Gynecomastia may be defined as enlargement of the male breast.

Adolescent gynecomastia – As a consequence of the changing hormonal environment that occurs in the  adolescent male, end organ responses in the character and size of the breast can occur.

Senescent gynecomastia – Alternatively, persistent gynecomastia can develop later in life, generally after the age of 50.

Pathologic gynecomastia – Gynecomastia occurring during the relative extremes of life, i.e. in teenage boys or middle to aged to older men, is not an unexpected finding as it can develop as a normal consequence of changing hormonal levels that can occur at these times in life. Gynecomastia developing suddenly at any other time must be considered to be a pathologic finding until proven otherwise.

Gynecomastia can challenge the surgical decision making and technical expertise of the surgeon. Balancing issues such as incision placement, exposure, skin redundancy and scar demands that the nature of the condition be precisely identified so that a successful surgical plan can be developed for each individual patient. When these variables are carefully controlled and the surgical plan is executed with precision, excellent results can be obtained.

Because of the significant emotional and psychological overtones that can be associated with gynecomastia and the improvement that can result, particularly in adolescent boys, the rewards for both the patient and the surgeon make the effort well worthwhile.


It must be recognized that the teenage years are a vitally important time period during which significant social and

emotional growth occurs. In these patients, even modest cases of gynecomastia can result in social withdrawal. Once gynecomastia is recog- nized, it is reasonable to delay definitive surgical excision for up to 2 years or more, as some patients will spontaneously regress on their own as their internal hormonal environment stabilizes. Typically, this will occur by the age of 15.

Special mention must be made concerning those patients who present with gynecomastia in association with significant obesity. Certainly, in these patients, the major cause of the enlarged breast contour is the excess general fatty accumulation. Although some stromal overgrowth in the subareolar region may be present, it is generally overwhelmed by the significant amount of fat present in the breast. This combination can often lead to surprising levels of breast development that can result in significant breast ptosis.

In older men, the enlargement of the breast has typically occurred over a longer period of time in association with a pro- gressive weight gain. As such, the composition of the breast is largely fatty in nature.


Treatment of gynecomastia can be thought of as having two specific aims: Reducing the volume of the breast and retailoring the redundant skin envelope as needed.

  • Volume Reduction

Reducing the volume of the breast is a key element of any surgical technique designed to treat gynecomastia. With this in mind, there are three main techniques for volume reduction that are generally employed: Direct Excision, Liposuction or a Combination Approach.

  • Direct excision

When gynecomastia presents as an isolated fibrous mass directly under the areola, the most expedient surgical treatment is direct excision. Patients with this presentation are very commonly trim and well-developed adolescent boys who are often times very involved in  athletics and have low body fat levels. As such, there is no significant surrounding fibrofatty  stroma in the periphery of the breast, therefore, the subareolar mass creates a very obvious  contour deformity. It is not at all uncommon for this condition to present asymmetrically

  • Liposuction

When gynecomastia presents as largely a fibrofatty accumulation of tissue, liposuction contouring can be very effectively used to restore a normal chest wall contour. Typically, these types of patients will be either younger obese adolescents or older men who present with senescent gynecomastia.

Although a subareolar accumulation of fi brous tissue may be present, it tends to be infi ltrated by enough fat that the liposuction cannula can penetrate it to reduce the projection in the subareolar area and create a normal appearing chest wall.

  • Combination approach

Typically, most gynecomastia patients will present with a firm subareolar fibrous breast bud in combination with a peripherally located supporting fibrofatty stroma. To recontour both the breast and the chest wall appropriately, it is  necessary to address each of these anatomic features. A common error is to rely simply on liposuction to recontour the breast and leave the subareolar fibrous  component intact.

  • Skin Retailoring

In those patients who present with extreme skin laxity, skin with poor elasticity or in those patients who present with a redundant skin envelope after primary volume reduction, a skin reducing procedure is indicated.


Surgical correction of gynecomastia is typically a well-tolerated procedure that provides consistent results. Despite this, however, as with any surgical procedure, a certain percentage of the time a complication may well develop. While unavoidable complications such as infection, bruising, delayed healing, pain and loss of sensation may occur, these are usually self-limited and  if need be, easily treated. There are, however, certain procedure- specific complications that do merit comment.

  • Hematoma
  • Residual contour deformity
  • Excess skin
  • Insufficient excision