Which type of surgery has best results under arm pits or cut below nipple?

[Salsero33]

I have a case of Unilateral Gyno which has gotten worse over the years. I am mid 40's but in very good shape. I have decided to go with surgery and have met with several doctors. Some have talked about making an small cut under my arm pit and removing the tissue
that way. Most have talked about making a cut under the nipple and
removing it from the nipple. Which has the best results?

[Dr. Elliot Jacobs]

Both surgical approaches can work -- it depends upon the surgeon, his experience and the instruments he uses.  And most important, it depends upon your own tissues.  If you have a large, rock-solid mass of breast tissue, then the best approach might be a peri-areolar incision.  If it is softer, then perhaps an armpit type of incision would work.  You should discuss the pros and cons and alternatives of each incision with your surgeon.

My preferred method is to perform the armpit incision first and try to remove as much as possible through that incision (via liposuction with my own specific instruments).  If I discover during surgery that I cannot remove as much tissue as I would like during the lipo through the armpit, then, without hesitation, I will make a peri-areolar incision and complete the removal of tissue through the new incision.  In both cases, the incisions tend to heal exceedingly well.  What really counts is the final results -- a smooth, taut, contoured chest.

Dr Jacobs

[DrBermant]

I have a case of Unilateral Gyno which has gotten worse over the years. I am mid 40's but in very good shape. I have decided to go with surgery and have met with several doctors. Some have talked about making an small cut under my arm pit and removing the tissue
that way. Most have talked about making a cut under the nipple and
removing it from the nipple. Which has the best results?

True Unilateral Gynecomastia is the ultimate test of a doctor's skill. Make an operated side match something that never had surgery!  Here is another example of One Sided Gynecomastia. For most, the real problem is Uneven Gynecomastia, one side much larger than the other.

Gynecomastia Incision Placement depends on the problem to be treated, what needs to be done, skill of the surgeon, and doctor preferences. 

The edge of the areola is a great place to fool the eye in hiding a scar.  I can remove a large gland through a tiny incision at the edge of the areola / nipple.  My typical incision now is about 1.6cm (about 0.6 inch) for a typical gland.  Remote incisions make the work easier for the doctor with liposuction. It is much more difficult to perform the liposuction from the areola incision.  This location can take more skill and time.  Remote incisions offer a better vacuum for faster fat removal.  However, they also usually require a second incision at the edge of the areola to go after gland, can injure tissues between the remote site and what needs to be worked on, and have no place to hide on the chest or under the arm.  I have seen many patients unhappy with such additional scars and areas that look bad on animation. I also feel that a single small scar hidden at the edge of the areola are almost always better than 2 or more scars that often are as big or larger.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction