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Gynaecomastia surgery

Benefits of having your Gynaecomastia (also referred to as man boobs) surgery with Dr Beldholm FRACS- a specialist surgeon that is an expert gynaecomastia surgeon.

  • You are not alone! Dr Beldholm sees hundreds of men with gynaecomastia. It is a very common condition in men.
  • Boutique practice, we take care of you, and Dr Beldholm personally sees you throughout your recovery.
  • Dr Beldholm understands that it can be quite embarrassing to have gynaecomastia as a man, and therefore we do everything to keep your experience private. We have a private sedation clinic that we can do your operation in if you prefer.
  • Gland excision, as well as liposuction, at the same time for the best results.
  • Option of adding High Definition VASER liposculpture to your operation, to achieve a more chiseled appearance.
  • Tailored all inclusive packages

Gynaecomastia surgery cost

If you are done in our day procedure clinic under sedation and local anaesthetic than our all inclusive price is;

  • $4990 for standard gland removal including liposuction
  • $9900 for Hi-Definition VASER sculpting of the chest including gland removal

If you want to be done in the Private Hospital under a General anaesthetic than you will need to add the Hospital charges and anaesthetic charges.

Give us a call on (02) 4934-5700 and talk to our friendly staff!

There are many options for your Gynaecomastia operation

Modern gynaecomastia techniques include liposuction to sculpt and refine, and to avoid a depression where the gland has been.

The operation can be done either under local anaesthetic and sedation in our clinic in Newcastle or it can be done under a general anaesthetic in either Maitland Private Hospital or Hunter Valley Private Hospital.

All our packages include standard liposuction as well as gland excision, which is essential to get a great result. You can also elect to add VASER high definition liposculpture to your operation to get a highly refined look.

(This video contains multiple before & after photos. See our disclaimer)*

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While women tend to get a bad rap for being overly critical or self-conscious of their bodies, it’s not uncommon for men to feel exactly the same way. Besides weight gain, unusually large breasts in men will definitely make any guy feel shy about their body.

There is actually a medical term for this condition. It’s called gynaecomastia and essentially it is a disorder that involves the overdevelopment of the male breast. The less technical term for this endocrine disorder is “man boobs”.

Gynaecomastia affects approximately one third of all Australian men, causing them to be extremely self-conscious about their appearance, especially in situations where they have to remove their shirt, like at the beach or the bedroom.

If you are a male living with this condition, know that you do have options. You don’t have to live with this disorder thanks to advances in cosmetic surgery. If you are considering surgery to remove excess breast tissue, you likely have lots of questions. Below we answer your most common ones.

Dr Beldholm FRACS, FACCS runs a boutique cosmetic surgery practice in the Hunter Valley and Newcastle area. He has been performing gynaecomastia surgery and VASER liposculpture for more than ten years. We have created this page as an extensive resource for you to find out what is possible with modern gynaecomastia surgeries and how we can help you.

Dr Beldholm is among a select few cosmetic surgeons in Australia performing the High definition liposculpture technique that takes the results from this operation to the next level.

You are not alone!

gynaecomastia

Gynaecomastia (also referred to as man boobs) is a very common condition.

Some research studies show that this conditions may affect up to 70% of men (ref 1).

According to the american society of plastic surgeons there has been an increase of 36% in gynaecomastia surgeries performed from the year 2000 vs 2016.

How common is this surgery in australia?

There are not many sources to know for sure how many of these operations are done in australia. A lot of gynaecomastia surgeries are done in private clinics and are not recorded, so there is likely to be a massive discrepancy in the official numbers.

Australia’s universal health care program, or Medicare, has an item number for gynaecomastia and they record statistics on the number of operations performed using this item number.

According to these statistics 1438 gynaecomastia operations were performed in Australia from July 2015 to June 2016, of these 461 were performed in NSW which was the highest of all states.

July 2000 to June 2001 VS. July 2015 to June 2016

Australia a 42% increase in operations performed for gynaecomastia

NSW a 63% increase in operations performed for gynaecomastia

Source: http://medicarestatistics.humanservices.gov.au/statistics/mbs_item.jsp

Australian Government – Department of human Services

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What is on this page?

We will start by talking about how the surgery is done and how the different options can benefit you.

Click or press the headings to navigate directly to the section you are interested in, or just scroll down to read all of it!

The procedure - Getting rid of your gynaecomastia

The majority of men that consult Dr Beldholm are mainly interested in just getting their chest flat and getting rid of their Gynaecomastia. However, the high definition option is great if you have been wanting to get a more chiselled look and have been unable to achieve this in the gym.

  • We will compare the result of standard gynaecomastia surgery vs High definition gynaecomastia surgery.
  • Description of how the standard technique is done.
  • Description of how the High definition technique is done.

Where can you have your surgery?

  • General anaesthetic versus Sedation and local anaesthetic.
  • Maitland Private Hospital.
  • Hunter Valley Private Hospital.

Who is a good candidate for gynaecomastia surgery?

  • Who is suitable for high definition liposculpture.
  • Who is suitable for standard gynaecomastia surgery.
  • Very large breasts in men and issues with loose skin. My two stage approach

Very large breasts in men and issues with loose skin. My two stage approach.

Men that have large breasts equivalent to more than a C-cup need a different approach.

What recovery can I expect after my gynaecomastia surgery?

The recovery period will vary depending on how big your operation is and if you are having High definition VASER added as well.

When will I see results and how long does it last?

You will see a big difference straight after the surgery. However, there will be some swelling for a few months. Most of the swelling settles within three months. You should see the final result at around twelve months after the surgery.

Health insurance, MBS item numbers; Can I get my operation covered?

There is an item number for gynaecomastia surgery, and if you have private health insurance you may get the hospital covered and some of the surgical and anaesthetic fees as well. Over the last three years Private health funds have become increasingly restrictive with what they cover. In many cases, even if you have private health cover, they may not cover your operation, even if you have a proper MBS item number.

Gynaecomastia explained

We will go through what gynaecomastia is. What the causes are, and how these are treated.

Benefits of gynaecomastia surgery - These Results Speak for Themselves

Those who have received the gynecomastia procedure report a number of benefits. Patients enjoy physical benefits such as a more masculine chest, more pronounced muscles, and less sagging skin. Another big benefit is an improvement in posture. Patients with gynecomastia tend to slouch in order to conceal their chest.

Complications after gynaecomastia surgery

As with any operation there are potential complications that can occur. We will outline them for you here. You will get more detailed information at your consultation with Dr Beldholm.

Peer review journal articles supporting the way that I do things

Finally we have a long list of scientific articles that support the way we approach our Gynaecomastia surgery.

Information boxes on Gynaecomastia

I treat many men with gynaecomastia surgery and I have personally observed the positive impact that this surgery can have. Having breasts as a man is very embarrassing and can have life long impact on men. I have seen men that have quit university and even their jobs because of it. I have also seen men that have stopped dating and socialising because of it. Seeing the transformation after surgery in these men is amazing”

Dr Bernard Beldholm

Gynaecomastia is a not a trivial problem. It can have a major psychological impact on men, preventing them from enjoying life to the fullest. However, as an expert gynaecomastia surgeon my aim is not merely to remove the gland. Focusing on removing the gland only creates a poor cosmetic outcome, such as crater deformities, (see our fact box below) and who wants to swap one deformity for another?

My aim for each and every man that I see with gynaecomastia is to create a normal sculpted chest area. My focus is on getting a great cosmetic result. Liposuction assisted gland removal is therefore a must. I have also taken it one step further with the high definition Liposculpture technique that can create a 6-pack as well as a sculpted chest area.

“I’m here to help you get your shirt off! And be proud of your look”

Dr Bernard Beldholm

The Procedure

There are a variety of techniques for the surgery itself, depending on the specifics of each case. Generally, the procedure can be either a liposuction, a gland removal, or a combination of the two.

Liposuction is best for candidates whose enlarged breasts are caused by fatty tissue build-up only. This procedure can be performed under general or local anesthesia. Dr Beldholm will work to create a plan that best suits you.

Gland removal combined with liposuction is the preferred approach for candidates who have gynecomastia caused by enlarged glandular tissue. The procedure can be performed under general or local anesthetic with sedation.

Each procedure is tailored to the patient, but incisions are typically made around the edge of the areola.

High definition gynaecomastia surgery versus standard gynaecomastia surgery

What is the difference between Standard liposuction gynaecomastia removal and High definition VASER liposculpture with gland removal?

The best way to show this difference is to compare two results.

High definition VASER liposculpture with breast gland removal

(Individual results vary, See disclaimer)*

Standard VASER liposculpture with breast gland removal

(Individual results vary, See disclaimer)*

Whether you have your procedure performed under local anaesthetic or general anaesthetic the technique that is performed is the same, and you will get the same final result. We will go through the difference in having your surgery done in the Private Hospital vs having it done in our Newcastle day procedure clinic in the next section.

Standard approach to gynaecomastia surgery and gland removal

For this approach I use either traditional liposuction or VASER liposuction. In my experience it is critical to use liposuction for gynaecomastia removal. Even if you have only a small breast gland and minimal fat the liposuction is used to “feather” in the periphery of the gland excision site. By performing liposuction prior to gland removal the gland is also much easier to remove and more defined.

The initial step in the operation is to inject local anaesthetic solution with adrenalin. This is usually done through a small incision in the upper lateral part of the chest, as well as a small incision that is made in the junction of the areolar skin and the normal skin. Liposuction is then performed in the area around the gland to make sure that the result is smooth.

To remove the breast gland a small incision is made in the areola. The gland is dissected off the under-surface of the areola and removed though this small incision. There is usually some small blood vessels that need to be sealed in the area as well.

The Incision is then closed with absorbable sutures that do not need to be removed.

High definition VASER chest sculpting with breast gland removal

This is a much longer procedure and requires special VASER high definition instruments. The procedure begins the same with injection of local anaesthetic and adrenalin solution. However, after this it is very different. This procedure can also be combined with fat injection to create even further definition to the pectoralis muscle. The fat injection is used like a “pec implant” bulking up the natural contour of the pectoralis muscle.

The Incision is then closed with absorbable sutures that do not need to be removed.

The sculpting is done in three phases.

The first phase is a general “debulking” of fat in the chest area. This removes fat, similar to the normal approach to liposuction, to give some definition to the area. The second phase focuses on more aggressive removal of fat from the lower edge of the pectoralis muscle and the lateral side (axillary area of the chest).

The final phase is the scoring phase. This is when the true result of the high definition approach is created. The VASER probe is used to remove fat in the very superficial layer of the skin. Performing this step is not possible with traditional liposuction, and this is why VASER is essential in the high definition approach.  (Ref 2)

This step requires additional incisions for the VASER probe. Normally when performing liposuction you want to make the minimum amount of incisions possible. The liposuction cannulas usually reach a fair distance and this avoids having to make lots of incisions, which is beneficial cosmetically. However, when performing the final step of the high definition technique, the skin needs to be scored in-line with the probe.

The High definition approach takes around two hours longer to perform than the standard approach. There is therefore a premium package for this approach.

Give us a call on (02) 4934-5700 and talk to our friendly staff, to find out prices or book in a consultation!

Why I prefer the VASER liposculpture method and why this is essential in high definition liposculpture.

While liposuction is one of the most popular cosmetic surgical procedures performed worldwide, surgeons have continued to explore new ways to improve the procedure for their patients. Unlike traditional liposuction, VASER liposuction destroys body fat by melting the tissue with a vibrating probe used at a high frequency. This method minimises damage to the skin, blood vessels and nerves, making it a much gentler procedure. After the fat is melted, traditional lipo is used to suction out the body’s fat. However, only low suction is needed. This leads to less bruising, faster recovery, a smoother appearance, easier body contouring and minimal trauma. (ref 2,3)

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Private hospital vs Broadmeadow day procedure clinic

There are many options for you as a patient of Dr Bernard Beldholm. You can have your operation done in a fully accredited private hospital or you can have your procedure done in our custom built day procedure clinic.

The key difference between these options is the anaesthetic and the cost involved.

Private hospital

This option allows you to have a full general anaesthetic for your operation. This means that you are fully asleep, and you will not feel any pain during the procedure. It is done as a day procedure, i.e. you will only need to stay in hospital for the procedure, and are then able to go home. If you have private insurance, and it covers your hospital stay, then this is a very good option. The costs involved will include;

  • Hospital charges (day stay fee and procedure fee). If you have private health insurance then this may cover you for your hospital stay.
  • Anaesthetic charges. The anaesthetist will charge you for the operation.
  • Dr Beldholm’s surgeon fee.
  • Garments.

The costs for the private hospital option varies, depending on if you have private insurance or not, and also varies depending on which private insurance company and policy you have. It is therefore not possible to tell you exactly how much your out of pocket expense will be until you have had a consultation with Dr Beldholm.

If you do not have private insurance, and you are paying for your operation yourself, then we have tailored all inclusive packages, available. We have negotiated prices with the hospital and anaesthetist to make it as affordable as possible for you.

Day procedure clinic

Our day procedure clinic in Broadmeadow is specialised in VASER liposculpture procedures. Many of our male patients prefer this option, as it is very private setting. You will not need to mix with a large number of other patients, as is usually the case in the private hospital setting.

As we own and operate this facility we can offer you great tailored packages, that are all inclusive. We have found that even men that have private health insurance prefer this option.

The downside if this option is that you will not be fully asleep. You will have sedation, which will make you sleepy, and in the majority of cases, forget the actual procedure. The local anaesthetic solution does sting when it goes in. However, once this is done, it is usually pain free thereafter.

What To Expect From Gynaecomastia Surgery Done Under Local Anaesthetic and Sedation

To summarise the benefits:

  • Private setting with specialised staff.
  • VASER liposuction machine.
  • Affordable, all inclusive packages.
  • Quicker recovery.

Preparation the day before

We will normally give you a script for a mild sedative, which you will take the day before and on the day of the surgery. It will help calm your nerves and help you relax during the surgery. You will also get a script for antibiotics, as well as instructions for antibacterial wash.

Coming into our day procedure facility

Now, what’s going to happen when you come in? The first thing we do is go over all the paperwork, we have a chat with you, and go through the consent. You will see Dr Beldholm at that stage as well. He will do the markings where he will be performing the liposuction and gland excision. You will then be taken into the pre-anesthetic room. We put a cannula (small needle) in your hand, and we give you antibiotics, we also give you something to relax you as well. Then we take you into the theatre.

What happens once you come into theatre?

Now what happens in theatre?  You lay on the operating table, we get you all prepped up, and comfortable.  You will be given sedation through the cannula in your hand, so you feel half asleep. I will then put the local anaesthetic in the area that we are going to operate on. After the local anaesthetic has gone in, it should be more or less pain free. You will feel some twinges here and there, we can always top up the local anaesthetic if need be, but certainly most of the time it is pain free. The standard gynaecomastia operation usually takes about one hour, and the high definition liposculpture option takes around three hours.

Going to the recovery area after surgery

Once we have completed your surgery, you will taken to the recovery area. You will be given some light refreshments.  As you have had sedation, you will need to have someone organised to pick you up.

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Pre-Operative markings

I see all my patients before the surgery. Surgical markings are essential in getting a great result. In this patient we are creating a 6-pack as well as sculpting the chest wall to get a high definition result. His goal was to become an underwear model, and he was planning a trip to europe to enter a competition. He had already put in a lot of effort at the gym, but just wanted that little bit extra. The best candidates for the high definition liposculpture are the men that have already got a good body and are fit and well. They just want to take it to the next level and get the really defined look.

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Who is a good candidate for gynaecomastia surgery?

The important thing is to make sure that there is no secondary disease that is underlying your gynaecomastia. We will go through all the different causes of gynaecomastia later on this page. Most of the time there is no need to do any investigations if the history is clear.

The three main groups of patients that I see most frequently;

  • Men that have had gynaecomastia since they were teenagers. This is usually present on both breasts, and has not changed for many years.
  • Body builders that have used anabolic steroids to bulk up. Many have tried oestrogen blocking drugs, but have not been successful in reversing the gynaecomastia. Many times the glands are small, but because they are lean, the gland really stands out like a puffy nipple or more obvious lump under the areola.
  • Pseudo-gynaecomastia. This means that it looks like you have breasts, but there is no breast gland present. This is common in overweight men. Although technically this is not gynaecomastia, it is easy to treat with liposuction. If there is no breast gland present, then all you need is liposuction to fix the area.

When you come for your consultation with Dr Beldholm he will be able to examine you and tell you if you need to have further investigations. If you have a breast gland present, and what surgical treatment you need. 

When should you be worried that something else is going on?

There are a few warning signs that should make you go to your GP and have further investigations.

  • You have not taken medications or anabolic steroids, and you notice that you have gynaecomastia.
  • There is increasing pain in the area.
  • There is a discharge from your nipple.
  • It involves only one breast.
  • It is getting bigger.
  • There is color changes to the skin that are new.

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Very large breasts in men and issues with loose skin. My two stage approach.

I also see a lot of men that have very large breasts. In these situations I prefer to do a two stage approach for the best possible cosmetic outcome. The first step is a standard gynaecomastia operation, with extensive liposuction of the area, and removal of the enlarged breast gland. Because of the size of the removal, I usually insert drains, and these stay in for a few days after the operation.

The main issue with these large removals, is the potential for loose skin. The amount of loose skin is sometimes quite unpredictable, and depends a lot on the skin quality present. If for example, you have been gaining and losing weight and have extensive stretch marks in the chest area, then it is unlikely that you will get a lot of retraction of the skin, once the breast gland and fat is removed. However, if you are in your 20’s, and have very good quality skin, then you may find that the skin retracts amazingly well.

The benefit of having this first step done, is that over the coming twelve months the skin will retract, and any additional operation may need to be a lot smaller, or be obviated altogether. It is sometimes amazing how the skin retracts and forms around the new shape of your chest.

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What recovery can I expect after my gynaecomastia surgery?

The recovery period will vary depending on how big your operation is and if you are having High definition VASER added as well.

Standard liposuction based gynaecomastia surgery

You should have quite a quick recovery from this. There is usually no drains and the sutures are absorbable, so you will not need anything taken out. You will have a tight tape across your chest, and there will be a compression dressing, as well as a body suit over the top of this. You will need to come in to have this reviewed and taken down the day after the surgery. You will usually at this stage also have LED light treatment done. If you have a desk type job or a job that does not involve a lot of physical activity, then you will usually be able to get back to this in a few days, you should also be able to drive after a few days. Heavy exercise and gym work will need to wait for around four weeks.

High definition liposculpture with gland removal

This is more extensive surgery and it will take more time to recover from this surgery. You will have more bruising and discomfort. You can expect to take at least one week to get back to work if you are doing desk type work or minimal lifting at work, and you should wait one week to start driving. There will also be more swelling that will take some time to settle after this operation. Full exercise should be possible at around 4-6 weeks after the surgery.

Large gland excision with liposuction requiring drains

Even though this is more extensive surgery the recovery tends to be quick. The drains will stay in for around four days and are taken out in the office. You should be able to get back to desk type work in around one week. You will be able to walk around normally from day one of the surgery. You should be able to get get back to normal after four weeks, including heavy exercise.

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8 important facts about gynaecomastia

Gynaecomastia Infographic

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When will I see results and how long do they last?

It is unlikely that your breast gland will ever come back, and unless you put on a lot of weight you will not have the fat return..

You will see the final result straight after the surgery. However, the area will be swollen and the swelling will get worse towards the two week mark. After this stage the swelling starts coming down, and you will see most of the result one to two months after the surgery. At three months after the surgery you should see 80% of the result, and all of the result within six months. If you are having high definition VASER liposculpture, then you will see the final definition at around six months after the surgery. However, you should see a substantial result well before that.

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Health insurance, MBS item numbers; Can I get my operation covered?

The item number for gynaecomastia operation is 31525. The description according to the MBS schedule is:

“BREAST, mastectomy for gynecomastia, with or without liposuction (suction assisted lipolysis)…”

The MBS schedule however does not cover operations that are done for “cosmetic reasons”. Many health funds consider gynaecomastia a cosmetic operation. Even though there is a clear item number, many health funds will not cover this. If you already have private health insurance, you can call them  and quote the item number above to check if you are covered. If you are covered by your health fund then you will have the hospital charges covered, as well as get some money back for the anaesthetist and your surgical fee.

Over the last three years Private health funds have become increasingly restrictive with what they cover. In many cases, even if you have private health cover, they may not cover your operation, even if you have a proper MBS item number and it is not for “cosmetic reasons”. The type of cover that you have signed up for also makes a big difference. Many health funds sell policies that will not cover you in a private hospital, and in many cases are no better than not having any health cover at all. Check out this article in Sydney morning herald entitled “Medibank and NIB spruiking some of the worst ‘junk’ private health insurance policies”.

What do I do if I do not currently have health cover?

Individual situations vary and you should get independent advice on this. In many cases there are tax benefits of having health cover, that may outway the cost of the cover. You should also consider the stage that you are at in your life, and if you are likely to use your health cover for other conditions.

Many health funds have twelve months exclusions for pre-existing conditions. Meaning that even if you join a health fund today, you will need to wait twelve months to be able to access the health cover. One benefit of having a health fund is, if you get a complication, such as bleeding or infection, then you may get all your treatments paid for by the health fund.

If your only reason for joining a health fund is to access cover for your gynaecomastia operation, then consider that in many cases paying the health fund fees for twelve months will be more expensive than actually having your operation done in our day facility in broadmeadow.

Once you have had your consultation with Dr Beldholm, our Patient coordinator can go through these issues with you in detail.

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Gynaecomastia explained

If you talk to a lot of men, they can be pretty self-conscious about their bodies, too. It’s not just women who can be hard on themselves. For some men, living with gynaecomastia can really bring their confidence down (ref 1,3).

Gynaecomastia is the overdevelopment of the male breast tissue. This condition can be a result of too much oestrogen, a female hormone, or too little testosterone, a male hormone.The term is derived from the Greek words ‘gyne’ meaning woman and ‘mastos’ meaning breast.

This condition causes the glandular tissue of the breasts to swell and form a breast bud or an enlarged breast. Gynaecomastia can occur in babies, teen boys, and older men.

The breast gland development that occurs with gynaecomastia is not dangerous. However, it may be caused by conditions that are more sinister. A lump in a male breast may not be gynaecomastia, it can rarely be due to breast cancer. Breast cancer in men is very rare, however it does occur. Find out more information about this disease at breastcancer.org.

There are many causes of gynaecomastia; Check this list out. We will focus on the most common causes here.

Causes of gynaecomastia

Physiological gynaecomastia

This is due to hormonal changes in men during certain stages of their life. There are three well known stages that have potential imbalances of oestrogen and testosterone. Up to 90% of newborn babies can develop breast tissue due to the changes that occur in hormone levels at birth.

Teenagers can develop gynaecomastia as the hormone levels change in puberty. Up to 80% of these cases resolve on their own. Dr Beldholm has treated many teenagers for gynaecomastia, as this condition can have a severe psychological impact on a male in their teenage years. Even though this condition most commonly resolves, it can last for many years before it does, and it is in a period of teenage development. Dr Beldholm has seen many teenagers that have become depressed and socially withdrawn due to this condition. Getting rid of this condition quickly can have a massive positive impact on a teenage development. As with any surgery all the positives and negatives need to be discussed in detail. 

As men age testosterone levels can drop, and this is the third phase that can cause gynaecomastia development.

Obesity

In Australia, a whopping 63 percent of adults are either overweight or obese, according to the Australian Institute of Health and Welfare. Men who are overweight are more likely to develop enlarged breasts, due to significant fat build-up in the chest as well as stomach area. If there is no breast gland development this condition is referred to as Pseudo-gynaecomastia. This can usually be easily treated by liposuction.

Tumours

Testicular cancer can cause tumours that may produce hormones that can cause gynaecomastia. Male patients with prostate cancer may experience an onset of gynaecomastia if treated with therapy using androgen deprivation.

Chronic Diseases

Males who are living with cirrhosis or liver failure are also susceptible to developing gynaecomastia. If the liver is unable to metabolize estrogen, it is impaired. Additionally, males who are alcoholics and already have liver disease are at high risk to acquire gynaecomastia because the ethanol is liable to disrupt testosterone synthesis.

Anabolic steroid use and Gynaecomastia

One of the most common groups that Dr Beldholm sees is the bodybuilders that have developed gynaecomastia from anabolic steroid use. This is a special group and requires attention to detail and a refined result.

Many of my patients have been pursuing the perfect body, and unfortunately decided to use anabolic steroids to gain an advantage and help them. Usually they have minimal to no body fat and just a small breast gland, that is made more obvious because they are so well trimmed. To get a great result it requires a great deal of finesse, as you want to preserve a smooth looking muscle and not end up with depressions/obvious scars and other issues, that will make the operation obvious.

Anabolic steroids are synthetic testosterone, usually these are provided on the “black market” and are not taken under medical supervision. These derivatives are known as “juice” or “roids”. There are a range of supplements that may also contain testosterone in various doses.

There are many terms that are used, and bodybuilders generally get advice from each other as to how to use these substances.

Are you using steroids?

Have you got information about what advice you were given and how these substances are used?

Have you noted new trends?

Have I got the terminology mixed up?

I would love to find out!

I would love to be able to include this information on this page.

You can stay anonymous if you like.

There are many different approaches to steroids used and terminology used.

“Cycling” refers to taking several different combinations of drugs over a time period. “Stacking” refers to using more than one steroid. “Pyramiding” using variable doses.  There is also periodic abstinence from the steroids to allow the normal hormone levels to return.

There are many potential dangers of anabolic steroid use, check out this resource. I will focus more on the gynaecomastia side, and of the side effects, as this is what I see and can help you with.

There are various different agents that are used by bodybuilders and the mechanism of how the gynaecomastia is caused varies. Some of the synthetic androgens get converted to oestrogen in the peripheral tissues, which can explain the growth of the breast gland. Others suppress the natural production of testosterone in the body, and once the drug is stopped there is excess oestrogen that can cause the gynaecomastia.

Reversing agents and oestrogen blocking agents are also used by bodybuilders to try to prevent these effects with varying degree of success. In the medical literature the treatment of gynaecomastia with oestrogen blocking drugs has had a low success rate.

Most of my patients describe the gland as “puffy”, sometimes the only sign of gynaecomastia is a prominent nipple that stands out. Sometimes the areola gets bigger. The size of the gynaecomastia can range widely, however is usually the size of a grape when they come and see me. Even though the gynaecomastia is quite small, it is quite obvious to the patient, and many are very embarrassed about the appearance of the gland. (Ref 6-8)

Will the gland come back?

I see a lot of bodybuilders, and basically what they are concerned about is if the gland is going to come back? A lot of them have tried steroids, and after steroids they’ve tried reversing agents, and it hasn’t worked. They still have the breast gland there, and it is embarrassing.  They want to show off their muscles, and they can’t because they’ve got these nipples that stand out. A lot of them come to me and we remove the excess breast tissue. The question they have is, if they did go back to steroids in the future, are they ever going to get the breast glandular tissue growing back?

The short answer is – very unlikely.

However, we don’t actually remove the nipple, and there is still some remaining breast gland ducts in the nipple itself, just underneath the areola and nipple, so there is a potential for those to grow.

However, the potential is really tiny. It’s very, very unlikely that you will get that whole breast tissue growing back again.

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My story of a biker with gynaecomastia

Many years ago I had a female colleague that I worked with. She was a liposuction expert and did this as a full time occupation. One of her patients was a big bloke, a biker, that was very concerned about his gynaecomastia. She did the operation and thought that she had done a great job.

However, after a few months he came back to the clinic extremely unhappy, and I was asked to come and see him. I talked to him for some time and noted that the result was not actually that bad. The gynaecomastia was gone and he had a much flatter chest.

But what I discovered was that he was unhappy because he thought that the muscle had been removed!!

The issue was more of a definition of a manly chest, as opposed to doing a technically correct plastic surgical operation. He felt that his upper chest was now not in proportion to the rest of his body.

The key take-away lesson here is that cosmetic surgery is NOT about doing a technically correct operation, it is about knowing what result you want and achieving this.

Any plastic or cosmetic surgeon can learn the steps of these operations. However, to be truly great, you need to be able to use these techniques like an artist uses his tools, and sculpt a result that you will be amazed by.

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Benefits of gynaecomastia surgery - These Results Speak for Themselves

Those who have received the gynaecomastia procedure report a number of benefits. Patients enjoy physical benefits such as a more masculine chest, more pronounced muscles, and less sagging skin. Another big benefit is an improvement in posture. Patients with gynaecomastia tend to slouch in order to conceal their chest.

After surgery, many parents even remark of their son, “I have been trying to have him stand up straight for years!”

Furthermore, the benefits to the surgery can also be psychological. Patients report the relief that comes from no longer needing to wear multiple layers of clothing, avoid public showers, or tape down their chests. An Italian study of 128 young men, who had undergone the procedure, reported that all patients said their quality of life improved post-surgery. The average satisfaction score reported was 8.2 out of 10.

The results were so overwhelmingly positive that the researchers suggested patients with gynecomastia undergo surgery “always and as soon as possible.” (Ref 9)

Looking at these statistics, it’s no surprise that breast reduction is currently the third most popular cosmetic surgery among males. According to the American Society for Aesthetic Plastic Surgery (ASAPS), the over 26,000 procedures performed in the United States last year, reflect a 29 percent increase since the year 2000. As word of successful gynaecomastia procedures continues to spread, the number of procedures performed annually will surely continue to rise.

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man boobs surgery

How Dr Beldholm helps men with gynaecomastia

Once the root cause of a man’s gynaecomastia has been addressed, cosmetic surgery can prove to be a viable treatment option. When choosing a surgeon, it’s important to go with a practice that specialises in this surgery. Dr. Bernard Beldholm with Specialist Cosmetic Surgery has performed hundreds of gynaecomastia surgeries on men who are eager to regain their self-confidence.

Gynaecomastia surgery or male breast reduction surgery reduces breast size, flattening and enhancing the chest contours. Our male patients choose us for a variety reasons. Here are just some of them:

One-on-one personal consultation in a private setting

During your initial consultation, Dr. Beldholm listens in great detail to your goals. After all, you want to be happy with the end result. Whether you desire merely a flat chest or sculpted chest, we are here to fulfill each and every patient’s request.

Patients are given options

When our male patients choose us, Dr. Beldholm is able to perform the operation in a private hospital under general anesthetic or under local and sedation in our Broadmeadow Day Surgery. The choice is yours.

Dr Beldholm offers recommendations

Because Dr. Beldholm has performed this specific kind of surgery on many men. As a result, he’s able to offer some valuable insight. For the men who are bodybuilders, there is usually minimal fat, and mainly a breast glandular tissue to remove. For other men, there’s a significant amount of fat in the area that is removed with liposuction. The breast tissue is removed as well.

Loose skin is also addressed

For some patients, they not only have large breasts, but they also have excess skin in and around the area. Dr. Beldholm addresses this issue as well during surgery, by removing the excess skin during the gynaecomastia surgery.

The procedure requires minimal downtime

At Specialist Cosmetic Surgery, Dr. Beldholm understands that a patient’s time is valuable and something they have very little time. One of the things that makes Dr. Beldholm stand out, is that he and his clinic provide comprehensive post-operative care. This includes LED light treatment—a proven method that helps patients recovery from surgery faster.

Individual results vary (ref 10,11)*

Complications after gynaecomastia surgery

Crater deformity

This video shows a crater deformity also called a saucer deformity. This video is from Dr Miguel Delgado’s who is a plastic surgeon in San Francisco. Once you get this deformity you will need revision plastic surgery, that can be quite difficult as the nipple is then stuck down. It occurs when too much gland tissue has been removed and where the edges of the gland tissue have not been appropriately feathered in. I have seen quite a few men that have had gynaecomastia operations done by other plastic surgeons or cosmetic surgeons without using liposuction, which has caused this deformity. If you are seeing a plastic or cosmetic surgeon it is really important that you ask them about their technique and also for them to show you lots of before and after photos. In my opinion it is essential to use liposuction to avoid this problem.

Ideally, the liposuction should be done with a VASER liposculpture machine. The Vaser liposculpture machine melts the fat and can also remove quite a bit of the breast gland so that when you make the incision to remove the gland it is nicely feathered in.

Trying to fix these deformities can be quite difficult and depend on a lot of factors. Sometimes there is a depression there but the gland is not stuck down or tethered. I find that in these situations it can be quite easy to just do additional Vaser Liposculpture around the gland, and this will just complete the result. If the areola is really stuck down, then a small amount of fat injection, in addition to releasing the areola, and performing liposuction around the area would usually create a good result.

The other thing I tend to do, to give you an even better result, is to do a lot of liposuction on the side of the chest, because that defines the muscle edge. If you are a bodybuilder, then obviously you have a lot of muscle already, with very minimal fat, so we just have to do a tiny bit of lipo around the gland just to feather the gland in, make sure that there isn’t depressions, and then cut out the gland from there.

A manly chest is considered to look its best with defined pec muscles, and that’s what bodybuilders try to do, they try to increase their pec muscles. This can also be achieved with pec implants. What I do during surgery is to define the muscle edge. I achieve this by doing aggressive liposuction on the side of the chest wall and underneath the muscle. You really want to make sure that the muscle is nice and bulging in the middle, and that there is no puffy gland on the nipple areola complex. What you want to do is to show-off the pec muscle. The key thing is to understand how a male chest looks, it is not the same as doing surgery in women. I have a lot of patients that come in that obviously have a little bit of fat on top of the muscle. You don’t want to remove everything there, because that’s just going to make you look flat with no definition. It’s all about defining the pectoralis major muscle and making it look like you’ve really got the bodybuilding physique up top.

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Other complications

As with any operation there are potential complications that can occur. We will outline them for you here. You will get more detailed information at your consultation with Dr Beldholm. Most complications are minor and generally there is a low complication rate for this surgery.

General complications applicable to all types of operations include, but are not limited to:

  • Heart problems (although very uncommon with modern anaesthetic techniques).
  • Lung problems; small areas of the lungs may collapse, increasing the risk of chest infection. Such problems may require antibiotics and physiotherapy to correct. Other potential lung complications are quite rare.
  • Clots in the legs with pain and swelling. Rarely, part of such a clot may break off and go to the lungs, causing fatal complications.
  • Allergic reactions to medications.
  • Potential for injury to deeper structures including nerves, blood vessels, and muscles.
  • Itching, tenderness, or exaggerated responses to hot or cold temperatures. Usually this resolves during healing but, in rare cases, may be chronic.
  • Deep sutures may spontaneously poke through the skin, becoming visible or producing irritation that requires removal.
  • Wound disruption or delayed wound healing – especially in patients who do not stop smoking before their operation. Generally, if wounds are dressed daily, this heals up in a couple of months. Necrosis (skin death) can also occur, but is very rare.

Postoperative pain will occur in varying degrees, from quite severe to moderate to mild on the first day. It gradually improves over the next few days, and is usually well tolerated by patients if they take the painkillers prescribed. Increasing pain, unresponsive to pain-killers, should be brought to the attention of the surgeon, as this may be an indication that complications are developing. Intermittent mild discomfort or intermittent sharp pains during the first few weeks after surgery is also common, as the swelling resolves and the nerves recover. Chronic pain, ranging from mild aching pain to sharp nerve pain can persist for more than one year, but is very rare.

Bruising and swelling is normal after the operation, but this varies from mild to severe with each patient.

To reduce risks the patient should stop treatment with such drugs as Aspirin, anti-inflammatory drugs or other blood-thinning agents, including high dose vitamin E tablets or capsules, 10-14 days prior to surgery. We will provide you with a comprehensive list of substances to avoid in your pre-operative instruction sheet. However, if you are taking any medications and you are unsure if they affect bleeding, please ask us at least two weeks before your operation.

Specific complications relating to gynaecomastia surgery may include:

  • Excessive swelling of the breast.
  • Delayed healing along the margins of the incisions may occur occasionally.
  • Loss of the skin edges or of the nipple itself (or part of the nipple), requiring prolonged dressings or additional surgery for correction.
  • A change in the sensitivity of the nipples and the skin of your breast, or even permanent loss of sensation in one or both nipples can occur.
  • In the unlikely event of excessive bleeding after the operation, emergency treatment may be required to drain accumulated blood; a blood transfusion may even be necessary.
  • Infections – either superficial or deep.The infection rate for gynaecomastia surgery is about 1%.
  • The breast will have an irregular or “lumpy” feel and may feel uncomfortable for an indefinite period of time.
  • Scarring can be prominent at first after this procedure, but will gradually fade over time.

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Peer review journal articles supporting the way that I do things

  1. Ruth E. Johnson, MD, and M. Hassan Murad, MD, MPH, “Gynecomastia: Pathophysiology, Evaluation, and Management”, Mayo Clin Proc. November 2009;84(11):1010-1015
  2. AE Hoyos, JA Millard, “VASER-assisted high-definition liposculpture”, Aesthetic Surgery Journal, 27(6):594-604, 2007 Nov-Dec
  3. H.L. Devalia and G.T. Layer, “Current concepts in gynaecomastia”, Surgeon, The, 2009-04-01, Volume 7, Issue 2, Pages 114-119
  4. Nagy MW1, Vanek PF Jr., “A multicenter, prospective, randomized, single-blind, controlled clinical trial comparing VASER-assisted Lipoplasty and suction-assisted Lipoplasty.”, Plast Reconstr Surg. 2012 Apr;129(4):681e-9e
  5. CJ Tyrrell, “Gynaecomastia: aetiology and treatment options”,Prostate Cancer and Prostatic Diseases (1999) 2, 167±171
  6. Deepinder F; Braunstein GD., “Drug-induced gynecomastia: an evidence-based review. “ Expert Opinion on Drug Safety. 11(5):779-95, 2012 Sep.
  7. GRETCHEN DICKSON, MD, MBA,”Gynaecomastia” Am Fam Physician. 2012 Apr 1;85(7):716-722.
  8. Brooks JH; Ahmad I; Easton G. “Anabolic steroid use.” BMJ. 355:i5023, 2016 Oct 13
  9. Brafa A1, Campana M, Grimaldi L, et Al. “Management of gynecomastia: an outcome analysis in a multicentric study.”Minerva Chir. 2011 Oct;66(5):375-84.
  10. R Glen Calderhead, Won-Serk Kim and David B Vasily “Adjunctive 830 nm light-emitting diode therapy can improve the results following aesthetic procedures” Laser Ther. 2015 Dec 30; 24(4): 277–289.
  11. Kim, W. S. & Calderhead, G. R. (2011). “Is light-emitting diode phototherapy (LED-LLLT) really effective?” Journal for laser surgery, phototherapy and photobioactivation, 20(3): 205-215

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*Disclaimer; There is no guarantee of specific results and the results can vary from patient to patient. The photos shown have not been altered, other than removing identifiable marks such as tattoos and birthmarks at the request of the patient. If any such alteration has been done than it has been done equally on both before and after photos and there is a notation under the photo stating what alteration has been done.