Gynecomastia Surgery in Uberlândia, Brazil

No — in some cases, especially when the cause is recent and hormonal, it may be monitored clinically before surgery is indicated.

Diet and training reduce chest fat and do improve the picture when the predominant component is fatty. What they cannot do is remove glandular tissue: the gland does not respond to a calorie deficit or to exercise, and it often becomes more visible after weight loss, because it loses the fat that was disguising it — which is why lean, well-trained men arrive with this complaint. No cream, tea, supplement or device dissolves the gland. Where a cause is identified — a current medication, an anabolic steroid, a hormonal condition — the first step described in the guidelines is neither surgery nor medication: it is to stop or treat that cause and observe, since a proportion of cases regress in that interval. Drug treatment of gynecomastia itself is not recommended in general by European andrology guidance, and testosterone replacement is indicated only where deficiency is proven; any attempt on that front is led by a general physician or endocrinologist, not by the surgical team. Once the glandular disc is established and fibrotic, surgical removal is the described route for taking it out.

Lipomastia and pseudogynecomastia describe the same thing: increased chest volume from fat, with no glandular proliferation. True gynecomastia has a disc of glandular tissue behind the areola — firm, more clearly bounded than the surrounding fat, mobile over the muscle and often tender to pressure. On examination, pinching the area between the fingers allows the edge of that disc to be felt; in pure fat the consistency is uniform and continues without a clear border toward the armpit and flank. Ultrasound helps confirm the picture when examination is inconclusive. The distinction changes the operation: fat alone may respond to liposuction, whereas the glandular disc has to be excised — removing that disc is what is called a subcutaneous mastectomy — because it cannot be aspirated. In practice the two components usually coexist in differing proportions.

It is common. Bilateral gynecomastia is the more frequent presentation, but it is almost never symmetrical — one side tends to have more volume, more projection or a larger areola, and that difference should be documented before surgery, because resection is planned side by side and some degree of asymmetry can persist. The unilateral form exists and is not in itself a sign of a problem. What does deserve different attention is a one-sided lump that is hard, fixed, off-center from the position behind the areola, or that comes with skin retraction, nipple change or discharge: in that scenario imaging investigation comes before any aesthetic planning.

Surgical time varies according to the technique used and the proportion of glandular tissue to fat, and is estimated more precisely during the consultation.

Yes. The classification most used in the literature (Simon) describes four situations: grade I — small enlargement, no excess skin; grade IIa — moderate enlargement, no excess skin; grade IIb — moderate enlargement with excess skin; and grade III — marked enlargement with excess skin. The grade guides the technique: in the earlier grades, removing the glandular tissue and, when needed, local fat is usually enough; in grades with excess skin, skin resection and repositioning of the areola may also be required. Each case is classified on physical examination at the consultation.

No. The approach is discharge the same day, a few hours after the operation, once pain is controlled and you have recovered from the anesthetic — and always accompanied. The surgery is carried out in an operating theatre with an anesthesiology team, and recovery happens at home. Whether you go home the same day or stay overnight is always assessed case by case, according to the extent of the surgery, the anesthesia, whether other procedures are combined and your pre-operative assessment — and it is defined before the surgery, not on the day. That same decision determines the venue: procedures with same-day discharge are performed in the operating theatre of Healme Clinic itself, and those requiring admission in the operating theatre of the UMC Hospital — in the same complex, with no travel between sites.

There are two sets. The first is the general preoperative work-up requested for any operation under anesthesia: full blood count, coagulation screen, blood glucose, renal and liver function and, depending on age and history, an ECG with surgical risk assessment. The second is the investigation of the cause of the gynecomastia, and it does not depend on the history being suggestive — European andrology guidance is to investigate even when an apparent cause is already known, including a medication recognized as associated with it, since in adults investigation uncovers an underlying condition in about half of cases. That part is led by a general physician, endocrinologist or urologist, who will usually request and interpret measurements such as testosterone, estradiol, SHBG, LH, FSH, TSH, prolactin, beta-hCG and alpha-fetoprotein, and will review current medication and supplements, since several are associated with the condition. The same guidance has that investigation begin with the physical examination, including assessment of the genitalia to rule out a testicular tumor and testicular atrophy, supported by testicular ultrasound, because palpation alone has low sensitivity. On the surgical side, breast ultrasound is used to measure the glandular component and distinguish it from fat; mammography is added when a lump has features that call for investigation. The final list is individual and is given at the consultation.

General anesthesia is generally used, sometimes combined with sedation depending on the extent of the procedure and the pre-anesthesia assessment.

Most cases are performed under general anesthesia, sometimes combined with sedation depending on the extent of the procedure and the pre-anesthetic assessment. Under general anesthesia the airway is always controlled — either with an endotracheal tube or with a laryngeal mask, a device that sits at the entrance of the larynx without passing the vocal cords. Choosing between them is the anesthesiologist's decision and depends on the expected duration, your position on the table, your respiratory history and whether liposuction is combined. Monitoring is continuous throughout, whichever is used. What settles this is the pre-anesthetic assessment carried out before surgery — that is the appointment in which you can ask exactly which technique will be used in your case.

Pain is usually described as moderate and concentrated in the first 48 to 72 hours — more a sensation of tightness, weight or burning across the chest than sharp pain. It is worse when raising the arms, coughing or pushing up out of bed, and it is managed with the prescribed analgesia; the compression garment also helps, because it limits movement of the operated tissue. From the third or fourth day the need for medication usually drops considerably, while discomfort on arm movement tends to linger for one to two weeks. This is not a pain-free procedure: pain is treated on a planned schedule from the operating room onward.

Tenderness on pressure is characteristic of glandular tissue and is one of the signs that distinguish it from fat. In the early phase, while the gland is proliferating, its growth stretches the surrounding tissue and leaves the area behind the areola sensitive — hence the pain when pressing on it, lying face down, or from clothing rubbing. After some months the tissue tends to become more fibrous and less tender, which does not mean it has resolved. Pain or tension that appears and increases in someone who trains calls for attention to the cause before the mechanics: recent tenderness behind the areola usually signals active hormonal stimulation, and reviewing the use of anabolic steroids, prohormones and supplements comes first. Exertion can make the area uncomfortable, but it does not explain a picture that is growing. Back pain is not a typical gynecomastia symptom and deserves its own investigation. Any persistent one-sided pain should be assessed before surgery is considered.

Relative rest is recommended in the first days, avoiding strain and wide arm movements, with a gradual return to activity guided by the surgeon.

It depends on the type of activity — low-effort roles are usually resumed sooner than jobs requiring intense arm or trunk movement.

Driving is usually cleared once arm movements no longer cause significant discomfort, which is assessed individually during postoperative follow-up.

Light activity is usually reintroduced before higher-impact exercise or movements involving the chest and arm muscles, always following medical clearance.

Yes, a compression vest or band is generally recommended for a period of time, helping the skin settle and reducing swelling.

Walking around the house is not a stage to wait for: it starts in the first hours after surgery and is part of thrombosis prevention. What comes in stages is exercise, and chest work is the last stage to arrive. Walking as training usually starts in the first or second week; low-impact cardio and lower-body work without axial loading at around three to four weeks; exercises that recruit the pectoral, shoulder and back muscles — bench press, flyes, push-ups, pull-ups, rows — usually wait six to eight weeks, with maximal loads progressing after that. The reason is mechanical: the operated plane lies between the skin and the pectoral muscle, and repeated loaded contraction raises the risk of bleeding, seroma and scar widening in the early weeks. These are the usual intervals rather than a rule: cases with skin excision or extensive liposuction generally wait longer, and clearance is given at the follow-up visit.

For desk-based work, with no exertion and no heavy commuting, time off is usually seven to fourteen days — the limiting factor is not pain but use of the arms and the risk of bleeding in the first weeks. For work that involves carrying weight, raising the arms overhead, intense trunk movement, long-distance driving or working at height, three to four weeks or more is common. The medical certificate is issued by the team according to what you actually do, so it is worth describing your real daily tasks at the consultation, not just your job title. The compression garment is also worn continuously in the early days, which often weighs on the decision about returning to the workplace.

The incision is planned to stay discreet, usually along the areola border.

In the first months it tends to be firmer and redder, gradually softening and fading — this process varies from person to person.

It does not disappear. Every incision leaves a permanent scar; what changes is how much it draws the eye. In the most commonly used approach the incision sits at the areolar border, following the transition between pigmented skin and chest skin, which makes it hard to notice from a distance — but it exists and is visible close up. In cases with excess skin the incision may need to be extended around the whole areola, or larger chest scars may be added, and that is discussed beforehand. Male chest skin is thick and the area works under tension, which increases the chance of a widened or hypertrophic scar compared with other parts of the body; treatments can improve its appearance without erasing it.

Yes, this is a real possibility with this type of procedure, since tissue removal can leave space beneath the skin; when it happens, it is usually resolved with simple drainage.

Every operation under anesthesia carries risk, and setting out that risk is part of the consent process. The risk of death associated with anesthesia in a healthy patient having elective surgery in a hospital setting with an anesthesiology team is described as low in the literature, but it is not zero — and the figure varies with the measure used and with the service, which is why it is not something a web page can reduce to a single number. That risk rises with smoking, obesity, uncontrolled cardiac or pulmonary disease, long operating times and several procedures combined in one session. The published series of deaths after aesthetic surgery do not point to anesthesia as the leading cause: the recorded fatal outcomes come mainly from severe infection, hemorrhage and venous thromboembolism — a clot forming in the leg and traveling to the lung. That is why the assessment includes thrombosis risk stratification, and why walking early, stopping smoking and disclosing any hormone or anabolic steroid use genuinely change your risk rather than merely appearing to. The complications described most often are not the fatal ones: they are local and do not put life at risk. That is precisely what the preoperative tests and the pre-anesthetic assessment are for — knowing your risk beforehand rather than discovering it in the operating room.

The unwanted outcomes most often described are not catastrophic, but they do matter. Removing too much tissue under the areola can create a central depression — the crater or saucer deformity; removing too little leaves palpable residual tissue, and the complaint is that the chest still has volume. Asymmetry between the sides, contour irregularity where liposuction was combined, a retracted-looking areola, a thicker scar than expected and altered nipple sensation can also occur. Hematoma is the most common early complication and sometimes needs drainage. Wound infection is less frequent, but it is the complication that can deteriorate, which is why warning signs are set out at discharge — fever, increasing pain, spreading redness, foul-smelling discharge. Compromise of the skin or of the nipple-areola complex, up to partial loss of the areola, is rare and is described mainly in cases involving skin excision or repositioning of the areola. Review articles describe the need for a revision procedure in a minority of cases, with rates that vary with the grade and the technique. Acknowledging this beforehand is what allows the resection to be planned with a margin and revision to be discussed from the first consultation.

Venous thromboembolism prophylaxis is used in every patient, not only in those at higher risk. It has two parts. The mechanical one is routine: anti-thrombosis compression stockings and intermittent pneumatic compression of the legs, used during the operation and in the immediate postoperative period, until early ambulation — the third pillar, and the reason the team insists on short, frequent walks from the first hours. The chemical part is individualised: how long enoxaparin is used is defined by the Caprini score, a validated instrument that adds up factors such as age, body mass index, expected length of surgery, hormone use, smoking and personal or family history of thrombosis. None of these measures eliminates the risk, which is why asymmetrical pain or swelling in a leg, shortness of breath and chest pain need immediate assessment, not waiting.

The chest immediately after surgery is not the result: there is swelling, firmness and often a firm area behind the areola that alarms anyone who was not warned. In most cases it is healing fibrosis, and it tends to soften over the following months. Firmness that appears quickly, on one side only, with increasing pain or growing volume is a different matter and needs to be seen by the team, because that is how a hematoma or seroma presents. The bulk of the swelling usually subsides between the third and sixth week, with the compression garment in use; the contour starts to become recognizable at around the third month; and the stable appearance is generally assessed between six and twelve months, the period over which the scar also tends to fade — how much varies from person to person. Skin retraction, where there is laxity, takes the longest and has a limit: very loose skin may not tighten enough and can require excision. Checking yourself in the mirror week by week tends to hinder more than help.

It can come back. The glandular tissue that is removed does not grow back, but it is usual and deliberate to leave a thin layer behind the areola so as not to create a crater — and that layer is still hormonally responsive tissue. Part of exogenous testosterone is converted into estradiol in the body, and that imbalance stimulates the gland to proliferate again, by the same mechanism that produced the condition in the first place. It is not the only route: derivatives that aromatize poorly are also associated with gynecomastia, through direct action on the hormone receptor or through raised prolactin — so no regimen is free of the risk, with or without a blocker alongside it. Operating during active use therefore works against the result. The usual approach is to investigate and address the cause first, with a general physician or endocrinologist, and to schedule surgery once the hormonal picture is stable. Significant weight gain also alters the contour achieved, even without the gland recurring.

Surgical correction of gynecomastia is usually carried out by a plastic surgeon, and it is also performed by other surgical specialties trained in the field; in any of them, the credential to check is the RQE specialist registration at the Regional Medical Council, not the CRM licence number alone. Dr. Lorena Gidrão de Queiroz practices under CRM-MG 85769 and RQE 71258, is a member of the Brazilian Society of Plastic Surgery and a plastic surgeon at the Hospital de Clínicas of the Federal University of Uberlândia. Her work at HC-UFU is in the public service and follows SUS regulation; what is scheduled through this site is the private consultation. Before surgery, though, a case may involve other specialties: investigation of a hormonal cause, of medication or of substance use is led by a general physician or endocrinologist, and a firm, one-sided lump, or one with skin changes, is referred for specialist breast assessment before any aesthetic planning. That triage is part of the first consultation.

Breast enlargement at puberty is common — described in around half of adolescent boys — and in most it resolves on its own within six months to two years, as the hormonal balance settles. In newborns it comes from maternal hormones crossing the placenta and usually resolves on its own over the first months, generally within the first year of life. For that reason the initial approach in adolescents is usually observation, with clinical and, when indicated, endocrine assessment, rather than surgery. When the condition persists beyond two years, involves a large volume, or has a significant impact on social life and body image, surgery starts to be discussed — always with the parents or guardians, and with documentation that the condition is stable. In the practice of Dr. Lorena, surgery is considered from the age of 16, always with the guardians involved. Even so, age is not a number on its own: it depends on the stage of development and on how long the condition has been stable.

Removed tissue does not return, but hormonal factors or significant weight gain can influence the long-term result.

Surgical fees are always private — Dr. Lorena does not operate through health insurance. What is possible, when a genuine, documented medical indication exists — since gynecomastia is a health condition and not only an aesthetic concern —, is to guide the patient and attempt to have the health plan cover part of the hospital admission, which may include the operating room, the hospital stay and materials, according to the terms of her policy. Authorisation is the insurer's decision and cannot be guaranteed; the team advises on the documentation required and on how to proceed.

Yes, where there is a reconstructive or functional indication — for example gynecomastia itself, which is a health condition and not only an aesthetic concern. Surgery for purely aesthetic purposes is not covered by the SUS. Dr. Lorena is a plastic surgeon appointed by public examination to the Hospital de Clínicas of the Federal University of Uberlândia (HC-UFU) and preceptor of its plastic surgery residency, and she operates on SUS patients there. The route, however, does not run through this site or the private practice: the patient must register at the primary care unit (Unidade Básica de Saúde) nearest to where she lives, be assessed by a doctor there and, if there is an indication, be placed in her municipality's regulation queue. The surgeon cannot choose who is operated on through the SUS — the order follows the queue and the rules of the system strictly.

We do not publish isolated before-and-after pairs. Resolution 2,336/2023 of the Brazilian Federal Council of Medicine allows results to be demonstrated, but only within a set that also includes unsatisfactory outcomes and the complications described in the literature, across different body types, age ranges and stages of healing, and with no editing of the images (art. 14, II). An isolated pair of photos does not meet those requirements and also implies a guaranteed result, which the same resolution prohibits (art. 11, XII). At the consultation the expected outcome is discussed from your own anatomy — what is reasonable to expect, what is not possible, and what the risks are.