Is it standard to remove all of the gland tissue in gynecomastia surgery?

My doc advised he had to remove all my gland tissue due to it having a chance to return and that it would have left a hard lump if he didn't. However, when I flex/tense my muscle my nipples depress/cave inwards - this has me feeling fearful and discouraged. I read some surgeons leave some of the gland tissue remaining in order to prevent this very issue - what is the standard? Could this possibly be due to scar tissue tethering the nipple? Thank you in advance.

Doctor Answers 10

Gynecomastia Surgical Techniques

The excision technique is used on cases of #gynecomastia where excess skin and glandular breast tissue must be removed and the areola or nipple needs reduction and repositioning to create a natural looking appearance. The incision patterns are determined by the specific condition of the patient. The doctor will recommend this procedure which combines the liposuction technique and excision technique to create a natural look. Patients are given specific instructions for the recovery period.

Men who suffer from large #areolas may notice that after breast surgery, the skin of the chest muscles will tighten, causing the areolas to tighten and diminish in size. This is a result of the removal of glandular and/or adipose tissue.

Orange County Plastic Surgeon
4.9 out of 5 stars 110 reviews

Gland completely excised?

Gynecomastia is like a female breast reduction in that some, but not all breast glandular and ductal tissue are removed.  There are some ducts and glandular tissue associated with the nipple areola complex so unless the nipple is removed, there is still a little glandular tissue present after gynecomastia surgery.  Unless the patient is very thin, I usually leave some varying amount of glandular tissue directly beneath the nipple/areolar area to make sure the thickness is similar to the rest of the chest sub-Q thickness, and to prevent unsightly nipple retraction due to scarring that can retract to the underlying chest wall.  

Jeffrey D. Wagner, MD
Indianapolis Plastic Surgeon
4.9 out of 5 stars 26 reviews

Is it standard to remove all of the gland tissue in gynecomastia surgery?

Thank you for your question.  In order to prevent nipple retraction or tethering to the underlying pectoralis muscle, a small amount of glandular tissue is left behind the nipple areola complex.  If you are recently out from surgery, consider scar massage therapy to try and free the tethered nipples. 

Nelson Castillo, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 69 reviews

Removing all of the glands

You should have removed all of the glands during your gynecomastia surgery, but this does not mean that you should have created a divot. This can be corrected. Please see examples below.

Arian Mowlavi, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 68 reviews

Glandular excision

It is commonplace to have most of the glandular tissue removed.  This isn't a mastectomy, so not all of the breast will be excised.  Excision is often combined with liposuction to smooth out the chest contour.  Most of the time the tethering you describe will improve over time.

Tim Neavin, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 46 reviews

Gynecomastia Surgery

Thanks for the question. Essentially never should all of someone's gland be removed. Full excision leads to contour deformities and the nipple areola getting stuck down to deeper tissue. This can even happen with a well executed surgery if there is too much redundant skin. Some mild tethering can resolve with time and aggressive massage if your surgery was only a few weeks ago. It is possible that you may need the tethering released and some fat grafting or surgical shifting of the deep tissues to improve the contour problems. Good luck going forward.

Jeffrey Nelson, MD
Tucson Plastic Surgeon
4.3 out of 5 stars 8 reviews

Gynecomastia Surgery

Hi Tartanic,
Thanks for the post. Although there is no single standard, I tell patients that the goal in surgery is not to remove 100% of the gland in everybody. It is important to leave behind some tissue to prevent the very issue you are having. This is one of the most common reasons for revision.

Dr. Dadvand

Babak Dadvand, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 46 reviews


In general we DONT remove all of the glandular tissue because it may leave a depression deformity. Conservative is the key 

Stuart A. Linder, MD, FACS
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 42 reviews


I don't attempt to remove "100%" of the tissue. Most people will leave a small amount right behind the areola to prevent a depression. If it's early in your recovery they may indeed be some scar tissue tethering. 

Sherwood Baxt, MD
Paramus Plastic Surgeon
3.8 out of 5 stars 25 reviews


Thank you for your question and most surgeons do try to remove all the gland but leave soft tissue/fat behind over the pec muscle to prevent what you are describing.  See some experts in your area and see what can be done to correct it

Dr. Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 62 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.