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

Question

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.

Jeffrey D. Wagner, MD · Answer

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.

Jed H. Horowitz, MD, FACS · Answer

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.

Nelson Castillo, MD · Answer

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.

Tim Neavin, MD · Answer

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.

Stuart A. Linder, MD, FACS · Answer

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

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

Answers (10)