Gynecomastia is a benign growth of glandular tissue in the male breast, and one review states that surgical excision combined with liposuction can provide excellent results with a low rate of complications[1]. In a randomized trial of 60 patients, liposuction with or without an incision at the edge of the areola allowed effective removal of both fat and glandular tissue[2]. In a comparison of 32 breasts, liposuction alone gave cosmetic results similar to liposuction plus gland removal, but the liposuction-alone group had higher redo surgery rates[3].
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Studies classify gynecomastia as glandular or lipomatous (fatty) types, and describe a mixed type with both glandular and adipose tissue[4][5]. Gynaecomastia is a benign proliferation of the glandular tissue of the male breast that results from an imbalance between androgen and oestrogen[1].
One randomized trial defined gynecomastia as an increase in fibroglandular tissue of more than 2 cm in the male breast, felt under the nipple and areola[2]. Mixed-type gynecomastia is characterized by the proliferation of both glandular and adipose (fatty) tissue[5].
A long-term follow-up study grouped patients before surgery into lipomatous (fatty) gynecomastia and glandular gynecomastia[4]. In a series of 114 patients operated on for gynecomastia, examination of the removed tissue showed pseudo-gynecomastia in 6 cases[6].
Among 71 adolescents who had gynecomastia surgery at one hospital, 51 (71.8%) were classified as having a glandular-type breast component[7]. The authors of that study concluded that gynecomastia that did not go away on its own was mostly the glandular type, so surgical removal of glandular tissue was needed, not only liposuction[7].
One review arranges treatment options for gynecomastia across a modified Simon classification, and a surgical series used the Simon classification for staging before surgery[8][6].
One review states that gynecomastia in adult men can be the first symptom of an underlying disease and recommends thorough investigation[1]. According to the same review, treatment of an underlying cause is the first-line treatment[1].
The same review states that pubertal gynecomastia is found in 50% and often resolves spontaneously without treatment[1]. Gynecomastia is also a listed adverse effect of androgen-deprivation therapy, a key treatment for aggressive and advanced prostate cancer[9].
In the series of 114 patients, tissue examination found one papillary ductal carcinoma and one mucinous carcinoma[6]. The authors of that series concluded that gynecomastia can be associated with breast cancer, even in younger people, and that management should involve a multidisciplinary team[6].
If any change in your chest worries you, contact a doctor promptly.
A global survey of plastic surgeons reported that the top five surgical procedures for men were eyelid surgery, gynecomastia, liposuction, rhinoplasty and facial fat grafting[10]. In that survey, procedures performed on men represented 14.5% of the total[10]. For more on this topic, see the most popular cosmetic surgery for men.
Liposuction alone has been studied, but in one small comparison it led to more redo operations than liposuction combined with gland removal[3]. In a comparative study of 32 breasts, 17 were treated with liposuction alone and 15 with liposuction plus glandular excision[3].
In that study, endoscopy (a small camera) was used to assess whether fibroglandular tissue was present and whether glandular excision was needed[3]. Cosmetic evaluations showed similar outcomes in both groups, with the liposuction-alone group having higher redo surgery rates[3]. In the liposuction-alone group, "puffy nipples" led to one redo surgery[3].
A different approach was reported in 128 men, treating 252 breasts, who had power-assisted liposuction with a stab-flatten technique through a single armpit incision, without resection of tissue[11]. The complication rate in that series was 2.0%, with bruises in 5 breasts[11]. BODY-Q questionnaire scores for appearance satisfaction and health-related quality of life improved significantly when measured before surgery and at 3 months[11].
A systematic review of liposuction-assisted surgery through minimal incisions for Simon grade I and II gynecomastia included 18 studies[12]. The reoperation rate of liposuction-assisted surgery ranged from 0.6% to 25% in that review[12]. Only two studies, with a total of 25 patients, were considered good in quality[12].
One technique paper argues that simply removing the gland, or doing liposuction that addresses only the front of the chest, is not sufficient for a result that pleases patient and surgeon alike[13]. That paper describes liposuction in four directions that also treats the sides, the armpits and the area below the collarbone[13].
The combined approach pairs liposuction of the fibro-fatty tissue with removal of the glandular tissue, for example by open excision or an arthroscopic shaver[14].
In a study of 60 patients with Simon grade II-A or II-B gynecomastia, mean satisfaction on a visual analog scale was 8.25 in both the open excision group and the shaver group[14]. The authors concluded that the shaver technique did not hold superiority over conventional open disc excision[14].
In a retrospective study of 39 males with bilateral gynecomastia, adding tumescent liposuction to mastectomy (removal of the gland) significantly shortened surgical time, at 82 versus 123 minutes[15]. Global satisfaction was high in both groups, at 96% and 92%, and no reoperations were described with a minimum follow-up of 2 years[15].
Over a 10-year period, one department treated 41 patients with 75 operations using subcutaneous mastectomy alone, subcutaneous mastectomy with ultrasound-assisted liposuction, or ultrasound-assisted liposuction alone[16]. The surgical revision rate for all patients was 4.8%[16]. The authors suggested subcutaneous mastectomy combined with ultrasound-assisted liposuction as a first choice for grade II and III gynecomastia[16].
In 37 patients younger than 18, the combination of mastectomy and liposuction revealed better results in every measure except surgical duration when compared with mastectomy alone[17].
Several studies combined liposuction with gland removal through small or remote incisions[18][5][19]. In 30 patients who had nipple-sparing mastectomy through a single armpit incision, 20 also had liposuction, and the authors reported good cosmetic results without scarring on the front of the chest[18].
In 60 patients with mixed-type gynecomastia, vacuum-assisted mastectomy plus power-assisted liposuction used substantially smaller incisions than open periareolar excision, at 0.97 cm versus 4.47 cm on average[5]. The vacuum-assisted group also had significantly lower complication rates, particularly bruising and reduced skin sensation (hypoesthesia)[5].
A study of 77 patients found that gland removal through an areola incision had shorter operation time and lower cost, while liposuction with single-hole endoscopic gland removal gave superior results for scarring and patient satisfaction[19]. The areola incision group in that study had a higher incidence of fluid collections under the skin[19].
Recurrence appears to be more common in fatty than in glandular gynecomastia, according to one long-term study of 16 patients[4]. Of 41 patients invited for follow-up 10 to 19 years after surgery, 16 presented for a clinical examination[4].
In that group, 5 of 8 patients with lipomatous gynecomastia (62.5%) had recurrence, compared with 1 of 8 patients with glandular gynecomastia (12.5%)[4].
Recurrence was not observed among 71 adolescents treated with subcutaneous mastectomy with liposuction[7]. In 32 patients younger than 18 who had long-term follow-up after a median of 34 months, recurrence occurred in 2 patients (5%)[17].
Reported complications included hematoma (a collection of blood), seroma (a collection of fluid), bruising and crater deformity, and complication rates varied widely between studies[12][3][2]. In the systematic review of liposuction-assisted surgery, complication rates ranged from 0.06% to 26.67% across the included studies[12].
In the randomized trial of 60 patients, the group that had liposuction with an areolar skin incision had 3 hematomas, 2 surgical site infections, 1 case of nipple hypopigmentation and 1 seroma[2]. The group treated with liposuction without a skin incision had 1 hematoma and 1 seroma[2]. The difference in complications was not significant, but patients in the group without an incision were more highly satisfied[2].
In the comparison of 32 breasts, liposuction alone led to bruising and 2 hematomas[3]. Glandular excision in that study resulted in 4 cases of crater deformity and one case each of superficial skin necrosis, hematoma and seroma[3].
Among 71 adolescents treated with subcutaneous mastectomy with liposuction, 14 (19.7%) had complications, but only 3 cases (4.2%) required revision[7]. In 24 adolescents treated with endoscopic mastectomy and liposuction, complications occurred in 5 (20.8%), including small second-degree burns in 4 and a seroma in 1[20]. Read more about swelling and seroma after liposuction.
If you develop a rapidly growing swelling, fever, chest pain or shortness of breath after surgery, contact your surgeon or emergency services right away.
In a systematic review of liposuction-assisted surgery through minimal incisions for Simon grade I and II gynecomastia, satisfaction improved consistently, although the studies measured it in different ways[12]. The systematic review found consistent improvement in quality of life in terms of satisfaction, but the varied methods of measuring satisfaction made the results difficult to interpret[12].
Among 71 adolescents, 70 (98.6%) were satisfied with the aesthetic results[7]. In the 10-year series of 41 patients, average scores for overall satisfaction and improvement in self-confidence were 9.4 and 9.2 on a 10-point scale[16].
In the long-term follow-up study, younger patients tended to be more satisfied with surgery than older patients, especially regarding improvement of self-esteem[4].
Recovery varied between studies, from no lost time to normal life in a fast-track pathway to wearing a chest belt for weeks after endoscopic surgery[21][20]. In 126 patients with Simon grade I or II gynecomastia treated with liposuction plus a pull-through technique, 101 followed a fast-track pathway with patient education, local tumescent anesthesia, no drainage and effective pain control[21].
In that study, time to normal life and length of stay decreased to 0 after the fast-track pathway was introduced, with no difference in complications between the cohorts[21]. At the 3-month follow-up, 94.1% of patients ranked the fast-track pathway as "great" or "moderate"[21].
The average hospital stay was 2 days in the power-assisted stab-flatten series[11]. After endoscopic mastectomy with liposuction, adolescents wore a chest belt for 15 to 30 days[20].
These questions can help you prepare for a consultation with a board-certified surgeon:
For a broader overview, see the male breast reduction page and these questions to ask before and after liposuction.
In a comparison of 32 breasts, liposuction alone gave cosmetic results similar to liposuction with glandular excision, but the liposuction-alone group had higher redo surgery rates[3]. In one adolescent series, the authors concluded that persistent gynecomastia was mostly glandular, so removal of glandular tissue was needed, not only liposuction[7].
In a long-term study of 16 patients examined 10 to 19 years after surgery, recurrence was seen in 5 of 8 patients with lipomatous gynecomastia and 1 of 8 with glandular gynecomastia[4].
In 30 patients treated with nipple-sparing mastectomy through a single armpit incision, 20 of whom also had liposuction, the authors reported good cosmetic results without scarring on the front of the chest[18].
Gynecomastia in adult men can be the first symptom of an underlying disease, and thorough investigation is recommended[1]. Treatment of an underlying cause is the first-line treatment[1].