If excess glandular tissue is the primary cause of male breast enlargement, it can be excised, or removed. The excision may be performed alone or in conjunction with liposuction.  In a typical procedure, an incision is made in an inconspicuous location, either on the edge of the areola, the darkened skin around the nipple, or in the underarm area. Working through the incision, the surgeon cuts away the excess glandular tissue, fat, and skin from around the areola and from the sides and bottom of the breast.  Major reductions that involve the removal of a significant amount of tissue and skin may require larger incisions, which may result in more conspicuous scars.  If liposuction is used to remove excess fat, the cannula is usually inserted through the existing incisions.

If your Gynecomastia consists primarily of excessive fatty tissue, your surgeon will likely use liposuction to remove the excess fat.  A small incision, less than a half-inch in length, is made around the edge of the areola, the dark skin that surrounds the nipple.  Or, the incision may be placed in the underarm area.  A slim hollow tube called a cannula, attached to a vacuum pump, is then inserted into the incision.  Using strong, deliberate strokes, the surgeon moves the cannula through the layers beneath the skin, breaking up the fat and suctioning it out.  Patients may feel a vibration or some friction during the process, but generally no pain.  In extreme cases where large amounts of fat or glandular tissue have been removed, skin may not adjust well to the new smaller breast contour.  In these cases, excess skin may have to be removed to allow the remaining skin to firmly re-adjust to the new breast contour.