In my time as a plastic surgeon in the Scottsdale area, I’ve seen many men for gynecomastia, which is the development of excess tissue in the male chest. The tissues that cause this problem can be fat tissue, glandular tissue (firm, white, rubbery breast tissue), or a combination of fat and glandular tissue.
For those men suffering from primarily a fat excess, liposuction alone can be effective as it reduces the fat component of the chest by removing fat directly. For liposuction to have a nice result, the overlying skin must also be reasonably elastic so it can shrink down after the fat is removed.
However, most men I see for male breast reduction also have a collection of glandular tissue, usually centered behind the areola. In these cases, liposuction alone actually exaggerates the glandular component because the fat is removed but the glandular tissue cannot be (it is too firm and dense), so it becomes more visible after liposuction. For these men, it is critical that direct surgical removal of glandular tissue is performed at the same time. I use a small incision at the bottom of the areola that allows both the liposuction and direct tissue removal with minimal scarring.
Understanding these issues is very important, as I have seen some patients who had (by other surgeons) unsuccessful prior liposuction of the chest because the glandular tissue was not addressed. This made my revision surgery much more difficult due to the pre-existing scar tissue from the liposuction. The moral of the story is make sure your surgeon is familiar and comfortable with techniques to deal with both fat and glandular tissue before having gynecomastia surgery, as your first surgery is your best chance at having things done right.
Learn more about the causes of gynecomastia and my preferred techniques for correcting it.