Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
Most men who have it don’t talk about it. Many don’t know what it actually is, or whether what they’re experiencing counts. Gynaecomastia — enlarged breast tissue in males — affects somewhere between 35 and 50 per cent of adult men at some point in their lives, which makes it one of the most common male body concerns that almost nobody discusses in a GP consultation.
Dr Scott J Turner is a Fellow of the Royal Australasian College of Surgeons (FRACS) with specific experience in gynaecomastia surgery. He consults at his Sydney clinics in Bondi Junction and Manly, with surgery performed at Bondi Junction Private Hospital and Delmar Private Hospital, Dee Why.
What Is Gynaecomastia?
The short answer: it’s glandular breast tissue. Not chest fat, not a cosmetic quirk — actual glandular breast tissue, the same type that develops in female breasts, growing in the male chest in response to a hormonal imbalance.
That distinction matters more than most men realise, because it’s the difference between a concern that might respond to weight loss or lifestyle change, and one that categorically won’t.
Three presentations come up in practice:
True gynaecomastia is glandular tissue — firm, disc-like, sitting beneath the nipple. Press on the area and you’ll feel it. This doesn’t shrink with training or diet. The only way to remove it is by surgery.
Pseudogynecomastia is fatty tissue. No glandular component. It responds to weight loss, at least partially, though it doesn’t always resolve completely.
Mixed gynaecomastia is the most common presentation at surgical consultations — a combination of glandular tissue and surrounding fat. Which is actually what makes so many men confused: the fat component gives them hope that it might improve on its own, while the glandular component quietly doesn’t budge.
The only way to know which you have is a physical examination. This is why self-diagnosis from symptoms alone is unreliable — and why a proper consultation is where the conversation actually starts.
What Causes Gynaecomastia?
The underlying mechanism is the same in every case — an imbalance between oestrogen and testosterone. Either oestrogen levels are relatively elevated, testosterone is relatively low, or both. What varies is the reason for that imbalance.
Hormonal changes at life stages. Newborns, adolescent boys, and older men are the three groups most commonly affected, for different hormonal reasons. Neonatal gynaecomastia from maternal oestrogen exposure. Pubertal gynaecomastia from the hormonal turbulence of adolescence — this one usually resolves on its own within one to three years. Age-related gynaecomastia from the gradual testosterone decline that comes with getting older.
Medications. A surprisingly long list. Certain antihypertensives, antidepressants, anti-androgens, prostate cancer treatments, heartburn medications, and anabolic steroids are all associated with gynaecomastia. If you’re on regular medication, a review with your GP is a useful first step before anything else.
Anabolic steroids. One of the most common presentations in surgical consultations. Exogenous androgens suppress the body’s own testosterone production and get converted to oestrogen in the process. The result is glandular tissue development that stopping steroids doesn’t reliably reverse once it’s established.
Health conditions. Liver disease, kidney failure, hyperthyroidism, testicular conditions — anything that disrupts hormone metabolism can contribute. These need to be excluded as part of any clinical assessment.
Obesity. Fat tissue converts androgens to oestrogen. Higher body fat means more conversion, which means relatively higher oestrogen. This drives both the fatty component (pseudogynecomastia) and, in some cases, true glandular development.
No cause found. In around a third of cases, no specific cause is identified. This is idiopathic gynaecomastia — real, established, and still treated the same way.
Grades of Gynaecomastia
Gynaecomastia is graded I through IV based on how much tissue is present and whether excess skin has developed:
- Grade I — Minor enlargement confined to the areola region. No excess skin.
- Grade II — Moderate enlargement extending beyond the areola. Still no excess skin.
- Grade III — Moderate enlargement with minor excess skin.
- Grade IV — Significant enlargement with excess skin. The breast starts to take on a more feminised profile.
Grades I and II are typically addressed through glandular excision, liposuction, or a combination. Grades III and IV require skin excision as well.
Will Gynaecomastia Go Away on Its Own?
This is usually the first question, and it deserves a straight answer.
If it developed during puberty: probably yes, if you’re still in that window. Pubertal gynaecomastia typically resolves within one to three years of onset. Waiting is appropriate where the tissue isn’t causing significant discomfort.
If it was caused by a medication: possibly, if the medication is stopped early enough before fibrosis sets in.
If it’s been there for more than two years: unlikely without surgery. Once fibrosis has occurred — scar tissue forming within the gland — spontaneous resolution is off the table.
If it’s pseudogynecomastia (pure fat): weight loss may help. It won’t always resolve it completely, and the glandular component, if there is one, won’t respond at all.
The honest answer most men don’t want to hear: established gynaecomastia with a glandular component, present for years, is not going away with gym work or caloric restriction. That’s not a marketing line — it’s just how the tissue behaves.
Non-Surgical Options
The options are limited, and it’s worth being straight about what they can and can’t do.
Weight loss reduces the fatty component of pseudogynecomastia. It doesn’t touch glandular tissue.
Medication review — where a causative drug is identified and stopped early enough, partial resolution is possible. Once fibrosis has set in, less so.
Chest exercise builds the pectoral muscles underneath. The chest can look better. The tissue is still there.
For established true gynaecomastia, surgery is the only reliable path.
Surgical Treatment
Surgery depends on what the tissue looks like and the grade of presentation.
Glandular excision — the glandular disc is removed through a small incision at the areola border. This is the direct solution for true gynaecomastia.
Liposuction — addresses the fatty component. Doesn’t remove glandular tissue. Used for pseudogynecomastia or the fatty surround in mixed cases.
Combined excision and liposuction — the standard approach for most mixed presentations. Both the gland and surrounding fat are addressed in the same operation.
Skin excision — needed for Grades III and IV where excess skin has developed. Requires additional incisions beyond the areola.
Medicare. Item numbers 31525 and 31526 may apply to glandular excision where clinical criteria are met. A GP referral and documented clinical assessment are required. Purely cosmetic presentations are not covered.
For the full surgical guide, see the gynaecomastia surgery page.
When to See a Doctor
Most gynaecomastia is benign, but not all chest changes in men are gynaecomastia, and some need prompt attention.
See a GP if you notice:
- Rapid enlargement, particularly on one side only
- Hard or irregular tissue — gynaecomastia typically feels soft or rubbery; a firm, irregular mass warrants investigation to exclude breast cancer, which does occur in males
- Nipple discharge
- Breast pain alongside rapid growth
- Any symptoms suggesting an underlying systemic condition
Breast cancer in men is rare. It’s also real. One-sided, hard, or rapidly growing tissue shouldn’t be assumed to be gynaecomastia and then left alone.
AHPRA Regulatory Requirements
Where gynaecomastia surgery is performed for cosmetic purposes, the following apply under AHPRA cosmetic surgery guidelines (effective 1 July 2023):
- A referral from your GP or a specialist physician
- A minimum of two consultations with Dr Turner before surgery is booked
- A psychological evaluation to confirm suitability
- A mandatory cooling-off period before formal consent is given
Where surgery qualifies under a Medicare item number (functional/clinical indication), a different pathway applies. Dr Turner’s team will confirm requirements at consultation.
Frequently Asked Questions
What is the difference between gynaecomastia and chest fat?
Gynaecomastia involves firm glandular breast tissue beneath the nipple-areola complex, driven by hormonal changes. It feels like a firm disc or lump under the nipple and does not reduce with exercise or weight loss. Pseudogynecomastia is fatty tissue deposition in the chest without a glandular component — it can improve with significant weight loss. Many men have a mixed presentation involving both. A physical examination is needed to distinguish between the two.
Does gynaecomastia go away on its own?
Pubertal gynaecomastia — which develops in adolescent boys — typically resolves within one to three years without treatment. Where it persists beyond this window, or where it develops in adult men, spontaneous resolution is less likely, particularly once fibrosis has occurred within the glandular tissue. Medication-induced gynaecomastia may partially resolve once the causative drug is stopped. Established gynaecomastia of more than two years’ duration is unlikely to resolve without surgery.
What causes gynaecomastia?
Gynaecomastia is caused by an imbalance between oestrogen and testosterone — either relatively high oestrogen, relatively low testosterone, or both. Common causes include pubertal hormonal changes, certain medications (including anabolic steroids, some antidepressants, antihypertensives, and prostate treatments), underlying health conditions affecting hormone balance, obesity, and age-related testosterone decline. In approximately one third of cases no specific cause is identified (idiopathic gynaecomastia).
Is gynaecomastia surgery covered by Medicare?
Gynaecomastia surgery may attract a Medicare rebate under item numbers 31525 and 31526 where clinical criteria are met. A GP referral and documented clinical assessment are required. Purely cosmetic procedures are not covered. Dr Turner will assess Medicare eligibility at consultation and advise on the documentation required.
Can exercise fix gynaecomastia?
Exercise strengthens the pectoral muscles beneath the breast tissue and can improve the overall appearance of the chest. It does not reduce glandular breast tissue. Where the presentation is purely pseudogynecomastia (fatty tissue without a glandular component), significant weight loss may reduce overall chest volume. Where true glandular tissue is present, it will not be affected by exercise or dietary changes. Surgery is the only reliable way to remove glandular gynaecomastia tissue.
Consult with Dr Scott J Turner
Dr Turner consults for gynaecomastia surgery in Sydney at Bondi Junction and Manly. He also sees patients in Brisbane, Canberra, Newcastle, and the Gold Coast. Surgery is performed in Sydney at Bondi Junction Private Hospital and Delmar Private Hospital, Dee Why.
Contact the practice to arrange a consultation, or read more about Dr Turner’s background and training.
