The single most important day of your gynecomastia journey is not the day of surgery—it’s the day of your diagnosis. A safe and successful procedure is built on a foundation of meticulous, mandatory gynecomastia screening. This isn’t just a formality; it’s how we ensure your safety, rule out underlying health issues, and confirm that surgery is the right, permanent solution for you.
Before proceeding with your Gynecomastia Surgery, a rigorous preoperative screening process is mandatory. This phase ensures your safety, rules out any underlying health issues, and guarantees that surgery is both the necessary and permanent solution for your chest contouring goals.
Physical Examination Confirms Diagnosis
A thorough medical history and physical examination are mandatory before surgery to obtain an accurate diagnosis and evaluate your overall health. This is the foundational step. I will personally examine you to evaluate the male breast tissue and determine the specific type and extent of your gynecomastia.
Operative gynecomastia treatment remains a safe modality, but patients with known preoperative medical or surgical comorbidities necessitate more extensive perioperative assessment and monitoring
Palpation Distinguishes Glandular Tissue (Gland vs. Fat)
The primary goal of the physical exam is to differentiate true gynecomastia from simple fatty deposits, known as pseudogynecomastia. This is a crucial distinction, as we explore in our guide on what is gynecomastia.
The physical exam helps differentiate true gynecomastia (benign enlargement of the male breast resulting from glandular proliferation) from pseudogynecomastia (fat deposition only)
True gynecomastia is characterised by a soft, compressible, and mobile mass of breast tissue felt under the nipple. This is in contrast to the softer fatty tissue of pseudogynecomastia, which is not associated with a discrete mass. This diagnosis is critical because it determines the correct surgical technique—liposuction is used for fat, but excision is required for the permanent removal of glandular tissue.
Asymmetry Nuance: While many cases are bilateral, presentations such as asymmetric bilateral gynecomastia (ABGM) with a larger left than right breast, true-type (entirely glandular) breasts, and a higher asymmetry ratio require careful clinical attention.
Imaging Minimises Malignancy Risk (Breast Cancer)
While gynecomastia itself is benign, I will screen you for the rare possibility of male breast cancer. If a lump is felt or if the physical exam is suspicious (e.g., a painless, fixed, and irregularly shaped mass), mammography is the method of choice for examination. An ultrasound may also be suggested to confirm the diagnosis.
Ultrasound (US):
US is widely used in the case of breast disease.
Typical US findings for gynecomastia include hypoechoic retroareolar masses (nodular, poorly defined, or flame-shaped), with increased anteroposterior depth at the nipple.
The US is essential for preoperative assessment for the differential diagnosis of pseudogynecomastia and to estimate the amount of glandular tissue to remove.
During minimally invasive surgery, preoperative colour ultrasound should be used to help locate the boundary of the gland to facilitate the guidance of intraoperative endoscopic resection within the boundary, thereby avoiding blind, excessive resection.
MRI for Planning:
Magnetic Resonance Imaging (MRI) is useful for adequate preoperative planning to assess the quantity of fatty tissue, the size, and morphology of the gland and to make a differential diagnosis between gynecomastia, adipomastia, and/or adipo-gynecomastia and plan the surgical strategy.
MRI is particularly helpful in the surgical excision design for patients with idiopathic unilateral prepubertal gynecomastia (IUPG).
Counter-Argument on Routine Imaging: Although imaging studies, such as mammography, are useful in evaluation, diagnostic imaging had a minor influence on surgical indication in some patient series because indication was principally based on clinical findings. Therefore, diagnostic imaging should be left to clinically selected cases.
Laboratory Screening Rules Out Underlying Pathology
A physical exam confirms what, but lab tests help find the why. Laboratory investigations are recommended to find the underlying cause of gynecomastia, as the condition is often a symptom of other medical conditions. This is a key part of our surgical safety assurance. Completing all necessary diagnostic tests is mandatory to ensure you are in perfect health for the surgery.
Selectivity is Key: Routine hormonal studies in all gynecomastia patients are not cost-effective and do not significantly alter treatment outcomes
Blood Tests Quantify Organ Health (Liver, Kidney, Thyroid)
The initial panel of blood tests focuses on key organs that influence hormone balance. Recommended investigations include:
- Liver Function: AST and ALT tests to rule out liver disease.
- Kidney Function: Serum creatinine to check for kidney damage.
- Thyroid Function: TSH levels to evaluated for conditions like hyperthyroidism.
These are just some of the common underlying causes we must rule out before proceeding.
Hormonal Profiles Guide Treatment Focus (Estrogen/Androgen Ratio)
Gynecomastia is fundamentally a hormonally driven condition, so a blood test and hormonal profile are always observed. If initial lab tests fail to uncover the cause, a more detailed investigation is conducted.
Blood tests to assess serum levels of LH, FSH, estradiol, testosterone, prolactin, dehydroepiandrosterone, and human chorionic gonadotropin may be useful
In rare cases, if certain markers (like beta-hCG) are high, an ultrasound of the testicles is performed to rule out a tumour.
Once these mandatory tests confirm your health, rule out underlying issues, and confirm your diagnosis, we can finalise your personalised treatment plan. This screening is the first and most critical component of the mandatory readiness steps you’ll take before your procedure.
Histological Analysis: Assessing High-Risk Factors
While the surgical procedure is primarily aesthetic, the tissue specimen removed is often analysed to rule out pathology. The decision to perform pathological analysis is often dependent on patient risk factors.
Breast resection in men is performed for two objectives: restitution of a male chest contour (cosmetic indication) and histological clarification of suspicious breast lesions.
High-Risk Justification
Pathologic analysis of subcutaneous mastectomy specimens is justified by factors like:
- Presence of a palpable or visible mass within breast tissue, especially if firm, irregular, or fixed.
- Suspicion of malignancy based on clinical examination or imaging, such as rapid growth, skin changes, nipple discharge, or lymphadenopathy.
- Risk factors for male breast cancer include advanced age, prior radiation, family history of breast cancer, Klinefelter syndrome, or BRCA mutations.
- Asymmetric or unilateral gynecomastia may be associated with a higher risk of underlying pathology.
- Findings during surgery that are atypical in appearance, such as areas of necrosis, firmness, or unusual colouration.
- Previous history of malignancy or a significant change in clinical presentation since initial assessment.
Based on these reported results, surgeons are advised to send properly oriented specimens for pathologic examination in high-risk patients.
The Adolescent Counter-Argument: Given the financial and logistical costs, and the fact that the incidence of malignancy or abnormal pathology in adolescent males (21 years or younger) is extremely low (only 36 published articles reviewed 615 cases), pathologic examination of breast tissue excised for gynecomastia in individuals 21 years of age or younger should be neither routinely performed nor required.
Your Consultation in Jaipur
A precise, hands-on physical exam and comprehensive lab work are how we guarantee the safety and success of your gynecomastia treatment. I invite you to book a private consultation with my team to ensure your diagnosis is accurate and your treatment is perfectly tailored to your body.
To book your personalised, confidential consultation, please reach out to my team at Kalpana Aesthetics.
- Call or WhatsApp: 7718183535
- Visit Us: Kalpana Aesthetics, 2nd Floor, Jaipur Hospital, Mahaveer Nagar, Tonk Road, Jaipur
Disclaimer: The information provided on this webpage is for educational purposes only and does not constitute medical advice. The diagnostic tests mentioned are standard medical practices, but the specific tests required can vary based on individual medical history. Please consult with a qualified, board-certified plastic surgeon for a full medical evaluation.
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