Surgery for pure glandular (mild) gynecomastia, usually consisting of direct excision of breast tissue directly behind the areola, is performed on an outpatient basis in the office procedure room under local anesthesia and oral sedation.
Treatment of moderate to severe gynecomastia is performed in an operating room under deep IV sedation or general anesthesia. Patients who fly in or drive more than two hours to the surgical facility stay at the surgery center overnight (if indicated for patients having multiple procedures) or at a hotel convenient to the office so that they may be evaluated in the office on the first postoperative day.
Patients wear a postoperative compression vest around-the-clock (except for bathing and garment washing) for the first two weeks following surgery, and for half the day (either daytime or nighttime) for an additional two weeks. Many patients find the garment to be quite comfortable and wear it for longer than the prescribed amount of time, as it helps to control edema (swelling) and enhances outward appearance in a snug-fitting shirt.
In some cases a surgical drain is left in place to remove fluid that may accumulate in the space where breast tissue is removed. The suction bulb that collects fluid can be concealed under clothing. The drain usually is removed within the first few days following surgery.
Most gynecomastia surgery patients take one to three days off from work, depending on the extent of their surgery. Patients with minimal, retro-areolar gynecomastia are allowed to return to vigorous physical activity about two weeks postoperatively, while patients undergoing more extensive procedures are required to wait about four to six weeks