Is liposuction alone enough for treating gynecomastia or is an excision of the gland is needed? (Photo)

Question

I am 20 years old male that has gynecomastia I went to a famous doctor, he said to me that he would do liposuction only as it will remove fat and gland together but I don't believe it as in any video the doctors do liposuction and after that they do cut under the areola and remove the gland out because I guess the gland won't just melt from heat, I am paying a huge amount of money so I cannot afford another surgery if I didn't get the successful shape from the first time, So help me please.

Marwan R. Khalifeh, MD · Answer

Most gynecomastia experts would do liposuction followed by direct glandular tissue excision. If liposuction alone was recommended, it may mean that the surgeon who evaluated you  thinks you have pseudogynecomastia where the material is fat and not gland. You may want to get an opinion with a renowned gynecomastia surgeon in your area. In plastic surgery, fame and competence don't always go hand-in-hand.

Sam Speron, MD, FACS · Answer

It is very common for men to want male breast reduction or gynecomastia surgery. While surgery is the best option, nonsurgical treatment with Kybella injections and laser skin tightening are options for those not interested in surgery but you must be realistic and expectations need to be set accordingly.
I tell all my patients that there's a 100% chance of asymmetry after any breast surgery with or without a lift. Of course, the goal is to try to make you as equal as possible but everyone has asymmetries of the ribs, the muscles etc. It's very important to understand this as you, like all men, have some breast asymmetry that would be pointed out on examination and before any surgery. 
When men have excess breast skin, a reduction of this excess skin can be done through carious scars and there are 3 different types of scars including liposuction, areolar scar, as well as all sorts of other chest scars.
I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of male breast reductions and gynecomastia surgery. Good luck with your future surgery!
I hope this helps answer your question. If it does, please take a moment to up vote this answer on the “respond” button on the top right.

Nikesh K. Patel, MD · Answer

Liposuction can be very successful for someone who has small glands because it will remove the fat along with some thin glands while sculpting and tightening the chest.  For someone who has larger, harder glands (you can feel these when you touch your chest), gland excision will be required to remove the gland and then liposuction will get rid of any excess fat that was around the gland while also tightening/contouring the chest to get the look you desire.  Discussing your surgery goals and expectations with your surgeon prior to your procedure will help you achieve your desired results.

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Thank you for your question. Liposuction alone will not remove all the glandular tissue and this will almost certainly need excision as well.I would suggest a second opinion if you are unsure about what your surgeon has said to you. If you are paying a lot of money then you want to make sure you are doing the right thing. I would also ask your surgeon if after the surgery, if the treatment has not worked or you are not satisfied - what happens? Do you have to pay for a revision or is it that this will be covered.I hope this is of help to you

Scott W. Vann, MD, FACS · Answer

I do a lot of gynecomastia and I cannot tell ahead of the operation who will need liposuction only and who will need excision also. I always do lipo first which usually gets 90-100%of the tissue. If it is all gone 50-60% of the cases, I stop. The other 40-50% of the cases I proceed and open a small incision along the areola and remove the remaining tissue. Go to a surgeon who does a lot of this procedure. Good luck.

Miguel Delgado, MD · Answer

About 40% of my gynecomastia practice is revision surgery where only liposuction was done by other surgeons. Having to do revision surgery is more difficult because now there is scar tissue to deal with and the skin does not retract as well. Liposuction works well for men with pseudo-gynecomastia (fat only) but for men with true gynecomastia, surgical excision needs to be done to achieve the best contours for a natural looking chest. Be sure to see a board certified plastic surgeon who specializes in gynecomastia. Good luck.

Robert M. Tornambe, MD · Answer

A.R.20.    I completely understand your dilemma. Often times, liposuction alone is the only treatment needed to treat gynecomastia. If there is significant amount of dense breast tissue present, then direct excision may also be needed. Physical examination is required to assess your particular needs. Consult with a board-certified plastic surgeon for a second opinion if you have doubts.  Good luck!

Daniel Brown, MD, FACS · Answer

Hello and thanks for your questions and photo.  The short answer is no, liposuction alonw will not remove the dense glandular tissue that is the major cause of your discomfort and puffy nipples.  Liposuction will smooth and contour the area around where the gland has been removed.  You require direct excision of the gland and liposuction contouring to get the best result.  After reviewing your photos, you appear to be an ideal candidate for the above procedure and should get a great result after a properly performed surgery.  If you are not confident in your surgeon's advice and plan - and you seem to be correct in this instance - seek a second opinion consultation elsewhere.  Don't pay anything for the wrong procedure!  If the cost is that high, think about using some ot that money to travel elsewhere for a properly performed procedure. I hope that this advice helps.Best wishes!Daniel Brown, MD, FACSBoard Certified, American Board of Plastic SurgeryMember, American Society of Aesthetic Plastic SurgeonsMember, American Society of  Plastic SurgeonsCastle Connolly Top DocReal Self Top 500

David Azouz, MD, FACS, FRCS(C) · Answer

It is best to remove both the gland and perform liposuction.  In general the gland is far too fibrous and thick to be performing liposuction alone.  In my practice I see gynecomastia revision surgery very frequently.  This is often because the gland was not removed.  Incisions should be hidden even with removal of the gland, and drains are not needed in nearly all the cases I perform.

Amit Gupta, MD - Account Suspended · Answer

Thank you for posting your question. with regards to your question, only Liposuction will just remove the fat present in the chest area and in order for you to achieve the best of the results as per your expectations, my advise would be to have the gland removed. In your case the best advise would be contact a Board Certified Plastic Surgeon who would be able to assist you in this procedure.Regards,

Is liposuction alone enough for treating gynecomastia or is an excision of the gland is needed? (Photo)

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