Gynecomastia — Gland Removal

Surgical gland removal addresses true glandular gynecomastia — enlarged male breast glands that cannot be corrected by liposuction alone. At Art Ethic, five techniques are available ranging from targeted gland excision alone (grade I) to combined liposuction and skin excision for severe cases (grade IV). The surgeon assesses the composition of the gynecomastia at consultation — fat, gland, or both — and selects the approach accordingly. When both glandular and fat components are present, liposuction and gland excision can be performed in the same session.

True glandular gynecomastia involves hypertrophy of the male breast glandular tissue — the ductal and stromal structures that make up the breast parenchyma — rather than simple fat accumulation. Glandular tissue is firm, often tender, and located immediately beneath the nipple-areola complex; unlike fat, it does not respond to liposuction and requires direct surgical excision. Accurate diagnosis (typically confirmed by physical examination and ultrasound) determines whether gland removal, liposuction, or a combination is appropriate. At Art Ethic Beauty Clinic, doc. MUDr. Martin Molitor, Ph.D., MBA selects from five surgical approaches based on the Simon classification of gynecomastia severity: 1. **Grade I / liposuction only** — when imaging confirms the enlargement is purely fatty with no significant glandular component; a standalone liposuction session achieves full correction. 2. **Periareolar approach** — a semicircular incision at the border of the areola provides direct access to the glandular tissue for excision, with the scar concealed at the pigmented-unpigmented skin junction. Appropriate for grades I–II. 3. **Circumareolar approach** — a full circle incision around the areola, providing wider access for more substantial gland removal. Used for grades II–III. 4. **Vertical approach** — an extension of the periareolar incision downward through the lower breast pole; used when there is additional tissue in the inferior quadrant requiring removal. Grade III. 5. **Classic inverted-T (anchor) approach** — the most extensive technique, for grade IV gynecomastia with significant skin excess; removes gland, excess skin, and can reposition the nipple-areola complex. Appropriate only for the most severe presentations. In mixed-type gynecomastia (both fat and gland), liposuction is performed first in the same session to remove the fatty component and debulk the chest, followed by direct gland excision through the planned incision. This combined approach produces the most comprehensive correction in a single operative episode. Recovery involves one to two weeks at home; light activity resumes after one week; full unrestricted activity from eight weeks. A compression garment is worn during recovery to support healing and minimise oedema.