What happens during gynecomastia surgery?

The procedure takes one to three hours, depending on whether your treatment plan calls for just liposuction or a combination of liposuction and surgical excision (removing excess glandular tissue). If you have a condition called pseudo gynecomastia, with excess fatty tissue (as opposed to primarily glandular tissue) in the chest area—lipo alone may provide enough reduction, as long as your skin has good enough elasticity that it won’t sag. If you have true gynecomastia, you’ll likely need lipo paired with tissue (and possibly skin) removal.

Before the surgery, you’ll be given either general anesthesia, which puts you under for the entire procedure, or local anesthesia to numb your chest, combined with oral or IV sedatives (a combo known as twilight sedation).

Once the anesthesia takes effect, your surgeon will make a few small incisions. They may be under your arms, around your nipples, or to the side of your chest, depending on your anatomy and your surgeon’s technique.

If you need liposuction alone, your doctor will use a tool called a cannula (a thin tube) to remove the extra fat and lipo sculpt a more masculine-looking chest. Once that’s performed, the surgeon palpates and feels if there’s a gland. Often that unwanted gland is underneath the areola.

Traditionally, the surgeon makes an incision at the junction of the areola and the regular chest skin, to remove the gland. However, our doctor prefers a method that leaves smaller, more hidden scars. While in some more severe cases it may still be necessary to make these periareolar incisions, they can be very stigmatizing and a clear indication of having had surgery, so 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.

Depending on the extent of your gynecomastia, your doctor may also need to reposition your nipple.

Once the extra breast tissue is removed, your surgeon will close the incisions with stitches and may place surgical drain tubes near the incision, to prevent fluid build-up as you heal. These should be removed 24 to 48 hours post-procedure. You’ll recover from the anesthesia before heading home. You’ll be groggy, so plan to have someone escort you home and stay with you for at least the first night of your recovery.