Gynecomastia is a well known male breast tissue enlargement problem that appears in many different sizes. But the hallmark of gynecomastia is the very fibrous nature of the tissue with a distinct whitish appearance. While not a tissue mass that has a true capsule it is readily distinguished during surgery from the surrounding normal fatty breast tissue. By examination its size is also very palpable due to the firm feel of this benign breast tumor.
Many gynecomastias present with a palpable mass and are best treated by an open excisional technique. The small size of the areolar incision can make it seem incredulous that gynecomastia tumors of larger sizes can be removed through it. These firm breast tumors that are largely located under and around the nipple-areolar complex are fairly easy to see how they can be delivered through the areolar incision.
However as gynecomastia tumors become larger it becomes harder to imagine how they can be dissected out and then pass through an incision…whose diameter is far less than that of the mass which lies underneath it. The key is that a slow and careful 360 dissection technique is used.
With needlepoint electrocautery one edge of the firm tumor is dissected out. The tumor is released from under the nipple and then a circumferential dissection approach is used. By so doing even very large gynecomastias can be removed with minimal scarring.
Dr. Barry Eppley
World-Renowned Plastic Surgeon