Some patients have a small amount of nodular breast tissue just under the nipple and areola; this responds best to direct excision, which is generally done through a curved incision along the inferior border of the areola. This generally leaves a small scar in that area that is, often times, hardly noticeable.

More commonly, patients present with a more diffuse condition where there is enlargement of the entire breast extending onto the adjacent chest wall. In these cases, if there is minimal to no excess skin, the best treatment is some form of liposuction. Standard tumescent liposuction is satisfactory for some cases where the excess tissue consists purely of excess fat with very little glandular tissue. Unfortunately, this is not the case most of the time as the male breast tissue tends to be quite fibrous and not that amenable to standard liposuction alone.

Ultrasonic liposuction can be quite effective in these cases allowing for removal of a considerable amount of excess breast tissue while leaving minimal scars. Rare cases where the tissue is extremely dense may not respond to any type of liposuction and surgical removal of the tissue is necessary.

Patients who have more severe cases of gynecomastia where there is excess skin to the point that there is actual sagging of the breasts generally require more than just liposuction or surgical removal of the breast tissue. In these cases, removal of the excess skin is also required which includes elevation of the nipple-areola complex in order to create a smooth contour. Any time skin has to be removed, scarring is more prominent than when the procedure can be done by liposuction alone.

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