Can liposuction take out gland too if recently formed?

[spooon]

I am weighing up tamoxifen versus going for the jugular i.e. surgery. My gyno is recent onset namely 6 months ago due to propecia. If liposuction can take out the gland too would I be right in thinking the less invasive nature of lipo might just outweigh the sides from tamoxifen. I know it's a hard comparison to draw but if I can get an almost guaranteed pain free and instant result from lipo why risk the medication option? I understand the equation changes if I do in fact need a full surgery - sound logic?

[Michael Law, M.D.]

There will need to be some direct excision to remove glandular tissue. No gynecomastia should be considered an easy or straightforward surgery. But, when performed by a plastic surgeon with expertise, the results can be absolutely life changing. And, in some cases, the recovery can be minimal. The idea that liposuction alone is a non-invasive procedure with a guarantee of no pain is not accurate. 
Most men recover with limited gynecomastia can recover quickly and comfortably. An experienced plastic surgery will discuss options with you depending on your very particular situation. The goal of surgery is to provide you with the best result with the least invasive approach. 
Surgery with a board-certified plastic surgeon in an accredited facility is a much, much safer and much more predictable option than taking tamoxofen.

[spooon]

Dr. Law

Thanks for highlighting that lipo is not to be taken lightly. What's the difference between the 'hole' made for lipo versus the incision made for gland removal? I appreciate that surgery with the right surgeon is arguably safer it's just that the accepted wisdom in medicine is to try a pill before going under the knife. I can see there are exceptions just having a hard time getting my head round it.  

[Michael Law, M.D.]

In patients with pure glandular gynecomastia (usually teens and slender young adults), breast tissue is removed via incisions at the border of the areola. I prefer incisions at the upper and lower borders of the areolas (11- to 1-o’clock, and 5- to 7-o’clock).
 
Liposuction, in addition to direct excision of subareolar breast tissue as described above, is necessary for patients with breast area fullness that is caused by both central breast tissue and peripheral fat. Liposuction is performed first, using the upper and lower areolar border incisions, and often using an underarm-area incision as well. Then the areolar border incisions are enlarged enough to allow direct excision of fibrous breast tissue.
 
The vast majority of gynecomastia patients need both forms of treatment – liposuction and direct excision of breast tissue – so in most patients you start with a short incision for liposuction and then make the incisions a little longer for the direct excision part of the procedure.       
 

[spooon]

Dr. Law,

Very useful indeed thank you.

[Dr. Schuster]

I don't like the idea of being on Tamoxifen for the rest of your life. They don't even have women do that when they are being teated for breast cancer. I have found that in the majority of cases, there is a dense glandular component that will not come out with either traditional or ultrasonic liposuction. This tissue needs to be cut out, which can be done through a variety of incisions (I prefer the lateral pull through technique). Unfortunately it is nearly impossible to accurately predict. So the surgeon you choose has to be able to do both or you will likely be disappointed. Good luck.

[spooon]

Dr, Schuster,

Most of the studies reporting effectiveness of tamoxifen I believe had the participants taking the drug for 3 months. I would never entertain the idea of taking it for life not least because studies for long term use in males are lacking. 
Thank you I see now that the 'draw' of a liposuction only procedure is a bit false. 

[Litlriki]

The gynecomastia resulting from Propecia regresses on its own in some cases (I'm not sure of percentages), so waiting up to a year can be wise to see if it goes away once the Propecia is stopped.  I'm not sure if addition of Tamoxifen or one of the more specific anti-estrogen agents is more effective in leading to resolution.  If surgical resection is required, excision of the sub-areolar remnant is essential, otherwise, just liposuction and fat removal can actually cause that sub-areolar tissue to be more obvious and look like a puffy nipple.