Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
Most men who come in to discuss gynaecomastia have already spent time online trying to work out whether what they have is actually gynaecomastia, whether surgery is warranted, and roughly what it’s going to cost. They arrive with good questions. These are the ones I get most often.
Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS) consulting from his Sydney clinics in Manly and Bondi Junction. He also sees patients in Brisbane, Canberra, Gold Coast and Newcastle.
About the Condition
Does gynaecomastia go away on its own?
Sometimes — but it depends heavily on when it started and how long it’s been there. Pubertal gynaecomastia resolves spontaneously in the majority of teenage boys within one to two years. That’s genuinely common. In adult men, it’s a different picture. Once the condition has been present for more than 12 months and the tissue has firmed up, it almost never goes away without surgery. The glandular component becomes fibrotic. If there’s a reversible cause — say, a medication with known hormonal effects — it’s worth addressing that first. But the honest answer for most men who’ve had it for a few years is: surgery is the only way to remove it.
Can exercise fix gynaecomastia?
It depends what’s causing the chest enlargement. If it’s primarily fatty tissue, exercise and weight loss will help — that’s called pseudogynecomastia. If it’s true glandular tissue, no amount of chest training will change it. Glandular tissue doesn’t respond to caloric deficit. In fact, many men find the opposite happens: they lose overall body fat, their pecs get more defined, and the firm mound under the nipple becomes more obvious rather than less. That’s actually a useful diagnostic clue. If it’s still there after meaningful weight loss, it’s glandular.
See: Exercise and Enlarged Male Breasts
What causes it?
The underlying mechanism is an imbalance between oestrogen and androgen activity at the breast tissue level. Practically speaking, that can be triggered by puberty, age-related testosterone decline, certain medications — steroids (anabolic and some prescription), antidepressants, antihypertensives, proton pump inhibitors — alcohol, cannabis, or other illicit drugs. Liver disease, kidney failure, and hyperthyroidism are also associated. In a meaningful proportion of cases, no specific cause is found. I take a thorough history at consultation and discuss anything potentially reversible before we talk about surgery.
What are the grades?
The Simon Classification is what’s commonly used:
- Grade I: small enlargement, no excess skin
- Grade IIa: moderate enlargement, no skin excess
- Grade IIb: moderate enlargement, minor skin excess
- Grade III: significant enlargement with considerable excess skin
Grade matters because it influences the combination of techniques required. A Grade I might be addressed with excision alone. Grade III will need skin removal. I assess this at consultation.
What does it feel like?
The classic presentation is a firm, disc-like mound directly beneath the nipple — often described as a button or hard lump. Some men also experience nipple tenderness or sensitivity. Swelling and discomfort can be present. One thing worth flagging: if there’s fluid discharge from the nipple, that needs a medical assessment to exclude other causes before considering surgery.
Suitability and Timing
Am I a candidate?
The main things I’m looking for: confirmed glandular or persistent fatty tissue in the chest, good overall health, stable weight (ideally BMI under 29), non-smoker or willing to stop well in advance, and realistic expectations about what surgery can address. You also need to be willing to go through the regulatory process — minimum two personal consultations, GP referral, psychological assessment, cooling-off period. These aren’t optional under current AHPRA regulations.
Surgery in adolescence is usually deferred. Most teenage cases resolve. I’ll typically want to wait unless it’s severe or causing significant psychological distress.
What’s the minimum age?
18 in most cases — and only after puberty has completed and a period of observation has confirmed the condition isn’t resolving. There’s no maximum age. I see men in their 60s and 70s who’ve had this for decades and only recently decided to address it. Fitness for general anaesthesia matters more than age.
The Procedure
What does the surgery involve?
I use a combination of techniques based on what each patient needs:
Subcutaneous mastectomy — this is the glandular excision part. Firm breast tissue is removed through an incision along the lower edge of the areola, where it heals inconspicuously. If you have true gynaecomastia, you need this. Liposuction alone won’t touch it.
Power-assisted liposuction — using the MicroAire system to remove the fatty component. For mixed gynaecomastia, this runs alongside the excision. For pure pseudogynecomastia, it may be all that’s needed.
Skin excision — occasionally necessary in Grade III cases with significant skin redundancy. Not common, and only recommended when the anatomy genuinely calls for it.
Everything is done under general anaesthesia in an accredited private hospital. Day procedure for most patients. Usually one to two hours.
Can it be done under local anaesthetic?
Not in my practice. General anaesthesia gives me the control I need, particularly when combining excision and liposuction. Some practitioners do liposuction-only cases under local — that’s not my standard approach.
Won’t liposuction alone fix it?
Only if there’s no glandular component. And in my experience, most men who think they have “just fat” actually have some glandular tissue too. If you do the liposuction and leave the gland behind, the nipple mound is still there after surgery. That’s a preventable outcome if the assessment is done properly beforehand.
Do I have to wear a compression garment?
Yes — you’ll wake up wearing one. It stays on continuously (except showering) for about two weeks. It’s not optional. It reduces swelling, supports the healing tissue, and helps the skin adapt to the new contour.
Recovery
How long until I’m back to normal?
Desk work: one to two weeks for most men. The gym and physical labour: four to six weeks minimum. Swelling peaks around day three to five, then gradually reduces over two to three months. The full result isn’t visible until the swelling has fully resolved — that can take three months or more. Individual variation is real and I give specific guidance based on what was done.
When can I sleep on my side?
Back sleeping with slight head elevation for the first one to two weeks is ideal. Side sleeping is fine if comfortable and there’s no pressure on the chest. Stomach sleeping should wait until four to six weeks. Most men are back to normal by that point.
When can I shower?
48 hours post-surgery for most patients. Warm water, brief and gentle over the incision sites, pat dry. No soaking, no high-pressure water directly at the chest. You’ll get specific wound care instructions at discharge — follow those rather than general advice.
What should I avoid before surgery?
Nicotine needs to stop at least six weeks out — smoking significantly increases complication risk. Aspirin, anti-inflammatories (ibuprofen, naproxen), and various herbal supplements need to stop ahead of surgery because of their effect on bleeding. Alcohol should be avoided in the days before. Your pre-operative assessment covers all of this in detail, including a full medication review.
Cost and Medicare
What does it cost in Sydney?
All-inclusive costs — surgeon, hospital, anaesthesia, follow-up — typically run from $8,000 to $16,000 depending on complexity. Simpler cases sit at the lower end. Grade III with skin excision sits higher. A detailed written quote is provided after consultation.
For a full breakdown: Gyno Surgery Cost in Australia: What to Expect
Does Medicare cover it?
It can. Medicare item numbers 31525 (unilateral) and 31526 (bilateral) may apply where the case is glandular, has been present for a defined period, and involves documented physical or psychological impairment. Cosmetic-only cases don’t qualify. A GP referral is required. And even with a rebate, there’s still a significant out-of-pocket gap — it’s not free. My team can walk you through eligibility at consultation.
Full detail here: Will Medicare Cover My Gynaecomastia Surgery?
The Consultation
How do I get started?
Get a GP referral first. It’s required under AHPRA regulations that came in on 1 July 2023, and it may also make you eligible for a partial Medicare rebate on the consultation fee. Once you have it, contact my practice to book. I consult in Sydney (Manly and Bondi Junction), Brisbane, Canberra, Gold Coast and Newcastle. Consultation fee is $450.
What happens at the consultation?
I take a full history — how long, what it looks like, what medications you’re on, what you’ve tried, and what you’re hoping to address. I examine the chest anatomy and assess the tissue composition and grade. I explain what I’d recommend surgically and why, go through the recovery and risks honestly, and take clinical photographs for planning. You leave with a written quote.
How many times do I need to come in before surgery?
Under AHPRA regulations, a minimum of two personal consultations with the operating surgeon before proceeding. Plus a psychological assessment and a cooling-off period. I see every patient personally at both consultations — it’s not delegated to a coordinator.
Book a Consultation
To discuss your situation, contact Dr Scott J Turner’s practice. A GP referral is required before your first appointment.
Related resources:
- Gynaecomastia Surgery Sydney
- Gyno Surgery Sydney — Treatment Options
- Gyno Surgery Cost in Australia
- Will Medicare Cover My Gynaecomastia Surgery?
- Exercise and Enlarged Male Breasts
This article is for educational purposes only and does not constitute medical advice. All surgical procedures carry risks and individual outcomes vary. A comprehensive consultation with Dr Scott J Turner is required to assess your suitability for any procedure and to discuss risks, alternatives and realistic expectations specific to your circumstances.
