Successful Bilateral Liposuction and Gland Excision for Grade III Gynecomastia in a 41 Y.O. Male

Chief Complaints

A 41-year-old male patient with a body mass index (BMI) of 21 presented to the Plastic and Reconstructive Surgery Department at PACE Hospitals, Hitech City, Hyderabad, with a history of bilateral breast enlargement for the past 7–8 years. The enlargement had gradually progressed over time, prompting the patient to seek medical evaluation and surgical management.

On admission, the patient was conscious, coherent, and cooperative. General physical examination revealed no pallor, icterus, cyanosis, lymphadenopathy, clubbing, or pedal edema. The patient's vital signs were stable, and no other significant systemic abnormalities were noted.

Upon admission to PACE Hospitals, the patient underwent a comprehensive evaluation by the Plastic and Reconstructive Surgery team, including a detailed review of the medical history and a thorough clinical examination to assess the severity of the bilateral breast enlargement.

Following clinical assessment and appropriate preoperative evaluation, the patient was diagnosed with bilateral Grade III gynecomastia. The diagnosis was based on the patient's long-standing, progressively enlarging bilateral breast tissue and clinical findings consistent with advanced gynecomastia.

Based on the confirmed diagnosis, the patient was advised to undergo Bilateral Gynecomastia Grade III Treatment in Hyderabad, India, to remove excess glandular and fatty tissue, restore a flatter and more masculine chest contour, and improve physical comfort and aesthetic appearance.

After a thorough evaluation by Dr. Kantamneni Lakshmi (Senior Consultant Plastic, Reconstructive & Aesthetic Surgeon), a comprehensive assessment was carried out to determine the most appropriate management plan for the patient diagnosed with bilateral gynecomastia.

Based on the clinical findings of long-standing progressive bilateral breast enlargement involving both glandular and fatty components, it was determined that bilateral liposuction with gland excision under general anaesthesia was the most appropriate treatment approach. This decision was made after careful evaluation of the extent of tissue hypertrophy, exclusion of secondary causes through multidisciplinary assessment, and the need for effective contour correction and symptomatic improvement.

The patient and his family members were counselled regarding the condition, the need for surgical management, associated risks and benefits, and the importance of postoperative care, including wound care, use of compression garments, activity restriction, medication adherence, and regular follow-ups.

Following the diagnosis, the patient was scheduled to undergo a Bilateral Liposuction Surgery in Hyderabad at PACE Hospitals, along with Gland Excision under the supervision of the expert Plastic and Reconstructive Surgery team.

The surgical procedure involved the following steps:

• Anaesthesia and Patient Preparation: The patient was prepared for surgery under general anaesthesia. Under strict aseptic precautions, the operative field was painted and draped in a sterile manner.

• Incision and Tumescent Infiltration: A 5 mm incision was made in the anterior axillary fold bilaterally. A total of 750 ml of tumescent fluid was infiltrated bilaterally.

• Liposuction Procedure: Liposuction was performed bilaterally, and approximately 400 ml of aspirate was removed from each side to reduce the fatty component of the breast tissue.

• Gland Excision and Contouring: An inferior periareolar incision was made bilaterally, and the glandular breast tissue was excised. Superior periareolar mastopexy was performed to achieve proper contour and chest symmetry.

• Haemostasis and Wound Closure: Haemostasis was secured. The wound was closed in layers using 3-0 Vicryl and 3-0 Monocryl sutures. An aseptic dressing was applied, and a compression garment was placed to support healing and contour maintenance.

The patient was managed postoperatively with intravenous fluids to maintain hydration and physiological stability, infection prevention, postoperative pain management, and gastric protection during the hospital stay. The postoperative period remained uneventful without any complications, and the patient demonstrated satisfactory recovery with stable vital signs and healthy wound status. The histopathology showed benign breast tissue changes with fibro-fatty tissue and no malignancy, confirming bilateral gynecomastia. The patient was subsequently discharged in stable condition with advice for routine follow-up and proper wound care.

Upon discharge, the patient was prescribed medications for the prevention of postoperative wound infection, local wound care to promote healing, gastric protection to prevent medication-induced stomach irritation, pain relief for postoperative discomfort, nutritional supplementation to support recovery, prevention of postoperative thromboembolic complications, and additional rescue pain relief as needed.

The patient was advised to follow a high-protein diet, maintain proper wound care, avoid excessive shoulder and chest movements, and refrain from heavy exercises for 6 weeks. He was also instructed to continue using a compression garment for 6 weeks to support healing and contour maintenance.

The patient was advised to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, increased pain or swelling at the surgical sites, wound discharge, bleeding, or any signs of infection.

The patient was advised to return for a follow-up consultation with the Consultant Plastic, Reconstructive & Aesthetic Surgeon in Hyderabad at PACE Hospitals after 2 days for dressing.

This case highlights the successful surgical management of bilateral Grade III gynecomastia using liposuction and gland excision with satisfactory aesthetic and functional outcomes. The postoperative course was uneventful with stable recovery and no complications. The patient was discharged in stable condition with appropriate follow-up and postoperative care advice.