There are certain drugs that can induce glandular development, such as in steroids in body-builders, and excessive intake of marijuana. Some of the time it is a combination of fatty and glandular tissue excess and sometimes it is mostly fat. Depending on the amount of glandular and fatty tissue different techniques can be performed to improve the appearance.
I use ultrasonic assisted or power assisted liposuction for fatty gynaecomastia. In cases where there is both fatty and glandular tissue combination I use a combination of ultrasonic assisted or power assisted liposuction and direct excision – which can be through another small incision or through the same liposuction incision.
In glandular gynaecomastia alone the gland needs to be removed and this is achieved through open surgical technique. The open incision around the areola from the 3 o’clock to the 9 o’clock position or the scar heals usually very well and is mostly not a problem aesthetically.