In short
- Liposuction does not remove gland. It does its job on the fatty component very well, but the firm disc under the areola cannot be suctioned.
- Glandular excision removes that disc through an incision at the lower edge of the areola, where the scar is camouflaged in the change of colour.
- The combination is the commonest indication, and it is also the one that best resolves the transition between the area treated and the rest of the chest.
- The skin is the third factor. When a lot is left over or it has lost elasticity, removing it is considered; that decision, and not the size, is what separates a straightforward operation from a complex one.
- A thin layer of gland is deliberately left under the areola. Removing too much is what produces a crater-like hollow.
- The published series put revisions at around 5% and describe residual tissue and contour irregularities as the commonest reasons.
- The recovery of quality of life is well documented: patients who have had surgery improve significantly in self-esteem and across most of the quality-of-life domains measured.
The technique is not chosen from a catalogue: it is determined by what lies under the skin. Liposuction removes fat and only fat; excision removes the glandular disc; and the combination of the two is, by a long way, the commonest indication, because most male chests that are operated on have both tissues in differing proportions. To those two factors is added a third that decides more than it appears: how the skin behaves once the volume disappears.
This page explains what each technique does, how far it goes, what it aims to avoid and what the published series say about complications and revisions. Not so that you can choose over the internet —that is done by examining—, but so that you arrive at the consultation understanding why one thing is proposed and not another.
This page sets out the surgical side of the general guide to gynaecomastia. If you still do not know whether yours is gland or fat, start with how gland is told apart from fat.
The question is not which technique, but what is underneath
When someone arrives asking “can it be done with liposuction alone?”, the honest answer is that it depends on a two-minute examination. What is being looked for is the glandular disc: if it is there, liposuction on its own will leave it where it was.
It helps to order the decision into three questions, in this order:
- Is there glandular tissue? If there is, it will have to be removed.
- Is there excess fat around it? If there is, it will have to be suctioned so that the result is not left with a step between the area treated and the rest of the chest.
- How is the skin going to respond? If it is elastic, it will retract on its own; if not, a decision has to be made about it.
The European guidelines on gynaecomastia make the underlying indication clear: surgery is the treatment of choice in long-standing gynaecomastia, the kind in which the tissue is already fibrotic and is not going to resolve on its own. In recent cases, and once the cause has been treated, what is indicated is to wait.
What liposuction does and how far it goes
Liposuction is carried out through two very small incisions, usually in the inframammary fold and at the side, through which fine cannulas are introduced. Its job is twofold: it removes the fatty component and, above all, it evens out the transition with the rest of the chest, which is what makes the result look natural rather than like a patch.
It also has a surgical advantage that does not show in the result but does in the recovery: working with the cannula first leaves the plane cleaner and reduces bleeding when the gland is removed afterwards.
What liposuction does not do is remove glandular tissue. The gland is firm and fibrous: the cannula passes around it. That is why liposuction on its own makes sense when the work-up confirms that there is only fat —pseudogynaecomastia— and falls short when there is a disc underneath.
What excision does and why the incision goes where it goes
Glandular excision removes the disc through an incision at the lower edge of the areola, on the line where the skin changes colour. It is a place chosen for two reasons: it gives direct access to the tissue that has to be removed and the scar is camouflaged in a natural boundary.
Here is the technical detail that most determines the result, and that is worth understanding before surgery: not all the gland is removed. A thin layer of tissue is deliberately left just beneath the nipple-areola complex. That layer is what supports the areola and stops it being stuck to the muscle forming a hollow —the so-called crater-like hollow—, which is a result far harder to correct than the original problem.
Put another way: in this surgery, removing more is not doing it better.
The combination, which is the usual thing
Most cases are resolved by combining the two: liposuction for the fatty component and the transition, excision for the disc. It is not a commercial add-on; it is what the commonest anatomy calls for.
The surgical literature points the same way. A ten-year series published in Annals of Plastic Surgery, with 41 patients and 75 operations, concludes that subcutaneous mastectomy combined with ultrasound-assisted liposuction can be used as a first option in grades II and III, and puts the overall surgical revision rate at 4.8%. The patients scored their overall satisfaction at 9.4 out of 10 and the improvement in their confidence at 9.2.
The third factor: the skin
The grades of gynaecomastia —the classification usually used in surgery— do not order cases by size, but by how much skin is left over and where the nipple is. That is the variable that changes the operation:
- When the skin is elastic, it retracts on its own once the volume is removed. It does not have to be touched, and the scar is limited to the edge of the areola.
- When there is excess skin but it keeps its quality, there are intermediate resources for making it adapt without adding long scars.
- When the skin has lost its elasticity —typically after a large weight loss—, removing it is part of the surgery, and that means additional scars that have to be discussed beforehand, not afterwards.
In the Annals of Plastic Surgery series cited above, the skin-preserving procedure gave good results in grades IIb and III with low rates of revision and of complications. It is good news for the patient: the bar for having to add scars is higher than many people fear.
What the complication figures say
They are worth looking at squarely, because they are better than the names of some of them suggest.
The largest series published recently —448 patients and 896 breasts, treated with liposuction and complete excision through a periareolar incision— recorded some complication in 25.9% of the patients. The commonest was seroma, a collection of fluid drained in the consulting room, followed by superficial changes to the skin. The authors themselves sum it up like this: the complications are frequent, but manageable, and satisfaction was high.
A piece of work in Plastic and Reconstructive Surgery with 145 young patients supplies the detail of what really compromises a result: 36% of the breasts had at least one problem over a median follow-up of 8.6 months, and the three commonest were residual tissue (12.6%), contour irregularities (9.2%) and haematoma (7.8%). The first two are precisely the ones avoided by a complete excision and a good transition: that is why it matters so much that the techniques should be combined where appropriate.
That same piece of work measured something that does not usually appear in surgical statistics: the patients improved significantly in self-esteem and across most of the quality-of-life domains assessed.
Drains: why sometimes yes
It is a common question and it has an answer backed by figures. A study of 163 breasts compared operating with and without suction drainage: without a drain, 6.5% of cases developed a seroma that had to be aspirated; with a drain, none did. There was no difference in the rate of haematomas or in the total number of fluid collections.
The authors themselves qualify what the patient notices: the drain is uncomfortable, it means one more visit and there is no universal standard. The reasonable conclusion —and the one applied— is that it is not an automatic decision: it depends on the volume removed, on the state of the bed at the end and on whether it has been combined with liposuction.
Anaesthesia and duration
The anaesthetic is matched to the volume that has to be removed. Low-volume cases can be planned under local anaesthetic, with or without sedation; higher-volume ones are done under general anaesthetic. In most cases it is day surgery, with no hospital stay.
It is a reassuring fact and worth saying: this is not a long operation or a recovery spent in hospital.
What moves the price
The price falls, as a guide, between €3,000 and €6,500 (2026), and the range is wide because the cases are. What moves it is exactly what has been explained on this page:
- At the lower end, the cases that can be resolved under local anaesthetic, or those in which the component is essentially fatty and liposuction is enough.
- At the upper end, those requiring wide glandular excision, skin removal and a general anaesthetic.
The quotation given after the first consultation is a fixed figure with everything included: theatre, anaesthetist, later check-ups, compression garment and VAT. There are no items that turn up afterwards. What it does not include are the optional post-operative treatments —radiofrequency, massage or lymphatic drainage—, which are recommended according to what each patient needs and quoted separately.
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Frequently asked questions
Can it be done with liposuction alone?
Yes, when the examination confirms that the volume is entirely fatty. If there is a glandular disc, liposuction on its own does not remove it and the result is left half done. It is the reason the prior examination is not a formality.
Is all the gland removed?
No, and that is deliberate. A thin layer is left under the areola so that there is no hollow in the centre of the chest. Removing too much is what produces the crater-like hollow, which is considerably harder to correct than the gynaecomastia you started with.
What scar is left?
In the usual plan, an incision at the lower edge of the areola, camouflaged in the change of skin colour, plus two very small access points for the cannulas. Only when there is a lot of excess skin are additional scars considered, and that is decided and explained before surgery.
How often does it have to be touched up?
In the ten-year series cited, surgical revision was 4.8%. The usual reasons when it happens are residual glandular tissue or a contour irregularity, not the overall result.
Will I have drains?
It depends on the case. The available data indicate that they reduce the seromas that have to be aspirated, but they are also uncomfortable and mean one more visit. It is decided according to the volume removed and the state of the surgical bed at the end.
Can I have surgery if I am still losing weight?
It is better to operate with the weight settled. If you carry on losing weight, both the fatty component and the behaviour of the skin change, and that can alter the result. On the other hand, if the weight has been stable for months, there is no reason to wait any longer.
Can it come back after surgery?
A proper excision leaves no tissue to grow back, so recurrence is uncommon. What can reproduce the problem is keeping the cause going: anabolic steroid use, an untreated hormonal disorder or a substantial weight gain.
Sources
- Li CC, Fu JP, Chang SC, Chen TM, Chen SG. Surgical treatment of gynecomastia: complications and outcomes. Ann Plast Surg. 2012;69(5):510-515. PMID 21712702 — ten-year series, 41 patients and 75 operations: an overall revision rate of 4.8%, a good result from the skin-preserving procedure in grades IIb and III, and subcutaneous mastectomy combined with ultrasound-assisted liposuction as a first option in grades II and III.
- Ramasamy K, Tripathee S, Murugesh A, Jesudass J, Sinha R, Alagarasan AR. A Single-Center Experience With Gynecomastia Treatment Using Liposuction, Complete Gland Removal, and Nipple Areola Complex Lifting Plaster Technique: A Review of 448 Patients. Aesthet Surg J Open Forum. 2023;5:ojac095. PMID 36866186 — 448 patients and 896 breasts: some complication in 25.9%, with seroma the commonest, and high satisfaction; the authors conclude that complications are frequent but manageable.
- McNamara CT, Nuzzi LC, Firriolo JM, et al. Complications and Quality of Life following Gynecomastia Correction in Adolescents and Young Men. Plast Reconstr Surg. 2022;149(6):1062e-1070e. PMID 35349529 — 145 patients aged 12 to 21: 36% of the breasts had some complication over a median of 8.6 months, the commonest being residual tissue (12.6%), contour irregularities (9.2%) and haematoma (7.8%); significant improvement in self-esteem and in seven quality-of-life domains.
- Chao JW, Raveendran JA, Maly C, Rogers G, Boyajian M, Oh AK. Closed-Suction Drains After Subcutaneous Mastectomy for Gynecomastia: Do They Reduce Complications? Aesthetic Plast Surg. 2017;41(6):1291-1294. PMID 28842781 — 163 breasts: seromas requiring aspiration were 6.5% without a drain against 0% with one, with no difference in haematomas; the authors stress that there is no universal standard and that the drain has drawbacks of its own.
- Kanakis GA, Nordkap L, Bang AK, et al. EAA clinical practice guidelines—gynecomastia evaluation and management. Andrology. 2019;7(6):778-793. PMID 31099174 — surgery is the treatment of choice in long-standing gynaecomastia; in recent cases, and once the cause has been treated, watchful waiting is recommended.
Sources checked one by one against PubMed on 12 August 2026.
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The decision between liposuction, excision or both is taken by examining, not by reading. At the Instituto de Cirugía Plástica del Mediterráneo, in Valencia, the first consultation serves to establish what proportion there is of each tissue, how the skin is expected to respond and what plan applies to your case —including the possibility that what is indicated is to wait.
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Educational content reviewed by Dr Alessandro Thione, registration no. 46/4621959, and Dr Alberto Ruiz Cases, registration no. 46/4624050, specialists in Plastic, Aesthetic and Reconstructive Surgery. Deciding on one technique or another requires an examination in person; this information does not replace a medical consultation.
Registration no. 46/4621959
Registration no. 46/4624050
Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.
