Medical management has been shown to produce variable results. Reports of successful medical treatment have been most consistently linked to instances when the gynecomastia is of recent onset and is caused by testosterone deficiency. (However, many reports of "successful" medical treatment of gynecomastia are simply misconstrued attempts to treat adolescent individuals with normal findings during puberty that would have resolved spontaneously. It must be stressed that minimal development of the breast bud during puberty is a normal finding in males that resolves in time with no treatment.)
Testosterone administration has inconsistent effects in persons with Klinefelter syndrome, but it can cause dramatic improvement in those with other forms of testicular failure (eg, anorchia, viral orchitis). Testosterone therapy involves an element of uncertainty because testosterone can serve as substrate for extraglandular estrogen formation
Medications are administered for your comfort during the surgical procedures. The options include intravenous sedation and general anesthesia. Your doctor will recommend the best option for you.
In cases where gynecomastia is primarily the result of excess fatty tissue, liposuction techniques alone may be used. This requires insertion of a cannula, a thin hollow tube, through several small incisions. The cannula is moved back and forth in a controlled motion to loosen the excess fat, which is then removed from the body by vacuum suction. There are various liposuction techniques that may be used; the technique most appropriate in your case will be defined prior to your procedure.
Excision techniques are recommended where glandular breast tissue or excess skin must be removed to correct gynecomastia. Excision also is necessary if the areola will be reduced or the nipple will be repositioned to a more natural male contour. Incision patterns vary depending on the specific conditions and surgical preference.
Sometimes gynecomastia is treated with both liposuction and excision.