What gynecomastia actually is
Gynecomastia is the growth of true glandular breast tissue in men, driven by the balance between oestrogen and testosterone. It is extremely common, affecting a substantial proportion of adolescent boys and adult men, and it is not the same thing as simple chest fat.
The distinction matters because it dictates the operation. Glandular tissue is firm, rubbery and sits directly under the nipple-areolar complex. Fat is soft and spread across the chest wall. Most patients have a mixture, and the proportion of each is what decides technique. Pseudogynecomastia, where there is only fat and no gland, responds to liposuction alone; true gynecomastia does not.
Grades, and what each one changes
Gynecomastia is graded from I to IV. Grade I is a small amount of gland around the areola with no skin excess. Grade II adds a moderate volume with the chest beginning to take a breast-like shape but skin still tight. Grade III involves marked enlargement with mild skin excess, and Grade IV has significant excess skin and a drooping nipple position.
- Grade I–II: gland excision plus VASER liposuction, areolar incision only, no skin removal
- Grade III: gland excision, liposuction and limited skin tightening at the areolar border
- Grade IV: gland excision with formal skin excision and nipple repositioning, longer scar accepted
- Puffy nipple variant: targeted gland excision under the areola, minimal liposuction
Why liposuction alone leaves patients disappointed
This is the single most common reason men come to Gurgaon for a revision. Liposuction removes fat efficiently but cannot remove firm glandular tissue. When only liposuction is performed, the fat around the gland is taken away and the gland is left sitting proud under the nipple, producing a hard disc and sometimes a more obvious deformity than before.
The correct operation removes the gland directly through a small incision at the lower border of the areola, then uses VASER liposuction to feather the edges into the chest wall so there is no step-off. Doing both is what produces a flat, masculine contour that holds up with the arms raised.
The operation and the same-day discharge
Surgery takes ninety minutes to two and a half hours under general anaesthesia or local with sedation, depending on grade and whether both sides are treated. The areolar incision is roughly three centimetres, sited at the pigment border where it becomes very difficult to see once healed.
The excised tissue is routinely sent for histopathology. You go home the same evening in a compression vest, which is worn continuously for four weeks and then at night for a further two.
Recovery
- Days 1–2: mild to moderate soreness, arms kept below shoulder height, compression vest on at all times.
- Days 3–4: most patients return to desk work. Driving usually comfortable.
- Weeks 2–3: bruising resolves, light cardio resumes, still no chest or overhead work.
- Weeks 4–6: vest reduced to nights. Upper-body training reintroduced gradually from week six.
- Months 3–6: final contour visible as swelling fully settles and the areolar scar begins to fade.
Will it come back after surgery?
Once the gland is properly excised, it does not regrow. Recurrence in practice comes from two causes: incomplete excision at the first operation, or a continuing hormonal driver such as anabolic steroid use, certain medications or an untreated endocrine condition.
For that reason a hormonal workup is done before surgery when the history suggests one, and patients using anabolic steroids are advised to stop well before the operation. Weight gain can add fat back to the chest even with the gland removed, so the result is durable rather than immune to lifestyle.
Who performs this procedure
Every gynecomastia case at this clinic is planned, marked, operated and reviewed personally by Dr. Ashish Khare, MCh Plastic and Reconstructive Surgery, in an NABH-accredited theatre with a consultant anaesthetist present throughout.
