Now I Am Going to Learn to Swim

Let me answer first: what determines the shape after gynecomastia surgery is not how much was removed, but what and how much was left.

Gynecomastia is a mixed state of overgrown glandular tissue and accumulated fat, and the ratio between the two differs from person to person. Performing liposuction alone on someone with a high proportion of glandular tissue leaves the firm mass in place, and it can still be felt. Conversely, removing glandular tissue entirely leaves the area beneath the areola sunken like a pressed dish — what is commonly called a crater deformity.

So when excising glandular tissue through an incision beneath the areola, I leave tissue of a certain thickness directly under the areola and taper the edges so they blend into the surrounding fat layer. Only when a gentle curve remains over the pectoralis major does it look natural not just in clothes but out of them.

This person wrote that the glandular tissue and fat had been removed appropriately and the shape seemed well set. But satisfaction with shape varies with the original tissue volume, skin elasticity, and Simon grade, so I cannot promise the same result to everyone.

Asked about their first impression, they said the staff were kind, and added the observation that — perhaps because it is a men's clinic — there were only men.

Gynecomastia requires an examination in which the shirt comes off and the chest is assessed by hand. Quite a few people put that examination off for years because the process feels like a burden. That is the reason the clinical environment is arranged this way. The diagnosis itself takes only a few minutes by visual and manual examination, with ultrasound added when needed. Reducing what makes people postpone those few minutes comes first, in my view.

For what they wanted to do after surgery, they chose swimming. They said they had wanted to learn but had put it off because taking their shirt off at a pool was embarrassing.

Practicing in this field, I see answers like this often. Not some grand plan, but one thing others do without a second thought that this person has gone without. What surgery changes is usually a matter of about that size.

To others facing the same concern, they left the advice to at least come in for a consultation.

On coming in for a consultation, I agree. Rushing the timing is a separate matter. This is their experience, and whether surgery is needed — and if so, when is appropriate — is something to judge after confirming the amount and degree of glandular tissue at an examination. For someone still growing, watching the course is sometimes the right call, and when a medication being taken or a change in weight is the suspected cause, that has to be checked first.

What you need to know before deciding on surgery is which of those cases you are. Once that is confirmed, the rest of the decision becomes far simpler.