Male breast reduction surgery takes one to three hours, depending on whether your treatment plan calls for just gynecomastia liposuction of excess fat, or a combination of lipo and surgical excision, to remove excess glandular tissue.
If you have a condition called pseudogynecomastia, with excess fatty tissue in the chest area, lipo alone may provide enough reductionâas long as your skin has good enough elasticity that it wonât sag once the fat is removed.
If you have true gynecomastia, youâll likely need a combination of lipo and the surgical removal of glandular breast tissue, along with any excess skin. Your surgeon may also reposition your nipple and areola. Every surgeon has their own preferred techniques, so itâs worth having a detailed conversation during your consultation about your aesthetic goals, and how they plan to achieve them.
Before the surgery, youâll be given either general anesthesia, which puts you under for the entire procedure, or local anesthesia to numb your chest, combined with an oral or IV sedative (a combo known as twilight sedation).
Once the anesthesia takes effect, your procedure will begin.Â
First, your surgeon will make a few small incisions. They may be under your arms, around your areolas, or to the side of your chest, depending on your anatomy and your surgeonâs technique.
If your treatment plan involves liposuction, your doctor will inject tumescent fluid (to help anesthetize the tissue and reduce bleeding) and use a tool called a cannula (a thin tube) to remove the extra fat and liposculpt a more masculine-looking chest. Dr. Schlesinger always starts with tumescent fluid, to make the fat and gland tissue rigid, and then performs liposuction for patients with either pseudogynecomastia or true gynecomastia.Â
Once the excess fat is removed, the surgeon feels if thereâs a gland. Often that unwanted gland is underneath whatâs called the ânipple areolar complexâ (the medical term for the nipple and areola).Â
To access that gland, Dr. Schlesinger makes an incision along the bottom of the areola, down to the level of the glandular tissue. He removes almost all of the gland, as well as some areolar tissue, to allow the puffy, 3D areolar complex to flatten outâexcept for the area immediately around the nipple. Any excess skin is removed and the incisions are closed with tiny sutures. This can leave a small scar, but thereâs a trick for hiding it: âShould any scar around the areola persist for more than 6 months, we have an excellent local tattoo artist who tattoos areolar pigment over the periareolar scar, leading to a complete obliteration of any persistent scarring,â notes Dr. Schlesinger.
In some cases, Dr. Schlesinger fully detaches the nipple areolar complex, âsews the bottom of the chest in such a way to give the appearance of large, well-placed pec muscles, and then replants the free nipple graft on newly created recipient beds.â This technique âgives the appearance of well-developed pectoral muscles and symmetrically positioned nipple areola complexes.â
Dr. Mathew Plant, a plastic surgeon in Toronto, Ontario, prefers a technique that he says makes the scars very well-hidden. âWhile in some more severe cases it may still be necessary to make these periareolar incisions, in most cases a smaller (1cm) incision can be made away from the areola, towards the armpit, and the gland can be removed this way without creating the telltale scar on the areola.â
Some surgeons place thin surgical drain tubes near the incisions, to prevent fluid build-up as you heal. These should be removed 24 to 48 hours post-procedure.
Once youâve recovered from the anesthesia, youâll be ready to head home. You will still be groggy, so plan to have someone escort you home safely and stay with you for at least the first night of your recovery.
