Full or partial removal? I see conflicting opinions regarding gland removal for gynecomastia?

The gland should definitely be nearly completely removed in order to get hte best results. A very small amount should be left directly beneath the nipple in order to avoid depression and retraction. How it is removed is not really important and can be done a number of different ways. I prefer the Lateral Pull Through technique which avoids the scar along the areola.

The technique used will vary depending on the individual's unique situation. Over or under resection of breast tissue will lead to gynecomastia revision. Some tissue remains in order to sculpt the chest in a normal fashion. If too much or all the breast gland is removed you may end up with a "crater deformity." It is very rare for the breast tissue to grow back. Good luck.

I prefer in most cases do perform a partial tissue removal through direct excision and Lipo of the chest to avoid a chest wall deformity result. 

Thank you for the question. Leaving a small amount of glandular tissue in place is important in my opinion;  otherwise, you would be at risk for contour ("saucer") deformity complications.  In the end,  you will be happier with the outcome if you do not have a "surgical look" resulting from over resection.   Best wishes.

Most surgeons try to leave a cuff of subareolar tissue right under the areolar skin to avoid a depressed "saucer" deformity of the nipple region. This cuff can be 1-3cm or so in thickness depending on your overall breast skin and fat thickness vs the amount of gland that is bulging the central area. The majority of the gland is removed but by definition at least a small amount will remain unless the surgeon were to completely resect all the way to the undersurface of the nipple, which would be risky from the standpoint of blood supply compromise to the nipple as well as increase the risk of saucer deformity. Most of the time the tissue is removed "en bloc" as a mass from the incision without mincing it into pieces as this is the more elegant and surgically precise way to do it. Additionally, it is common to send this tissue to pathology for analysis to make sure it is benign gynecomastia. Liposuction is also used in most patients to blend the transition from the subareolar region to the rest of the breast.

A gynecomastia procedure is a cosmetic procedure.  Therefore the removal should be in line with the aesthetic goal.  If all the gland needs to be removed, then it should be removed.  I usually leave a 1 cm of tissue underneath the nipple to prevent a deformity there.  I have never experienced a return of gynecomastia after removal.  

a common misunderstanding is what the gland is. There is not a single wad of tissue that is called the gland. The entire breast is the gland. The tissue causing the enlarged breast is composed of fat and breast tissue, a mixture with different consistency in different areas. There is no way to remove the entire amount of breast tissue present because of this, so there is always a chance of recurrence, especially with certain types of medications. The plan for surgery is to optimize the contour.Sincerely,Thomas C. Wiener, MDHoustonthis information is not a substitute for a consultation with a board certified plastic surgeon