Why are plastic surgeons not recommending gland removal for my gynecomastia procedure? (photo)

I do a lot of gynecomastia surgery and find that I can resolve all the volume with liposuction only in about 70% of cases. The other 30% require some fibrous gland removal usually right under the nipple which I do at the same time as soon as I finish the suction. I cannot always tell before I do the suction if gland excision will be needed, but I am simply prepared to proceed every time as needed. Find a plastic surgeon who does a lot of these procedures. Good luck.

In my experience, liposuction does help reduce the size of the male breast, but usually, an excision of the breast tissue itself is required to achieve the desired contour.  While excess fat can be removed pretty effectively with liposuction, the breast tissue is more dense than the fat.  This makes it difficult to remove using standard liposuction.  Some advanced liposuction units add laser or heat energy to help "melt" the breast tissue, allowing it to be removed more easily with the liposuction cannula. Good luck!

In my experience, patients with puffy nipples almost always need some kind of gland excision. Make sure that you are seeing board certified plastic surgeons (can find the ones in your area on the American Society of Plastic Surgeons website) who have a lot of experience treating gynecomastia. Hope this helps and best of luck.

Hi erzfdjf,Thanks for the post and photo. In my experience, patients who developed gynecomastia during puberty who have puffy nipples and are of normal body weight will absolutely require excision as part of their treatment plan. If someone doesn't have excess fat in other parts of their chest, why would they have fat just under the nipples? The answer is that they don't and it is most likely breast tissue.Sincerely,Dr. Dadvand

That's a great question. In almost all cases that I have treated it was beneficial to remove some gland/residual fibrous tissue beneath the areolas so they won't be puffy after treatment. This incision is TINY to remove this tissue so why wouldn't you do this? I believe that treatment with liposuction alone "sounds" less invasive and therefore it's a good selling point.

I will often start out with liposuction first. Many times this avoids the need for excision of tissue.  If a palpable glandular mass is felt, then excision can be performed. 

I always start with aggressive liposuction. Then I feel for a button of breast tissue. If it's present, I remove a portion of the gland (button). 75% of the time this step isn't necessary.

Gynecomastia is variously glandular, fatty or a combination. Usually you can feel the glandular portion if it is there, but not always. Even if not felt initially, about 70-80% of gynecomastia surgery will involve removal of glandular tissue. Make sure that whoever you choose has significant experience in treating gynecomastia.

There are two issues:) you have gynecomastia2)you have glandular tissue present which requires removal.The surgeons who did not recommend removal have minimal experience with gynecomastia. To achieve a satisfactory result in your situation will require removal of glandular tissue.