Gynecomastia (Male Chest) | Surgery Procedure and Anesthesia

Under local anaesthesia, chest tissues are numbed while the patient remains awake, requiring no preoperative fasting. Dr. Purohit performs grades 1 to 3 under local anaesthesia in 60 to 120 minutes. Grade 4 cases require a longer procedure lasting up to 4 hours and are conducted under general anaesthesia with 6 hours of fasting. Preoperative tests include CBC and renal function tests. Dr. Purohit utilizes a dual-modality technique pairing circumferential liposuction with sharp gland excision through a lower hemi-periareolar incision. Drains are placed only in grade 4 cases, and excised tissue is sent for histopathology.

Operative duration reflects the specific tissue components addressed. Grades 1 to 3 take less time under local anesthesia, combining circumferential VASER or power liposuction through two lateral pectoral incisions with sharp hemi-periareolar gland excision. Grade 4 requires a longer procedure under general anesthesia with excess skin removal, where the areola is preserved without reduction and surgical drains are placed. Sedation is never used. In documented plastic surgery practice, standard operative recording notes the exact surgery start and end times, anesthesia start and end times, and time of transfer to the postanesthesia care unit.

Surgical correction combines circumferential VASER or power liposuction with sharp periareolar gland excision. For liposuction, Dr. Vishal Purohit makes two small openings on each side at the outer edge of the pectoralis major muscle along the anterior axillary line, enabling multi-directional access while preventing contour irregularities. The firm glandular tissue is then excised directly through the inconspicuous hemi-periareolar opening along the inferior areolar margin. In grade 4 gynecomastia, excess skin is removed when needed, but the areola is not reduced. Incision scars are permanent but gradually fade over time as post-surgical healing progresses.

Before surgery begins, anaesthesia fully blocks nerve transmission in chest tissues so operative steps do not cause pain. Dr. Purohit performs a dual-modality approach combining circumferential tumescent liposuction with sharp periareolar gland excision through an inconspicuous hemi-periareolar incision along the lower half of the areolar border. Under local anaesthesia, used for grades 1 to 3, tumescent fluid is infiltrated directly into the surgical field to ensure localized numbing, requiring no fasting. Grade 4 requires general anaesthesia with six hours of fasting, keeping the patient asleep and completely unaware. After local infiltration or induction, operative maneuvers proceed without causing distress.

Discharge timing depends directly on the surgical anaesthesia approach and patient grading under established safety protocols. Grades 1 to 3 gynecomastia are performed under local anaesthesia with operative times between 60 and 120 minutes, allowing safe same-day departure once immediate recovery is confirmed. In contrast, grade 4 gynecomastia requires a longer operation lasting up to about 4 hours, skin excision when needed, drain placement, and general anaesthesia. Consequently, general anaesthesia cases necessitate mandatory inpatient admission for at least 24 hours to monitor systemic recovery and wound status before discharge. Sedation is never used, ensuring a clear operational divide between outpatient local anaesthesia and inpatient general anaesthesia.