Gynecomastia (Male Chest) | Types and Techniques of Gynecomastia Surgery

Gynecomastia involves proliferation of breast gland ducts and stromal components, including fat. Circumferential liposuction contours the chest through two small openings on each side along the anterior axillary line, while sharp excision through a hemi-periareolar incision removes the dense subareolar glandular tissue to prevent residual puffiness. For grade 4 gynecomastia, excess skin is removed when needed, though the areola is not reduced. Grades 1 to 3 are performed under local anaesthesia, whereas grade 4 requires general anaesthesia. Operative times range from 60 to 120 minutes for simpler cases up to about 4 hours for grade 4 gynecomastia.

Gynecomastia typically consists of variable proportions of adipose tissue and fibrous parenchymal gland. Suction lipectomy alone cannot reliably clear firm glandular tissue, frequently leaving an obvious residual subareolar disc. Conversely, isolated gland excision without peripheral contouring can produce a hollow saucer deformity. Dr. Vishal Purohit places two small liposuction access openings on each side at the outer edge of the pectoralis major muscle along the anterior axillary line. VASER liposuction targets superficial fat to promote skin tightening, while careful surgical dissection prevents crater deformities. Direct sharp excision through an inconspicuous hemi-periareolar incision along the lower half of the areola border completely extracts the gland.

Ultrasonic VASER technology delivers ultrasound-assisted liposuction via alternating energy transmitted through small probes featuring specialized rings and grooves. These acoustic waves induce micromechanical, cavitational, and thermal effects that emulsify dense fatty deposits and disrupt fibrous septa without damaging adjacent blood vessels or nerves. For chest contouring, Dr. Vishal Purohit accesses the subcutaneous layer through two small openings on each side at the outer edge of the pectoralis major muscle along the anterior axillary line. Targeting the subdermal layer allows smooth, controlled tissue disruption across fibrous zones, supporting contraction and surface definition over the underlying pectoralis musculature.

In this dual-modality protocol, liposuction is performed first to debulk fatty tissue and facilitate skin redraping. Because fibrous glandular tissue cannot be aspirated by cannula alone, sharp surgical excision is required. Dr. Vishal Purohit visualizes and excises the gland through the lower hemi-periareolar access, camouflaging the incision against the natural areolar border transition. Careful dissection prevents a saucer deformity. For grades 1 to 3, surgery is completed under local anaesthesia. Grade 4 cases require general anaesthesia, where excess skin is removed if needed while preserving the areola without reduction. Inconspicuous scars heal well with natural chest flattening.

In published surgical reports, the dense fibroglandular mass resides directly in the subareolar space. Following circumferential liposuction to clear surrounding adipose until cannula resistance is lost, the remaining fibrous tissue is isolated and pulled through a small incision in strands. Surgeons deliberately preserve approximately 5 mm thickness of subareolar fibrous tissue beneath the nipple-areolar complex. This tissue cuff is essential to maintain vascularity to the nipple and areola, preventing ischemia while avoiding central saucerization or depression deformities. Leaving sufficient subareolar tissue also preserves natural projection, after which fat equalization without suction and a rolling pinch test are performed to verify bilateral contour symmetry across the chest wall.