Unusual Approach to Gynecomastia?

I am a 32 year old male who had Liposuction of breasts about a year ago. Also, my surgeon chose to address the gynecomastia through incisions below and medial to my nipples. Is this an unusual approach?

Doctor Answers 22

Areola Incision for Gynecomastia Treatment

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What you are describing is not unusual.

Your surgeon must customize the procedure to give you the best result.  There are many different incision approaches we use on a regular basis.

Denver Plastic Surgeon
4.7 out of 5 stars 46 reviews

Gynecomastia options

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Gynecomastia may be treated surgically by direct excision (removal) of breast tissue, liposuction, and in some cases by removal of breast skin, when indicated. The majority of patients have at least some degree of glandular tissue proliferation immediately behind the nipple and areola, which is usually removed through an incision placed at the inferior border of the areola. The incision can be limited, in many cases, from about the 4 o'clock to the 8 o'clock position of the areola. The color difference between areolar skin and chest skin serves to conceal this incision nicely for most patients.
Some patients have proliferation of primarily fatty breast tissue over the pectoralis major muscle, which can be effectively reduced by liposuction. In many of these cases there is actually little glandular breast tissue present, and this situation is sometimes referred to as "pseudogynecomastia". For the majority of liposuction procedures, whether involving the chest/breast area or other sites, I perform power-assisted liposuction. The surgical device involves an electrically-driven handpiece that pistons a modified liposuction cannula several thousand times per minute, enhancing the efficiency of fat removal.
The power-assist handpiece turns an 'elbow grease' operation into a sculpting and finesse operation. For patients with densely fibrous breast tissue, and for planned 'second stage' liposuction procedures for gynecomastia, I generally prefer to use an ultrasonic liposuction device. Ultrasonic liposuction uses heat energy to emulsify (liquefy) fat, allowing removal of fatty tissue that may not be extractable by suction alone, and is also highly effective in assisting the passage of the cannula through densely fibrous areas.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Gynecomastia can be treated with several different methods

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Patients suffering from gynecomastia or male breast enlargement can be treated with several different surgical modalities. These include:

  • Liposuction only (preferably power-assisted liposuction)
  • Liposuction along with surgical excision
  • Excision of the glandular tissue (subcutaneous mastectomy) only.

Surgical excision can be performed using semicircular incisions along the lower border of the areola or small 'stab' incisions along the areola. The appropriate method chosen will depend on the underlying problem.

Sanjay Grover, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 245 reviews

Gynecomastia surgery: Choice of Liposuction Incision Sites

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Gynecomastia can occur in young children, adolescents, and seniors. It also persists into adulthood in some males.

Liposuction is a valid treatment option for gynecomastia without excessive skin redundancy.

In choosing liposuction incision sites, the ideal incisions should be placed at points which provide safe exposure to all aspects of the treatment area and which are relatively inconspicuous. In certain patients, based on anatomic characteristics of the chest wall, the incision sites may have to be altered.

There is no one specific incision pattern for liposuction of gynecomastia. There are, however, many options to improve the scar if you do not like the current scar pattern.

Raffy Karamanoukian, MD

Kare Plastic Surgery & Skin Health Clinic

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Gynecomastia treatments

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Gynecomastia is the growth of glandular tissue in male breasts. It is usually a benign condition that can cause significant psychological distress. Patients present with an increase in breast tissue, which is unilateral in one third of cases. Enlargement is usually central and symmetric. Gynecomastia associated with medications is usually unilateral; however, in pubertal and hormonal cases, the changes are often bilateral. The most common cause in the US is obesity.

The Simon classification of gynecomastia is as follows:

Group 1 is minor but visible breast enlargement without skin redundancy.

Group 2A/2B is moderate breast enlargement without skin redundancy (2B is minor skin redundancy)

Group 3 is gross breast enlargement with skin redundancy that simulates a pendulous female breast.

Patients in groups 1 and 2 require no skin excision, but the breast development associated with group 3 is so marked that excess skin must be removed. In my practice for patients with minimal skin excess I always consider ultrasonic liposuction. It is an effective way to remove the dense male gynecomastia tissue and provides some degree of skin tightening. The challenge with this technique is what is called "the breast bud" with can be an especially dense area behind the areola (the dark area around your nipple).

In some cases, this tissue is too dense for even ultrasonic liposuction and needs to be resected primarily and usually can be accessed by making a small incision at the edge of your areola where it can be camouflaged by the color change.

Your surgeon may have also used more than one port site for the liposuction. Each treatment must be individualized of course but my typical incision sites for my liposuction for gynecomastia patients is at the anterior axillary line (the side of the chest) which is usually not seen when looking straight on. For mild gynecomastia I usually don't need a second port. If I do, sometimes I consider the base of the breast or if I think I'm going to need to resect the breast bud I would use an incision that allows me to remove the breast bud at the same time in addition to my lateral lipo incision. If a patient needs skin resected then there are a variety of skin resection patterns.

The key here is that the skin excision pattern is significant different than a female breast reduction where the goal is to create a skin envelope that creates a round well shaped breast. I hope this helps.

Steven Williams, MD

Tri Valley Plastic Surgery

Unusual Approach to Gynecomastia?

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My common approach is to place an incision in the inferior border of the nipple areolar complex.

Ron Hazani, MD

Ron Hazani, MD, FACS
Beverly Hills General Surgeon
4.9 out of 5 stars 318 reviews

Unusual Approach to Gynecomastia

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Several common factors can cause gynecomastia including excessive levels of #estrogen, natural #hormone changes, use of recreational drugs or alcohol, medications and their associated side effects, and, various health conditions. Also, there are different types of #gynecomastia. There are three types of surgical #treatment #options available that treat gynecomastia. Your board-certified plastic surgeon will recommend the type best suited for you.

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.

The most important decision to be made before performing any surgical procedure is determining whether you are an ideal #candidate.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Gynecomastia Surgery Incisions

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Thanks for the post.  The most important factors with incision location are:

1. Allows adequate access for the surgery to be performed
2. Placed in a discrete as possible location
3. Place along natural lines of tension.

There is no one set of incision that works best for every patient and adopted by every surgeon.  As long as the surgery was able to be performed adequately and the incisions heal well, then there is no need to be concerned.


Dr. Dadvand

Babak Dadvand, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 51 reviews

Gynecomastia incisions

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There are several different liposuction approaches for gynecomastia.  Incisions on the border of the areola can scar poorly from trauma from the cannula.  I usually make an incision around the inferior part of the areola to perform direct excision of the gland and place a single stab incision for the cannula lateral to the areola where the pec muscle ends. 

Tim Neavin, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 53 reviews

Unusual Approach to Gynecomastia?

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It is not unusual to make small incisions in different locations depending on the anatomy of the patient and the particular need for access. 

John T. Nguyen, MD, FACS, FICS
Double Board Certified Plastic Surgeon

John Nguyen, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 88 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.