There are two methods for treating male chest enlargement: liposuction and excision. In the pre-liposuction era, the only thing to do was to cut out the tissue ("excision"), usually using a small incision around about half the diameter of the areola. This worked great when there was a small and well-demarcated and circumscribed gynecomastia mass under the areola. But it didn't work well when there was fat spread throughout the chest. Liposuction is ideal for the reduction of fat, because fat is soft and is easily removed through the liposuction instrument (much like a straw.) However, firm and glandular gynecomastia tissue cannot be removed by liposuction; it needs to be excised.
How do we know what we will do? The preoperative physical exam is often very helpful in revealing what will need to be done to reduce a man's chest so that it looks the way that he wishes it to look. On one extreme, imagine a very thin man, who has just a little puffiness deep to his nipple; other than that the chest is flat. When feeling the chest, a very firm and well-delineated mass can be felt beneath the nipple. So with no excess fat distributed throughout the chest, and a firm, well-circumscribed mass that is too firm to be removed by suction, excision through an incision around the areola would be the method for reducing his chest.
On the other extreme would be an overweight man who has diffuse fat throughout his whole body, but with disproportionately more in the chest area. His whole chest feels evenly smooth and spongy, with no discernable discrete mass beneath his areola. Since fat is best removed with liposuction and he has no firm tissue that needs to be excised, he would best be treated with liposuction alone.
Most men are somewhere in the middle: they have some fat, but they also have some firm glandular tissue that can only be removed with excision. Oftentimes in the operating room, once the fat is removed, the mass of glandular tissue can be more easily felt. It is kind of like a chocolate bar with almonds in it; once the chocolate is melted away, the almonds become more visible.
So we usually have a discussion before surgery. Some men want to be "as flat as possible," and so we go into surgery knowing that we will do both suction and excision. Others want to have the excision only if I determine during surgery that it will make a noticeable difference. In these cases, we start with the suction, and if I can feel or see a bulge after I am done with the suction, then I proceed to do the excision.
Author Resource:-
Dave Stringham, the President of LookingYourBest.com offers information on gynecomastia and male breast reduction surgery along with information about other plastic surgery procedures.
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