What are the different procedures that treat gynecomastia and which is best?

Doctor Answers 4

Gynecomastia Treatment

There are no ‘magic techniques’ for treating gynecomastia, and a proposal for “suturing under the skin” to “tighten and flatten” your chest sounds unconventional and ill-advised. The treatment of mixed gynecomastia (patients with both fibrous breast tissue and excess fatty tissue) in most experienced hands is liposuction of the fatty soft tissue excess followed by some form of excision of the residual fibrous mass of breast tissue behind the areola. The excision can be done by a direct approach using an inferior areolar border incision, or by means of an arthroscopy shaver that can be used to ‘chew up’ the fibrous tissue from an incision placed in the underarm area (for bare-chested or limited chest hair patients) or subpectoral fold area (for hairy-chested patients).

Surgery for gynecomastia should focus on two primary concepts: limiting surgical incisions and the associated permanent scars as much as possible, and respecting the fact that skin laxity may limit the amount of fat and breast tissue that can be removed in a single surgery. No one with gynecomastia wants to trade the appearance of having excess breast tissue for a set of obvious scars, or for sagging skin that looks like surgery gone wrong. Either way you still won’t want to take off your shirt at the pool.

First, the scars: incisions limited to the inferior areolar border will result in most cases in scars that are faint to even invisible. In many patients that is the only incision you need. In patients with significant chest hair, small liposuction access incisions in the subpectoral fold (the crease at the bottom of the male pectoral area) are acceptable as they will be invisible, but not in patients with little to no chest hair. When needed, an axillary incision can be used for liposuction cannula or arthroscopy shaver access, and a well-designed incision in that location is also minimally noticeable to invisible in most cases. Surgeons who are experienced with and proficient at gynecomastia surgery limit the incisions to areas where the scars will be imperceptible.

Second, skin laxity: if there is some degree of skin laxity and or skin excess, it is important to avoid reducing a patient’s gynecomastia to the point that the skin is even looser and sagging. For patients with this issue, I perform gynecomastia surgery in stages that are scheduled 6 to 12 months apart. The first procedure removes as much fat and breast tissue as possible within the limits of a patient’s skin laxity in order to avoid a ‘saggy’ appearing breast area, and then 6 to 12 months later a secondary liposuction +/- direct tissue excision procedure is performed. This approach takes advantage of the fact that in youthful skin (teens, twenties, thirties and in some patients even in their forties and fifties) the chest area skin will shrink and tighten over several months, allowing a secondary procedure to be performed that produces an aesthetically ideal chest contour without any skin excision. And without unsightly surgical scars.

Patients with droopy or saggy skin at the outset have to be treated by total excision of gynecomastia with removal and replacement of the nipple/areola complex as a full-thickness skin graft. This approach creates a long scar in the subpectoral fold, and should be restricted to patients who have too much skin laxity to be treated by a limited-incision, two-stage (and in some cases, even a three-stage) approach. If that is the approach you need, make sure that the surgeon you choose has a proactive and comprehensive program of scar treatment, to help you achieve a scar appearance that is as faint as possible.

A surgeon’s ability to create aesthetically ideal and natural-appearing gynecomastia results will be apparent from their ‘before and after’ photos. Make sure that the surgeon you choose uses an approach that is designed to avoid the two issues that may leave you still self-conscious about taking off your shirt once you’ve recovered from surgery: obvious scars, and saggy-appearing skin.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

Gynecomastia procedures

There are several procedures for gynecomastia. These can include direct excision of the breast tissue, liposuction and a direct excision or a combination of the two plus a breast lift. The types of procedure  needed would be based on a physical examination.  Most of the incisions can be limited to  skin around the areola.  These surgeries are done own an outpatient basis. I usually have my patients wear a compression garment post op for 2-3 weeks. Hope this helps.

Jon E. Rast, MD
Kansas City Plastic Surgeon
5.0 out of 5 stars 32 reviews

Gynecomastia procedures

There is no best gynecomastia procedure, only the best procedure for a specific patient and his anatomy. The most common surgery  in my experience is a  combination of liposuction for the excessive  chest wall fat and direct excision of glandular breast tissue. In some cases repositioning of the nipple and areola or larger skin excision may be required. The only way to know what is best is to consult with an experienced surgeon who can help you weigh the pros and cons of different approaches. Good luck with your decision.

Stanley G. Poulos, MD
Greenbrae Plastic Surgeon
4.5 out of 5 stars 29 reviews

What are the different types of procedures for gynecomastia?

There are several different procedures for gynecomastia and each is suited to treating a different aspect of the condition. Liposuction is used to remove the less dense fatty tissue present in gynecomastia. Direct excisional techniques are used to remove the denser tissue that is often present deep to the nipple and areola. Skin excision techniques are used to remove redundant skin and fatty tissue in patients with more extensive gynecomastia that would not be addressed by liposuction alone. The best procedure for an individual patient is determined by their exam findings and can be any one of or a combination of two or more of the above procedures. Consultation with a board certified plastic surgeon will help determine the right procedure for you.

David P. Stapenhorst, MD
Sugar Land Plastic Surgeon
4.8 out of 5 stars 6 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.