Gynecomastia is the development of male breast tissue. There are numerous causes of gynecomastia, and in order to receive the most effective treatment, it is essential to identify the likely cause and the extent of tissue growth. Surgical correction of gynecomastia may be an option for patients experiencing this condition.

Understanding your diagnosis
Gynecomastia is characterized by the development of glandular breast tissue, similar to female breast tissue, and may be caused by an imbalance in hormones. Occasionally, increased fat or adipose tissue in the chest region also contributes to the appearance of male breasts.

This condition may be normal in infants, adolescents undergoing puberty, and elderly individuals. In some men, adolescent gynecomastia can persist into adulthood. Other gynecomastia causes include medications, steroids, marijuana, androgen (hormone imbalance) deficiency, testicular tumors, obesity, liver disease, and kidney disease.

Therapeutic options
Gynecomastia treatment options include waiting for spontaneous resolution, discontinuing drugs or offenders, medications, weight loss, and surgical excision. Your physician can help you determine which option is optimal.

Which patients are good surgical candidates?
Due to permanent fibrosis, patients who have completed puberty and have had persistent gynecomastia for more than a year are unlikely to experience a complete reversal of gynecomastia with medical treatment alone and are therefore good surgical candidates. Other qualities that make someone a better surgical candidate include:

Overall healthy status
Capability to stop agents that cause gynecomastia
Willingness to adhere to postoperative treatment
Reasonable anticipations
Being able to complete a trial of gynecomastia medication treatment
Patients with breast tenderness, an inability to discontinue the offending agent, and a medical condition that makes surgery unsafe should not undergo gynecomastia surgery.

The alphabetical order of gynecomastia surgery
Gynecomastia surgery involves the removal of excess tissue and possibly skin, and depending on the severity of the condition, a plastic surgeon may remove three different types of tissue.

A: Adipose tissue (fat tissue) is removed from gynecomastia patients with excessive fat tissue. This is achieved through liposuction. The same liposuction technique is used on the chest as on other areas of the body. The plastic surgeon injects tumescent, which is a combination of saline, epinephrine, and lidocaine, to stiffen the fat tissue and control pain. After injecting tumescent and stiffening the fat tissue, the surgeon inserts a small, thin suction tube through one or more small incisions in order to remove the excess fat tissue. For patients with gynecomastia, liposuction is used in conjunction with breast tissue removal (described below).
B: Breast tissue (glandular breast tissue) is the primary cause of gynecomastia; therefore, its removal is the primary objective of gynecomastia reduction surgery. During the surgical procedure, a U-shaped incision is typically made at the edge of the areola. The surgeon removes excess breast glandular tissue via the small incision. Greater quantities of glandular breast tissue may necessitate a wider incision.
C: Cutaneous tissue (skin tissue) may be removed from patients with excess, sagging skin following the removal of breast tissue and/or adipose tissue. Patients who have lost a significant amount of weight or who have had large amounts of tissue removed frequently have sagging skin. For a flat chest, excess skin is removed and the nipple-areolar complex is realigned. This involves a larger incision beneath the nipple in the shape of an inverted “T,” which will leave a larger scar, but can produce significant results.