s physique but also his mental wellbeing. Therefore, choose your doctor wisely. 

Following are some pointers that might help you in your decision:

1. First of all, as per the Indian Medical Association, the qualifications of the doctor should be  M.Ch in Plastic Surgery to perform a Gynecomastia procedure.
2. Experience is another factor that must be taken into consideration when choosing a doctor. The higher the number of years of experience, the easier it is to trust the surgeon.
3. Check what technology is available with the doctor and how well equipped his clinic is. If the doctor is using the latest technology then probably the results will be better and natural-looking.
4. Review the testimonials of past patients. Most patients post their reviews on social media pages or Google or even the website of the doctor. Go through them to understand the quality of his/her work and what the ultimate results look like.
5. The cost of Gynecomastia surgery with the doctor you choose will also play a major role in choosing the right doctor for you. Depending on the amount of money you are ready to spend, choose a surgeon who falls in your budget range.
6. A vital element that is often not listed, is your personal equation with the doctor. It is very important that you feel comfortable with the surgeon and trust his judgement and course of action.  This comfort level is intangible and cannot be measured, but it does affect your choice and your ultimate happiness.

The consultation is an important time for both the doctor and the patient. It is a one-on-one meeting where the doctor will thoroughly examine you, understand your problems and set realistic expectations for the course of the treatment. 
Dr Shree Harsh of Pinnacle Cosmetic Clinic, Lucknow, urges the patient to ask the doctor all their queries during the consultation. He believes it is the best time to get everything clearly sorted out for both the doctor and the patient. 
Here are a few questions that you should ask before the surgery:

1. Am I the right candidate for the procedure?
2. What will the outcome of the surgery be?
3. What are the risks or complications that might occur during the procedure?
4. Are there any regulations that must be followed in order to avoid the risks?
5. What will be the duration of the surgery and of the stay after that?
6. What are the pre-operative and post-operative precautions that must be taken?
7. Is the solution through surgery permanent and what care must be taken to maintain the result of the procedure? 

Before the procedure, the doctor might ask you to run a few routine blood and urine tests to ensure that you have no other pressing medical issues. 
You may be asked to stop any of the daily medication that you have been taking if it will adversely affect the Gynecomastia surgery.  
Avoiding the intake of nicotine in any way before the surgery is a must to omit any risks that might come up either before, during or after the surgery.  

Gynecomastia Surgery is generally performed under local or general anaesthesia along with sedation. For the extraction of the glandular tissue, the procedure involves making a small incision on the margin of the nipple-areolar complex. The areola is the pigmented area on the chest around the nipple. 
The incision, after healing, blends with the areolar complex thus avoiding the issue of visible scarring. In cases of large male breasts, skin excision is required. After the tissue is extracted, the surgeon makes sure that the contour line that is being sculpted looks natural on the body of the patient.
Gynecomastia surgery also involves Liposuction which is the removal of excess fat tissue from the area. Liposuction is generally performed in case of Pseudogynecomastia to achieve a smooth, flat chest. However, in many cases, the enlarged glandular tissue and fat tissues are found together which requires surgery through both the methods: excision and liposuction.
Once the cosmetic surgeon performs the excision and liposuction, he will close the incision with sutures, gel and surgical bandages. 
The doctor may leave a drain pipe in to remove any excess fluid from the system.

The recovery process after the surgery is generally easy and relaxed. A patient is given a compressor garment to counter the swelling and help in healing the tissues. This garment should be worn mandatorily in order to speed up the recovery process. Also, this garment helps in maintaining the new shape of the chest. 
Your cosmetic surgeon also might give medications in order to combat the discomfort or pain that accompanies the healing process. Generally, patients are barred from doing any vigorous exercises for a few days after the surgery. Patients can start with their routine schedule after a few weeks comfortably.
The results are long-lasting and scarring is minimal. You can start seeing the difference within the first two weeks itself. 

Gynecomastia surgery is a very safe and trusted process. The complications are rarely seen in real life. However, even when utmost care is taken, complications are sometimes unavoidable. 
The risks that involve the surgery include:

1. Excessive bleeding from the incisions
2. Swelling
3. Numbness in the nipple area
4. Loss of sensation in the areola or the nipples which might be temporary or permanent
5. Misalignment of the chest contour.

The cost of the procedure greatly depends on the amount of fat to the removed, the condition of the glandular tissue and sculpting to be needed. 
At Pinnacle Cosmetic Clinic in Lucknow, our charges for Gynecomastia Surgery without skin reduction range from INR 35,000 to INR 55,000. In case the patient requires the procedure with excess skin reduction then we charge INR 60,000 for the surgery. 

In most of the cases, no insurance covers gynecomastia surgery because it is a cosmetic medical procedure. 

Gynecomastia surgery is not just a safe and trusted process but also an effective solution to battle Gynecomastia (primary and secondary).  It helps in getting rid of the excessive glandular/fat tissue to give a smooth, masculine appearance to the chest. 
Most importantly, no need to feel awkward going shirtless on the beach once you achieve that perfect, chiselled chest. 
We hope this blog helped you in understanding Gynecomastia and the Gynecomastia surgery. In case you have any further queries Dr Shree Harsh will be happy to help you. Send in your doubts at pinnaclepswh@gmail.com