The surgical treatment depends on the clinical picture of the patient and the type of gynecomastia observed.
In cases of class I and IIA gynecomastia, the surgical removal of the gland through an invisible incision from 3-9 hour in the areola seems to solve the problem.
These patients will undergo surgery with local anesthesia, IV sedation or with a light general anesthesia. During the surgery the glandular tissue is removed while a small layer beneath the areola is left to avoid an inward retraction of the nipple.
These patients can return home in the afternoon or occasionally spend a night in the clinic. In cases in which fat deposition is also involved, liposuction can be performed at the same time.
However, in similar cases, in which only fat deposition is involved, liposuction is indicated. In such cases, the patients do not have to stay in the clinic
In IIB cases, with a slight skin relaxation , in consultation
with the patient we may remove the gland through a circular
incision that is ultimately hidden in the nipple-areola. If
there is fat
deposition, liposuction is also recommended. In such cases, spending a night in the clinic is necessary.
In class III, there is usually large skin sagging along with gynecomastia. In these cases, we either proceed with a circular incision and removal of the gland or in consultation with the patient we totally remove the skin and breast proceeding also to a free transportation and repositioning of the nipple-areola. In these cases if fat is involved, liposuction can additionally help.
Specific cases-Gynecomastia in Bodybuilders
Gynecomastia in that cases is pure galndular and the cause is the increased doses of anabolic and the intake of testosterone.Gynecomastia in bodybuilders requires an expert plastic surgeon because the abnormal breast tissue is adherent to muscle and the dermis as well and a meticulus excision is necessary.
Patients of all classes of gynecomastia who have undergone surgery should get antibiotics for a few days and paracetamol type mild painkillers. 24 hours after surgery they should wear a special vest for three weeks. Exercise is allowed after 4 weeks.
Algorithmic approach of the surgical treatment
Watch a gynecomastia surgery video by Dr Nodas Kapositas