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Gynaecomastia: Causes, Tests, Treatment & Male Breast Reduction

  • Prof. Dr. Zahid Mahmood
  • August 7, 2026

Gynaecomastia: Causes, Tests, Treatment & Male Breast Reduction

Medically reviewed by Prof. Dr. Zahid Mahmood, MBBS, FCPS — General, Laparoscopic & Laser Surgeon, Lahore.

Gynaecomastia—also spelled gynecomastia—is benign enlargement of glandular breast tissue in a male. It may affect one or both sides and can cause tenderness, embarrassment or difficulty with clothing and physical activity.

Gynaecomastia is common and is usually not cancer. However, a new breast lump, particularly if hard, off-centre or associated with nipple or skin changes, must be assessed properly.

What happens in gynaecomastia?

Male breast tissue responds to the balance between oestrogen activity and androgens such as testosterone. Glandular tissue may grow when this balance shifts toward oestrogen effect, even when individual hormone levels are not dramatically abnormal.

The typical finding is a rubbery or firm disc of tissue centred beneath the nipple and areola. Recent, rapidly developing gynaecomastia may be tender.

Gynaecomastia versus chest fat

True gynaecomastia contains enlarged breast gland tissue. Pseudogynaecomastia or lipomastia is enlargement mainly from fatty tissue, often associated with overweight or obesity. Many patients have a mixture of both.

Weight loss can reduce chest fat but usually does not remove established fibrous glandular tissue.

Common life stages

Newborn period

Temporary breast enlargement can occur because of maternal hormones and usually resolves without treatment.

Puberty

Pubertal gynaecomastia is common and often improves spontaneously within one to two years. Reassurance and follow-up are appropriate when examination is typical and there are no concerning features.

Older age

Age-related reduction in testosterone, increased body fat, medicines and medical conditions make gynaecomastia more common later in life. New enlargement in an older man should be assessed rather than attributed to age alone.

What causes gynaecomastia?

Possible causes include:

  • Normal hormonal change during puberty or ageing
  • Overweight or obesity
  • Low testosterone or testicular failure
  • Overactive thyroid
  • Chronic liver or kidney disease
  • Certain testicular, adrenal or other hormone-producing tumours
  • Klinefelter syndrome and other uncommon endocrine conditions
  • Heavy alcohol use
  • Anabolic steroids or testosterone used without medical supervision
  • Cannabis and some other recreational substances
  • Medicines that alter hormone action or metabolism

In many patients no single cause is found. This is called idiopathic gynaecomastia.

Medicines that may contribute

Examples include some treatments for prostate disease or cancer, spironolactone, certain heart and blood-pressure medicines, some psychiatric medicines, anti-ulcer medicines, antifungal or antiviral drugs and anabolic steroids.

Do not stop a prescribed medicine yourself. Your doctor must balance its benefits against the likelihood that it is causing the breast enlargement and decide whether an alternative is safe.

Symptoms

  • Enlargement beneath one or both nipples
  • A rubbery or firm disc of tissue under the areola
  • Tenderness or sensitivity, particularly in recent cases
  • Puffy or projecting nipples
  • Unequal breast size
  • Emotional distress, self-consciousness or avoidance of sport and fitted clothing

Warning signs that require prompt assessment

See a doctor promptly if you notice:

  • A hard, irregular or fixed lump, especially away from the nipple
  • Skin dimpling, ulceration or nipple retraction
  • Bloody or clear nipple discharge
  • A lump in the armpit
  • Rapid unexplained enlargement
  • A testicular lump, pain or change in size
  • Unexplained weight loss or serious illness

Male breast cancer is rare, but it must be excluded when clinical features are suspicious.

How is gynaecomastia diagnosed?

Assessment includes:

  • Age at onset and duration
  • Pain, rate of growth and whether one or both sides are affected
  • Prescription medicines, supplements, gym products, steroids, alcohol and recreational drugs
  • Symptoms of low testosterone, thyroid, liver or kidney disease
  • Family history of breast or ovarian cancer
  • Breast, lymph-node and testicular examination
  • Assessment of body weight and distribution of chest fat

A typical longstanding case may need no extensive investigation. New, painful, rapidly growing, one-sided or otherwise unexplained enlargement is more likely to require tests.

Blood tests and scans

Tests are selected according to age, history and examination. They may include:

  • Testosterone, luteinising hormone and sometimes follicle-stimulating hormone
  • Oestradiol and beta-hCG when clinically indicated
  • Thyroid, liver and kidney function
  • Prolactin in selected patients
  • Breast ultrasound or mammography if the diagnosis is uncertain or cancer is suspected
  • Testicular ultrasound when examination or hormones raise concern
  • Needle biopsy of a suspicious breast mass

Tumour markers or hormone tests must be interpreted in clinical context; an abnormal result does not by itself establish the cause.

Does gynaecomastia go away by itself?

Pubertal gynaecomastia often resolves spontaneously. Enlargement caused by a medicine or medical disorder may improve when the cause is corrected. Recent glandular growth has a better chance of regression than longstanding tissue that has become fibrous.

Observation is reasonable when examination is reassuring, the cause has been addressed and symptoms are mild.

Lifestyle measures

  • Lose excess weight gradually if overweight.
  • Avoid anabolic steroids and unregulated bodybuilding products.
  • Limit alcohol.
  • Do not use hormones without medical supervision.
  • Review medicines with a doctor rather than stopping them independently.
  • Exercise for general health and chest contour, while recognising that exercise cannot remove firm glandular tissue.

Can medicine treat gynaecomastia?

Medical treatment may be considered for selected patients with recent, painful or progressive gynaecomastia after serious causes have been excluded. Tamoxifen has the best evidence among commonly used medicines for acute idiopathic gynaecomastia, but it is not suitable for everyone and should only be prescribed and monitored by an experienced clinician.

Medicines are less likely to shrink longstanding fibrous tissue. Testosterone is appropriate only for confirmed deficiency and does not reliably reverse established gynaecomastia.

When is surgery considered?

Surgery may be appropriate when:

  • Enlargement persists after puberty or observation
  • The underlying cause has been treated but the breast remains enlarged
  • There is pain or tenderness
  • The condition causes substantial psychological or social distress
  • Clothing, sport or daily activity is affected
  • Medical treatment is inappropriate or unsuccessful
  • Tissue diagnosis is required because cancer cannot be excluded

In adolescents, surgery is generally deferred until breast development is stable and puberty is substantially complete, unless there are exceptional circumstances.

Types of gynaecomastia surgery

Liposuction

Liposuction removes excess fatty tissue through small openings. It is useful when fat is a major component but cannot reliably remove a dense gland beneath the nipple.

Gland excision

Firm glandular tissue is removed, commonly through an incision at the lower edge of the areola. A thin layer may be preserved beneath the nipple to reduce the risk of a hollow or stuck-down appearance.

Combined liposuction and excision

Many patients need both techniques to create a smoother chest contour.

Skin reduction

Large breasts with significant loose skin may require removal and repositioning of skin and the nipple-areola complex, resulting in longer scars.

Possible complications of surgery

  • Bleeding or haematoma
  • Infection
  • Seroma
  • Uneven contour or asymmetry
  • Visible or thickened scars
  • Numbness or altered nipple sensation
  • Under-correction or excessive tissue removal
  • Nipple retraction, skin injury or impaired blood supply
  • Need for revision surgery
  • Recurrence if the underlying cause persists

Recovery after surgery

Most patients go home the same day or after a short stay. A compression garment is often used to reduce swelling and support the new contour. Bruising, tightness and soreness improve gradually over several weeks.

Walking is encouraged early. Return to desk work is often possible within several days to two weeks, depending on the procedure and discomfort. Heavy lifting, gym training and strenuous chest exercise must wait until the surgeon confirms healing.

Seek advice for rapidly increasing swelling, severe pain, fever, wound discharge, marked redness, breathing difficulty or a darkening nipple or skin area.

Can gynaecomastia return?

Recurrence is uncommon after adequate surgery if the cause has been corrected. Continued anabolic steroid use, untreated hormone disease, weight gain or a causative medicine can lead to renewed enlargement.

Key message

Gynaecomastia is benign enlargement of male breast gland tissue and is commonly related to puberty, ageing, medicines, weight or hormonal conditions. Proper examination distinguishes it from chest fat and identifies warning signs for cancer or endocrine disease. Observation, treatment of the cause, selected medical therapy and surgery are available according to duration, symptoms and patient goals.

Gynaecomastia assessment and surgery in Lahore

Prof. Dr. Zahid Mahmood can assess male breast enlargement, arrange appropriate investigations and discuss observation, gland excision, liposuction or combined treatment.

For an appointment, call 0300 413 0159 or visit professorzahid.com.

This article provides general education and does not replace individual assessment. A hard fixed breast lump, nipple bleeding, skin dimpling or a testicular lump requires prompt medical review.

Medical references

  1. Williams NS, O’Connell PR, McCaskie AW, editors. Bailey & Love’s Short Practice of Surgery. 28th ed. CRC Press; 2023. Chapter 58, “The breast,” pp. 935–964.
  2. Swerdloff RS, Ng JCM. Gynecomastia: Etiology, Diagnosis, and Treatment. Endotext. Updated 2023.
  3. European Academy of Andrology. Clinical practice guidelines—gynecomastia evaluation and management.
  4. NHS. Male breast reduction for gynaecomastia.

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