How is Gynecomastia Surgery Performed? A Step-by-Step Guide

Gynecomastia surgery is a surgical procedure that removes glandular breast tissue, excess fatty tissue, or both from the male chest through liposuction, direct gland excision, or a combination of both techniques, producing a flat and permanently contoured chest. The approach is selected based on the grade of gynecomastia, the composition of the tissue present, and the patient’s anatomy confirmed at physical examination. In most cases, the procedure is completed within 2 to 2.5 hours. 

Dr. Dhruv Chavan, founder and lead surgeon at Dr DC Plastic Surgery in Pune, determines the surgical approach for each patient before the operating date. He performs all steps of the procedure personally. The decision between liposuction-only, excision-only, and combined technique is finalised at the pre-operative consultation, not made during surgery.

At a Glance: Key Facts

• Gynecomastia surgery takes 2 to 2.5 hours in most cases
• Two primary techniques are used: liposuction for fatty tissue and direct gland excision for firm glandular tissue
• Most patients return to desk work within 3 to 5 days
• A compression garment is worn for 4 to 6 weeks post-operatively
• Dr. Chavan performs all surgical steps personally at Dr. DC clinic, Pimple Saudagar in Pune

Surgical Overview

How the Surgical Technique Is Decided?

The surgical technique is determined by the grade of gynecomastia confirmed at physical examination, the ratio of glandular to fatty tissue, and the degree of skin laxity present.

Grade I gynecomastia involves a small amount of glandular tissue without excess skin. This is typically addressed with liposuction alone or a minor intra-areolar excision. Grade II involves moderate tissue without significant skin excess and usually requires a combined approach.

Grade III and Grade IV cases involve substantial glandular tissue, often with excess skin, and require formal gland excision in addition to liposuction. For patients in this category, the surgical candidacy assessment at pre-operative consultation is particularly detailed, as skin management decisions must be made in advance.

Skin elasticity is assessed in all grades. In younger patients, skin contracts well after tissue removal. In older patients or those with significant tissue volume, additional skin reduction may be required after 6 months. 

What Happens During Gynecomastia Surgery, Step by Step?

Gynecomastia surgery follows a defined sequence. Each step is performed by Dr. Chavan personally.

Step 1: Pre-operative marking. Before anaesthesia, Dr. Chavan marks the chest to outline the area of tissue to be addressed. The markings define incision entry points and the extent of liposuction or excision planned.

Step 2: Anaesthesia. Local anaesthesia with sedation is used for Grade I and Grade II cases. General anaesthesia is used for Grade III, Grade IV, and all combined procedures. The type is confirmed at the pre-operative consultation. The doctor takes the call on which anesthesia to use on a case by case basis. 

Step 3: Liposuction (where indicated). For cases with a significant fatty component, liposuction is performed first through small stab incisions of 4 to 5 mm placed at inconspicuous sites [both axillas]. A cannula removes fatty tissue and softens the area before any glandular work.

Step 4: Gland excision (where indicated). For firm, fibrous glandular tissue that does not respond to liposuction, the glandular disc is removed through a intra-areolar incision at the lower border of the areola. The gland is dissected carefully to preserve the overlying skin and nipple-areolar complex.

Step 5: Fat Equalization– In gynecomastia surgery, fat removal is not just about suction—it’s about creating a uniform thickness across the chest so there are no dents or uneven areas.

Precise fat equalization is essential in gynecomastia surgery to avoid contour irregularities and achieve a smooth, natural chest.

Step 5: Haemostasis and closure. The surgical field is checked for bleeding. Drains may be placed for larger procedures. Incisions are closed in layers and the chest is dressed with a compression garment before the patient leaves the operating table.

Step 6: Recovery room. The patient is monitored for 1 to 2 hours post-surgery. Vital signs, surgical site, and recovery from anaesthesia are assessed before discharge is authorised.

Which Gynecomastia Technique Is Used for Each Grade?

The technique is not a matter of preference during surgery. It is determined systematically at the pre-operative consultation based on grade and tissue composition.

Combined liposuction and excision is the most common approach at Dr DC Plastic Surgery. Liposuction addresses the fatty envelope first, then excision removes the glandular disc. This produces the most complete chest contour result and is appropriate when both tissue types are confirmed at examination.

Grade III and IV cases with skin excess may require additional skin reduction at the lateral chest. Grade 3 gynecomastia surgery involves a specific pre-operative planning process, as skin management and scar placement require separate discussion at consultation.

To Summarise What We Have Covered So Far?

Gynecomastia surgery at Dr DC Plastic Surgery uses liposuction, gland excision, or a combined approach based on the grade and tissue composition confirmed at examination. Dr. Chavan performs the procedure personally and the technique is fixed before the operating date. The section below covers what to expect in the immediate post-operative period.

What Should You Expect Immediately After Gynecomastia Surgery?

The immediate post-operative period covers the first 24 to 72 hours. Understanding what is normal at this stage supports recovery and reduces anxiety.

In the recovery room: The patient is monitored for 1 to 2 hours after surgery. Vital signs and the surgical site are assessed before discharge is cleared.

Compression garment: A fitted compression garment is applied before the patient leaves the operating table. It must be worn continuously for the first 4 weeks. The garment manages swelling, supports tissue adhesion to the chest wall, and shapes the final result. The full recovery timeline and garment protocol is provided in writing at the pre-operative consultation.

Pain and swelling: Moderate chest tightness and swelling are normal in the first 48 to 72 hours. Most patients describe the discomfort as manageable and report significant improvement by day 3.

Drains: When drains are placed for larger procedures, they are typically removed at the first post-operative visit, 24 to 48 hours after surgery.

Activity in the first week: Rest for 24 hours post-surgery. Light walking is permitted from Day 2. Desk work and seated activities resume from day 3 to 5 in most cases.

Dr. Chavan’s Approach to the Gynecomastia Procedure

Dr. Dhruv Chavan performs all aspects of gynecomastia surgery personally at Dr DC Plastic Surgery. Pre-operative marking, anaesthesia supervision, liposuction, gland excision, haemostasis, and wound closure are carried out by Dr. Chavan, not delegated.

The pre-operative consultation includes a physical examination, an assessment of grade and tissue composition, an ultrasound referral where indicated, and a detailed walkthrough of the technique planned. Patients receive a written surgical plan before the procedure date.

For patients considering surgery, an in-person assessment at one of the 6 Dr DC clinic locations in Pune is required before any technique recommendation is made. Remote or photograph-based assessments do not provide sufficient information to confirm technique selection or grade.

As Verified By

1. [Rohrich RJ, Ha RY, Kenkel JM, Adams WP Jr](https://pubmed.ncbi.nlm.nih.gov/12560721/): Classification and management of gynecomastia: defining the role of ultrasound-assisted liposuction. Plastic and Reconstructive Surgery, 2003. Foundational grade-based technique selection framework referenced across the speciality.
2. [Braunstein GD](https://pubmed.ncbi.nlm.nih.gov/17881754/): Clinical practice. Gynecomastia. New England Journal of Medicine, 2007. Surgical indications, anaesthesia selection, and approach overview.
3. [Niewoehner CB, Nuttal FQ](https://pubmed.ncbi.nlm.nih.gov/6486139/): Gynecomastia in a hospitalized male population. American Journal of Medicine, 1984. Foundational tissue composition and grading data underpinning technique selection.
4. [American Society of Plastic Surgeons](https://www.plasticsurgery.org/reconstructive-procedures/gynecomastia-surgery): Gynecomastia Surgery Statistics and Procedure Overview. Procedural benchmarks and outcome reporting standards.
5. [Endocrine Society Clinical Practice Guidelines](https://www.endocrine.org/clinical-practice-guidelines): Evaluation and Treatment of Gynecomastia. Journal of Clinical Endocrinology and Metabolism, 2010. Evidence-based framework for surgical eligibility and timing.

Related Reading

1. Gynecomastia Surgery in Pune: Full Treatment Overview
2. Am I a Good Candidate for Gynecomastia Surgery?
3. Gynecomastia Surgery Recovery: Week-by-Week Guide
4. Gynecomastia Surgery Risks
5. What Are the Grades of Gynecomastia?
6. Grade 3 Gynecomastia Surgery in Pune
7. Is Gynecomastia Permanent Without Surgery?
8. Does Gynecomastia Come Back After Surgery?

Frequently Asked Questions

How long does gynecomastia surgery take?

Most gynecomastia procedures take 2 to 2.5 hours depending on the grade of tissue and the technique required.

Is gynecomastia surgery performed under local or general anaesthesia?

The type of anaesthesia depends on the grade of gynecomastia and the technique planned.

Grade I and Grade II cases with a predominantly fatty component are typically performed under local anaesthesia with sedation. Grade III and Grade IV cases, and all combined liposuction-excision procedures, are performed under general anaesthesia. Dr. Chavan confirms the anaesthesia plan at the pre-operative consultation and it can vary on a case to case basis.

Will there be a visible scar after gynecomastia surgery?

Scarring depends on the technique used.

Liposuction-only procedures leave puncture marks of 4 to 5 mm that typically become nearly invisible within 6 to 12 months. Gland excision requires a intra-areolar incision at the lower border of the areola, which heals along the natural pigmentation border and is generally not visible in photographs at 12 months. No technique is completely scar-free, but incision placement is planned to minimise visibility.

Can gynecomastia return after surgery?

Gynecomastia does not typically recur after surgery if the underlying cause has been addressed and removed before the procedure.

If anabolic steroids, medications, or other hormonal factors that caused the original gynecomastia continue after surgery, new glandular tissue can develop. This is why modifiable causes are confirmed as resolved before the surgical date is set. In patients where no ongoing hormonal cause exists, recurrence is rare.

What is the difference between liposuction and gland excision for gynecomastia?

Liposuction removes fatty tissue from around the chest using a thin cannula inserted through small stab incisions.

Gland excision removes the firm glandular disc beneath the nipple through a periareolar incision. Liposuction alone cannot remove a firm glandular disc.