Gynaecomastia surgery is a commonly performed operation, but like all surgery it carries risks. General risks include bleeding, infection, blood clots and reactions to anaesthetic. Risks specific to male breast reduction include a collection of blood under the skin (haematoma), contour irregularities, a sunken or over-flattened nipple area, asymmetry, altered nipple sensation and scarring. Careful planning and aftercare aim to reduce each of these.
General surgical risks
- Bleeding: some oozing is normal, but significant bleeding can cause a haematoma, described below.
- Infection: usually minor and treated with antibiotics; rarely, a wound needs to be opened and drained.
- Blood clots: deep vein thrombosis (DVT) in the leg and, rarely, a clot travelling to the lungs. Early walking, compression stockings when advised and staying hydrated reduce the risk.
- Anaesthetic: a consultant anaesthetist assesses you beforehand. Nausea and a sore throat are common and short-lived; serious reactions are rare.
Your medical history, medications, smoking status and weight all influence these risks, which is why a thorough pre-operative assessment matters.
Haematoma
A haematoma is a collection of blood beneath the chest skin. It usually appears within the first day or two and causes one side to swell rapidly, feel tense and become increasingly painful. It can need a return to theatre to drain the blood. Stopping blood-thinning medicines and supplements when advised, controlling blood pressure, careful technique, compression and avoiding strenuous activity early on all reduce the risk. If one side of the chest swells rapidly after surgery, contact the surgical team urgently.
Contour irregularities and asymmetry
Removing tissue unevenly, or removing too much from behind the nipple, can leave dips, ridges or a ‘saucer’ shaped hollow under the areola. Leaving too much tissue can leave residual puffiness. Mr Nassab aims to remove the firm gland while leaving a thin layer of tissue beneath the nipple, and to blend the edges with liposuction. Some minor unevenness is common while swelling settles and often improves with time. Pre-existing differences in the chest wall, muscles and nipple position mean exact symmetry is not realistic.
Nipple and skin changes
Numbness, increased sensitivity or reduced sensation of the nipples is common after surgery and usually improves over several months, although occasionally changes are long lasting. Rarely, the blood supply to the nipple can be affected, particularly in larger reductions or in smokers. Loose skin may remain if the skin does not contract enough after tissue is removed, especially in grade 3 gynaecomastia or after large weight loss, and a further skin reduction may be considered later.
Seroma, scarring and recurrence
A seroma is a collection of clear fluid under the skin that may need draining in clinic. Scars around the areola usually fade well but can occasionally stretch, thicken or change colour, particularly in darker skin or with a tendency to keloid scarring. Recurrence after gland removal is uncommon, but gaining weight, anabolic steroid use or certain medicines can cause new fullness. Maintaining a stable weight and avoiding steroids helps protect the result.
What is normal and what is a concern
Normal: bruising that spreads and changes colour, firm swelling, mild tenderness, altered nipple sensation and slight fluid from small entry points in the first day or two. Concerning: rapid one-sided swelling or severe pain (contact the team urgently); fever, spreading redness or a wound that opens (contact the team the same day); sudden calf pain or one-sided leg swelling (same-day GP or NHS 111); chest pain or breathlessness (call 999).
Reducing your own risk
Stop smoking and all nicotine products for at least six weeks before and after surgery. Tell your surgeon about every medicine and supplement, including herbal remedies and any performance-enhancing drugs. Aim for a stable, healthy weight. Follow compression and activity advice, keep all follow-up appointments, and ask questions if anything worries you. Choosing a specialist plastic surgeon operating in a CQC-registered hospital, with clear aftercare arrangements, is an important part of staying safe.
Frequently Asked Questions
What is the most common complication?
Minor contour irregularities and temporary changes in nipple sensation are among the more common issues. Haematoma is less common but needs urgent attention.
Can gynaecomastia come back after surgery?
It is uncommon once the gland has been removed, but weight gain, steroid use or some medications can cause new fullness.
How is a sunken nipple avoided?
By leaving a thin layer of tissue beneath the areola and blending the surrounding area, rather than removing everything behind the nipple.
Is general anaesthetic safe for this operation?
For healthy adults, general anaesthetic given by a consultant anaesthetist in a hospital setting is routine, and your fitness is assessed beforehand.
Does smoking increase the risks?
Yes. Nicotine reduces blood flow to the skin and nipple, raising the chance of wound problems and delayed healing, so stopping well before and after surgery is strongly advised.
