Because approximately 70% of gynecomastia cases stem from unexplained mammary overdevelopment or mammary proliferation (glandular type) induced by an endocrine disorder, internal medicine diseases and the feasibility of treatment should be first excluded prior to the operation. The chests of such patients feel relatively tough and predominantly composed of mammary tissues at the inside (mammary proliferation), which are difficult to be corrected by a single liposuction and mostly require subcutaneous mastectomy. Technically, a semi-circular incision is made at the periphery of the areola, via which the mammary gland is subcutaneously separated. Then, a majority of hyperplastic mammary tissues are dissected, and an average of 80–90% of mammary glands are removed to restore chest flatness, but a small part of mammary and adipose tissues should be preserved to avoid breast depression postoperatively. This surgery is conducted along with peripheral breast ultrasonic liposuction or regional breast skin excision sometimes to redress severe breast hypertrophy and sagging. Resected mammary glands are routinely submitted for pathological inspection to further confirm the presence of tissue abnormalities or possible lesions.

For patients with severe breast tissue proliferation like the female breast, performing mastectomy alone causes chest skin looseness and sagging, which undermines patients’ self-confidence, so Dr. Chuang recommends further total mastectomy and concurrent partial breast skin excision through an inferior margin incision to remove subcutaneous mammary tissues and tightens the chest skin. This male breast reduction surgery not only improves the appearance and symptoms of gynecomastia but also simultaneously smooths the anterior chest contour to restore the normal appearance of the male chest.