01 Sep The Reality of Gland Removal in Gynecomastia Surgery: All the clinically significant gland is removed but it is not literally 100%

For individuals seeking surgical intervention to address gynecomastia, understanding the nuances of the procedures is essential. Contrary to common misconceptions, 100% removal of the gland tissue in gynecomastia surgery is impossible. Regardless of technique or surgeon, complete gland removal always results in a very small amount of tissue left behind. In this comprehensive guide, we will explore the realities of gland removal, delve into the open and pull-through techniques, and debunk the myth that leaving residual gland tissue affects recurrence.

Understanding Gynecomastia Surgery Techniques
Gynecomastia surgery typically involves the removal of excess breast tissue to restore a more masculine chest contour.

Two primary techniques are used: the open technique and the pull-through or our no scar technique.

The Open Technique:
In the open technique, also known as excision, an incision is made around the areola (nipple area) to allow direct access to the breast tissue. However, due to the inherent anatomy of the breast and the presence of blood vessels, nerves, and ducts, complete removal of all gland tissue is challenging. A button of tissue needs to be left behind the nipple so that it maintains blood supply. Furthermore, even with direct visualization, chest fat can be difficult to tell compared to glandular tissue. The best surgeons aim to remove as much glandular tissue as possible while preserving the integrity of surrounding structures.

The Pull-Through Technique or Our No Scar Technique:
While this technique is less invasive than the open technique, it can successfully completely remove any clinically significant breast gland. Similar to the open technique, however, certain structures have to remain present to maintain the blood supply to the skin and nipple. As such, a very small portion of the gland will remain.

To lastly illustrate this, male breast cancer treatment is an excellent example. Surprisingly, approximately 4% of breast cancer cases are in males. In male breast cancer patients, a mastectomy is performed (complete gland removal). In this case, aesthetics is not a consideration. The goal is remove the cancer and all the glandular tissue. Even in these cases, 100% of the tissue is not removed with the mastectomy. Large incisions and no concern for aesthetics still make it impossible to remove every single cell as the borders between gland and fat cannot be evaluated with 100% accuracy.

The Myth of Complete Gland Removal and Recurrence
We have established that while all clinically significant gland can be completely removed, a very small percentage will remain behind regardless of surgeon and technique. However, this does not impact the long-term outcomes or recurrence rates of the procedure. Recurrence is more likely to be influenced by factors such as hormonal imbalances, genetics, and weight fluctuations rather than residual glandular tissue growing.

Conclusion
While complete removal of all clinically significant gland in gynecomastia surgery is achievable, it is never 100%. it’s important to understand that leaving a minimal amount of residual tissue does not necessarily lead to recurrence or suboptimal outcomes. Both the open and pull-through techniques have their merits and limitations, and the best surgeons take a holistic approach to create natural-looking results that align with the patient’s goals. Gynecomastia surgery is a delicate balance between removing excess tissue, preserving vital structures, and achieving a satisfying aesthetic outcome. As individuals explore their options for gynecomastia surgery, a thorough consultation with a board-certified surgeon is essential to understand the nuances of each technique and make an informed decision based on realistic expectations and expert guidance.