The method of surgery depends on the type of gynecomastia and how severe the problem. Three techniques are used either separately or in combination.
The simplest method for fatty tissue is to use liposuction to remove the fat. However this does not work very well if the skin is stretched or there is a firm glandular component. Ultrasonic liposuction seems to have a role in this type of case and many surgeons now consider this the treatment of choice in most cases.
If there is a significant amount of loose skin, reduction mammaplasty techniques are used. These involve more scarring and run the risk that the patient will substitute one problem, about which he is already embarrassed, for another.
Another method for some patients is a form of subcutaneous mastectomy combined with liposuction. This is done under either local or general anesthetic although most patients are happier asleep. It is done as either an inpatient or an outpatient depending on the patient's needs . Most do well as an outpatient provided they feel comfortable looking after their drains. The incision is around half the circumference of the nipple at the junction with the beast skin. In some cases it may extend out on each side. The surgeon then dissects the excess breast tissue off the skin and muscle. This is then removed. A small amount is left under the nipple to avoid an indented appearance in this area. The surgeon separates the fold under the breasts which may have become quite marked if the breast was large. At the edges the dissection must be bevelled to avoid a "step off". Liposuction helps in these areas. At the end of the operation a drain is often used and a compression bandage applied.