Liposuction-assisted mastectomy with or without gland excision for gynecomastia patients can be performed under local anesthesia, intravenous conscious sedation, or general anesthesia. The choice of sedation should be determined preoperatively by the physician and patient. Any significant medical problems, such as heart disease, lung disease, or diabetes, must be excluded before the procedure is performed. Rapid or unusual progression or presentation of the disease may require endocrinologic evaluation, which is optimally preformed prior to any surgical intervention. If the etiology of the gynecomastia is related to an adrenal or pituitary tumor, the tumor should be addressed prior to any attempt to correct the gynecomastia. If the gynecomastia is related to drug use, the use of the offending agent should be stopped prior to surgery.

Males who are upset with the appearance of their chest may also have substantial psychological issues. A boy who is being abused or humiliated commonly focuses on some part of his external appearance to avoid dealing with internal pain that he feels unable to manage or control. What may have started as a minor physical condition can be a cover for much deeper emotional issues that no amount of surgery can resolve. While Yost has demonstrated that more than 91% of individuals who have had surgery are happy with the procedure and would recommend surgery to a friend, individuals who require multiple surgeries may need to be screened for body dysmorphic disorder (BDD) and referred for treatment.11

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