Glandular tissue removal - any specific technique or recommendation? (Photo)

I always remove glandular tissue when I treat gynecomastia. The glandular tissue is removed in such a way as to remove as much as possible, while leaving skin flaps of even thickness so that the patient does not develop uneven areas such as depressions or elevated areas. As well, the best surgical technique leaves a small button of tissue behind the nipple areola complex so that the area does not become depressed or look sunken in. So yes, the goal is to remove all of the glandular tissue, but in a way that does not damage the tissues so it heals with good contour.
Specifically for you, I recommend liposuction of your chest wall, and excision of glandular tissue through a small incision. In your case, I would prefer to use a small incision at the lower portion of your areola, however would need your approval to do so. I also would consider liposuction along the inframammary crease, and just below the crease as that can improve the contour there.
All the best to you,
Dr. Nancy de Kleer

Thank you for submitting your question and your photo. If you have true gynecomastia with glandular tissue then ideal treatment would be direct excision of the gland. In my practice, patients I have seen several patients who have been treated elsewhere with liposuction alone are were not completely satisfied with the result. I always perform direct glandular excision and combine it with liposuction to feather the area. I believe this gives the best result. Be sure to consult with a board-certified PS. Hope this helps.

We suggered this procedure for your case: Chest liposuction and maybe hypertrophic gland resection.

There are three tissue variables that contribute to let them Male chest looks like. These are semi cutaneous fat, glandular breast tissue and skin laxity.
All of them contribute and it’s very important to differentiate which one is causing the majority issue.
In other words making a quality assessment is paramount and understanding what each procedure or alternatives can or cannot deliver.
What’s the efficient skill and experience a surgeon should be able to accurately predict what your results will look like and should have a sufficient number of before and after pictures to show you examples of previous patients who had similar characteristics.
Glandular tissue or breast tissue will not be removed by Liposuction.
It’s simply too firm and Liposuction will not do the job.
To remove breast tissue always requires an open excision and direct excision of part of the breast tissue.
Over resection or taking out too much glandular tissue will leave it indentation which is highly undesirable and almost impossible to fix.
The best way to assess the Male chest is to put the skin and pectoralis muscle under tension by taking one arm at a time and stretching it behind your head.
Pretend you’re scratching your mid upper back one arm at a time.
Well holding that position either take a picture using the timer on your camera, have someone else take a picture or you can look in the mirror.
With the skin and pectoralis muscle under tension the glandular tissue outline is clearly defined. it becomes obvious if there’s excess glandular tissue and if so how much.
You can also see the contour of the chest gradually become full as you put your arm down and realize that even the mildest skin laxity contributes to fullness in the chest.
Young men who have not had weight fluctuations should do well with fat and glandular tissue removal if both are contributing.
Men who had any substantial weight fluctuations or are over the age of 35 may have a limited results because of loss of skin elasticity.
That doesn’t mean there’s a room for improvement but it’s hard to get home runs or perfect results on all patients requiring these procedures.
Gynecomastia surgery is a little tricky because all three tissues have to be assessed accurately in order to predict the outcome.
If you have two rounds of liposuction then subcutaneous fat is probably not contributing substantially at this point.
That leaves glandular tissue and skin is the only two tissues that are still leaving you with a chest you’re not happy with.
With The pectoralis muscle in the skin under tension you can easily see how much glandular tissue you have and soak in the plastic surgeon.
For quality results with consistent hi patient satisfaction and accurate assessments try to find the most experienced and talented providers for this procedure.
Relay exclusively on in person consultations and consult with a substantial number of providers.
There’s no other way to find the right person and to meet with individual providers in person.During each consultation ask each provider to open up their portfolio and show you their entire collection and before and after pictures.
As the provider defined as many pictures as possible a patient who have similar body characteristics to yourself
In your case considering you’ve already had liposuction it does make the differential a little more straightforward.
Typically if two rounds of liposuction didn’t fix the problem then the problem is no longer subcutaneous fat.
An experience provider should be able to show you at least 30 sets of quality pictures. Highly experienced surgeons will have hundreds.
Being shown a handful of sample pictures which represents the best results of the providers career is insufficient to get a clear understanding of what average results look like or results for someone who has similar tissue characteristics as yourself.
Results very dramatically based on candidacy for gynecomastia surgery.
They also very substantially on who does the procedure.
Usually quality results require both Liposuction and an open excision of glandular tissue.
Good luck,
Mats Hagstrom MD

i feel that liposuction alone is not aggressive enough and that better results are obtained with direct excision. The scar is hidden in the lower half of the areola. I always place drains which are removed in 4-7 days. you can shower the next day and return to full exercising in 2 weeks. definitely see a board certified plastic surgeon.

david berman md, frcsc

Thank you for your question. Gynecomastia is a condition that comprises two components. Fat (even in the leanest body builder) and gland. Now fat is the easy part. Liposuction is the modality of choice. When it comes to the gland, liposuction won't work. The gland is dense and wont suck through the cannula. The gland needs to be removed directly. Traditionally , this is done through a curvilinear incision on the bottom half of the areola. Problem is, that leaves the areola/nipple looking odd often times as the incision heals unpredictably. At our practice we access the gland through an incision in the axilla. This moves the scar off the chest and avoids unfavorable scarring. Typically, the entire gland is removed and the area contoured with liposuction to get a masculine, flat appearance.
Hope this is helpfulDr. Morrissey