Diagnosis begins with a detailed medical history (anamnesis), a physical examination of the breasts and testes, a complete hormonal profile panel, and endocrinological consultation when indicated. (In adolescent boys presenting with marked gynecomastia exceeding 4 cm in diameter, an endocrine disorder is diagnosed in approximately 12% of cases).
Classification is based on clinical presentation, categorizing gynecomastia into three severity grades based on tissue volume, glandular density, and the presence of skin excess.
The initial step is precise diagnostic assessment to determine tissue composition: whether the enlargement consists primarily of localized adipose tissue, dense glandular tissue, or a mixed pattern, as well as the overall extent of gynecomastia.
Adipose-Dominant (Pseudogynecomastia): Managed via targeted liposuction. Performed under general anesthesia, micro-incisions are placed laterally along the chest wall. Tumescent fluid containing local anesthetic and vasoconstrictors is infused, followed by controlled fat aspiration using specialized cannulas.
Glandular-Dominant: True glandular tissue requires surgical excision. This can be achieved by extending the liposuction access sites or through a semi-circular periareolar incision along the lower boundary of the areola, where the resulting scar is seamlessly concealed along the natural pigment transition line.
Grade 3 (Severe with Skin Excess): Cases featuring significant skin redundance and a ptotic (descended) nipple-areola complex require surgical reduction—excising both glandular tissue and excess skin envelope. This involves broader surgical approaches, incorporating periareolar, vertical, and inframammary fold incision patterns. Surgical drains are placed at the conclusion of the procedure.
Surgical drains are removed once fluid output decreases below 30 cc per day. Patients are required to wear a specialized chest compression garment continuously for one month post-surgery to eliminate dead space, reduce edema, and optimize tissue contouring during healing.
The most common early complication is hematoma formation, which may occasionally require surgical evacuation in the operating room. Other potential risks include mild asymmetry or over-resection, which can present as a contour depression behind the nipple-areola complex.
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