Welcome to the forum! You have asked some really good questions.
First, how much gland to remove? Understand that gland is concentrated under thee nipples -- but then it spreads out across the chest. No gyne surgery really moves all the gland -- you chest would then be mutilated. Rather, it is the surgeon's discretion to remove as much as possible so that the contours appear normal. Remember, ALL men have breast tissue -- even normal appearing men. So it is not the presence of breast tissue that is the problem -- it is the EXCESS amount of breast tissue.
When I operate, I generally like to remove as much of the breast tissue beneath the areola as possible but some tissue must be left in order to prevent a crater deformity. Each case is different.
I have designed my own set of instruments for gynecomastia surgery. They are sharp, aggressive and in some cases can remove sufficient tissue (both fat and gland) so that a direct excision is not needed. But this is determined during the actual operation. I am always prepared to perform an excision if needed -- and that is needed, on average, in over 85% of cases.
Vaser lipo is touted as better. Honestly, in the right hands, regular lipo is every bit as good -- or better.
Fees will vary around the country.
Good luck!
Dr Jacobs
