Gynecomastia Glossary

Aromatase

An enzyme that converts androgens (testosterone, androstenedione) to oestrogens (oestradiol, oestrone). Aromatase activity in adipose tissue is one mechanism by which obesity contributes to gynecomastia. Aromatase inhibitors are sometimes used to manage early-onset gynecomastia in selected cases.

Areola

The pigmented circular area surrounding the nipple. The natural colour transition between pigmented areola and surrounding chest skin is the anatomical landmark used to hide the periareolar incision in gynecomastia surgery.

Compression vest

A specialised garment worn continuously for 4–6 weeks after gynecomastia surgery. Reduces oedema, shapes the healing tissue to the new chest contour, reduces seroma risk, and improves final aesthetic outcome. The single most patient-modifiable factor in surgical result quality.

Crater deformity

A concave depression beneath the nipple-areolar complex, usually caused by over-resection of glandular tissue. Avoided by deliberately preserving 5–8 mm of retroareolar disc. The most common technical complication of gynecomastia surgery, occurring in 3–8% of cases.

FACS

Fellow of the American College of Surgeons. A senior surgical certification awarded after demonstrated clinical competence, ethical practice, and contribution to surgical literature. Awarded to Dr. Erdal at ACS Clinical Congress 2025.

FEBOPRAS

Fellow of the European Board of Plastic, Reconstructive and Aesthetic Surgery. The European board certification for plastic surgery, requiring rigorous written and oral examination plus evidence of clinical practice.

Gland excision

Surgical removal of the firm fibrous glandular tissue behind the nipple-areolar complex. Performed via inferior periareolar incision. The standard technique for Simon Grade IIa–IIb dense fibrous gynecomastia where pull-through is insufficient.

Gynecomastia

Benign proliferation of glandular breast tissue in males, producing visible enlargement of one or both sides of the chest. Distinct from pseudogynecomastia (fat only). Affects approximately one in three men at some point in their life.

Haematoma

A collection of blood beneath the skin, the most common acute complication of gynecomastia surgery (1–3% incidence). Risk is elevated in anabolic steroid users due to polycythaemia. Most resolve with conservative management; large haematomas occasionally require surgical evacuation.

Inframammary fold (IMF)

The natural crease at the lower border of the chest where the breast/chest tissue transitions to the abdomen. In Grade III gynecomastia surgery requiring extensive skin excision, an inframammary incision may be used as an alternative or addition to periareolar approach.

JCI accreditation

Joint Commission International accreditation, an international standard for hospital quality and patient safety. Hospitals where Dr. Erdal operates are JCI-accredited.

Klinefelter syndrome

A genetic condition (47,XXY karyotype) characterised by gynecomastia, hypogonadism, and elevated risk of male breast cancer (60-fold relative risk vs. general male population). Identified by karyotype testing when clinically suspected.

Liposuction

A technique using small cannulas to remove subcutaneous fat through tiny puncture incisions. The primary modality for pseudogynecomastia and an adjunct in mixed gynecomastia. Leaves only 3–4 mm puncture sites.

Morselli pull-through

A minimally invasive gynecomastia technique described by Morselli (1996) in which the glandular component is grasped through the small liposuction port and delivered without enlarging the incision. Optimal for Simon Grade I–IIa mixed gynecomastia.

Nipple-areolar complex (NAC)

The combined unit of nipple and areola. NAC repositioning may be required in Simon Grade III gynecomastia where significant skin excess and inferior NAC displacement coexist.

Periareolar incision

An incision placed at the inferior hemisphere of the areolar border, hidden at the natural colour transition between pigmented areola and surrounding skin. The standard scar location for gynecomastia surgery requiring open access.

Pinch test

A clinical examination manoeuvre where the surgeon pinches tissue at the areolar border. Firm rubbery resistance suggests glandular tissue (true gynecomastia); soft compressible tissue suggests fat (pseudogynecomastia). Distinguishes treatment pathways.

Pseudogynecomastia

Apparent breast enlargement in males caused by adipose (fat) tissue accumulation only, without glandular proliferation. Treated by liposuction alone. Distinguished from true gynecomastia by clinical examination (pinch test) and ultrasound.

Pull-through technique

See Morselli pull-through. The minimally invasive approach where the gland is delivered through the small liposuction port without enlarging the incision.

Retroareolar disc

The cuff of glandular and fatty tissue immediately behind the areola. A 5–8 mm thickness should be deliberately preserved at surgery to prevent crater deformity and maintain natural NAC projection.

Recurrence

Re-development of gynecomastia after surgical treatment. Typical rate 2–7% in adequately treated cases. Rate increases to 15–25% if anabolic steroid use continues post-operatively. Underlying cause identification and management is the most durable preventive measure.

SARMs

Selective Androgen Receptor Modulators. A class of compounds with anabolic effects, often used in athletic and bodybuilding circles. Some SARMs cause gynecomastia through aromatisation; full disclosure of SARM use during consultation is essential for accurate risk assessment and recurrence planning.

Seroma

A collection of clear serous fluid beneath the skin (1–4% incidence after gynecomastia surgery). Usually resolves with continued compression vest use; persistent seromas may require aspiration.

Simon classification

The 1973 grading system for gynecomastia (Simon, Hoffman & Kahn) that assigns severity based on tissue volume and skin redundancy. Grade I (minor, no skin excess), IIa (moderate, no skin excess), IIb (moderate, minor skin excess), III (marked enlargement with skin excess). Drives technique selection.

Subcutaneous mastectomy

Surgical removal of glandular breast tissue while preserving the overlying skin and nipple-areolar complex. Synonymous with formal gland excision in the gynecomastia context.

Tamoxifen

A selective oestrogen receptor modulator (SERM) sometimes used to treat early-onset gynecomastia (under 6 months from onset, before fibrosis). Standard dose 10–20 mg daily for 3–6 months. Less effective once fibrotic stage is reached; surgery is then the only reliable treatment.

True gynecomastia

Gynecomastia caused by genuine glandular tissue proliferation (as distinct from pseudogynecomastia). Felt as a firm rubbery disc behind the nipple-areolar complex on examination. Treated with gland excision or pull-through technique.

Assoc. Prof. Dr. Ayhan Işık Erdal, MD, FACS, FEBOPRAS

Double board-certified plastic surgeon · 30+ peer-reviewed publications · Memorial Sloan Kettering & Ghent University Hospital trained · ISAPS World Congress 2023 Gold & Bronze Awards