In recent years, more and more doctors and patients have begun to pay attention to male breast surgery, and a variety of surgical methods have sprung up, especially for patients, a little dazzling. How to choose the right surgery for you is one thing that has always confused big-boobed men. After seeing thousands of patients with gynecomastia, I suggest that the following two issues must be clear before surgery. First, to understand gynecomastia and to know if you need further treatment? (a) Identify true and false gynecomastia: 1. True gynecomastia is the presence of abnormally developed mammary glands in the male chest, forming female-shaped breasts. Obesity accelerates the development of gynecomastia! The aromatase enzyme in the adipose tissue will transform the androgens needed by men into estrogen, prompting male breasts to develop into the appearance of female breasts. 2. Pseudogynecomastia is the absence of abnormally developed breast glands in the chest, only a local accumulation of fatty tissue. (2) Gynecomastia typology: male breast development (mastopexy) can be divided into the following three types according to the degree of hyperplasia of breast parenchyma and adipose tissue in the breast tissue: 1. glandular type: the enlarged breast is dominated by hyperplasia of breast parenchyma; 2. fat type: the enlarged breast is dominated by hyperplasia of adipose tissue; 3. glandular fat type: the enlarged breast has hyperplasia of both breast parenchyma and adipose tissue. The enlarged breasts have hyperplasia of both breast parenchyma and fatty tissue. 3.What kind of gynecomastia patients need surgery? 1.The breasts are abnormally enlarged and look like women. Medication is not effective after a period of time. 2.Prominent localized enlargement of the chest with pain or tenderness, and the enlargement lasts for many years. 3.Large male breast development (breast diameter >4cm). 4.Testicular abnormalities or other possible diseases are found in combination. Malignant lesions are suspected. 5.Insurmountable worry or embarrassment, which seriously affects the aesthetic confidence and becomes a mental burden that is extremely annoying. Second, understand the male breast surgery method to minimize the trauma to correct the chest shape to relieve the trouble. The patients with gynecomastia surgery are very strict about themselves, and I often encounter patients who are confused about the results of the surgery during the pre-operative consultation and post-operative follow-up visits. Most patients with gynecomastia have a mixed fat-gland type, which means that surgical correction requires not only removal of the gland, but also moderate trimming of the subcutaneous fatty tissue of the chest to obtain a better post-operative breast appearance and to minimize post-operative sunkenness and other undesirable complications. Therefore, it is very important to choose a procedure that is suitable for you and obtain satisfactory results, and to be responsible for yourself. A. Traditional areola edge circumferential incision The circumferential incision is semi-circular, and the surgery is very traumatic (incision 2-5 cm, inexperienced doctors will cut more than 10 cm), requiring hospitalization for more than seven days, intubation and drainage, and no movement for several months. The traditional semi-annular incision at the areola margin will leave an annular incision scar, and the obvious incision marks on the areola may still form a shadow in the patient’s heart. Minimally invasive mammaplasty The traditional method of mammaplasty is to make three to four 1-2 cm incisions in the patient’s lateral chest wall, with each incision inserted into a tube-like working channel called a trocar. All subsequent operations are performed through these tubes, and the same steps as in open surgery are performed with extended surgical instruments guided by a monitor to achieve the same surgical results. Compared with the traditional large chest incision, breast lumpectomy reduces the surgical scar, but it still requires cannulae for drainage and leaves three incision scars on each side of the chest wall, which obviously leaves traces of chest surgery. EnCor is a minimally invasive sampling method for pathological biopsy to confirm breast lesions, especially those that are not clinically accessible. The EnCor procedure does not allow for liposuction of fat from the lateral chest wall and the parametrial area, and cannot correct the more severe breast shape of male breast development. At the same time, it will leave traces of breast surgery on the chest wall. Minimally invasive and scarless areola surgery I have summed up a set of my own techniques based on nearly 20 years of clinical experience in surgery through research and thousands of cases of surgical practice. Different surgical methods are decided according to the type of breast tissue enlargement of the patient: fat aspiration, fat aspiration combined with glandular excision, and simple glandular excision. In the case of gynecomastia removal, the incision is made in the areola with a minimally invasive incision of less than three millimeters (combined with our own Song’s super reduction fine suture technique, we can achieve a scarless post-operative effect), leaving no incisions on the lateral chest wall or breast, thus avoiding embarrassing incision scars in the breast area and lateral chest wall. Minimally invasive incision of the areola removes the breast tissue and preserves the blood supply to the nipple and areola to the greatest extent possible, thus avoiding the possibility of ischemic necrosis of the areola and nipple; at the same time, minimally invasive areola does not change the original tension state of the areola skin and ensures that the areola remains in its normal position on the chest after surgery. The purpose of the surgery is to correct the shape of the chest and to apply advanced technology to achieve true minimally invasive scarless! As a doctor, it is your most important duty to make sure that the guy who has the courage to have the surgery is satisfied with the results.