Finasteride-induced gynecomastia - Remove entire gland or try topical dutasteride?

Gynecomastia is best treated surgically by a board-certified plastic surgeon who has sufficient skill and experience to do the procedure well and give quality assessments knowing who will get good results and who will not.
The goal should never be to remove all the glandular tissue because that will leave a disfigurement with indentations. removing a sufficient amount of glandular tissue to get the correct contour should be sufficient. Over treatment in anticipation of continued glandular development is probably a mistake.
Invitations from over resection is unforgiving and almost impossible to correct.
If you keep taking the medication and the condition progresses it’s better to do a second round of tissue excision or consider not taking the medication if that’s an option.
Not all plastic surgeons have mastered this procedure so picking the right provider is key for both getting a good assessment and quality outcome.
I suggest having multiple in person consultations with local boards are tifiied plastic surgeons. During the consultation ask each provider to show their entire collection of before and after pictures. Being shown a handful of sample pictures which most likely represent the best results of the providers career is insufficient to get a clear understanding of what the average results look like in the hands of each provider. Ask the providers to show you as many pictures as possible of patients with similar chest characteristics as your self. you may also want to ask to see outcomes that are excellent, average and less then. an experienced provider should be able to show you at least 30 sets of before and after pictures so this fairly common procedure. highly experienced surgeons will have hundreds of before and after pictures.
I also recommend reading all reviews on various physician review websites avoiding providers with any significant number of justified negative reviews. The absence of justified negative reviews is more important and more telling than having an abundance of positive reviews.
Continue having consultations until you feel like you found the right provider.
Topical medications are unlikely to deliver visible results.
Best,
Mats Hagstrom MD

Direct removal of glandular tissue will definitely improve your appearance. However, it is necessary to leave some tissue beneath the nipple-areolar complex and this tissue can regrow if finasteride. This does not mean that you will necessarily have problems but i would suggest you consider prp for hair growth and stay away from finasteride. I would strongly recommend that you only use a board certified plastic surgeon for your gynecomastia surgery.

David berman md, frcsc