Total gland removal gynecomastia surgery with pectus excavatum: Alex's story
In this video, Dr Hassan Nurein performs total gland removal gynecomastia surgery under local anaesthetic on Alex, a patient with grade 2 gynecomastia and mild pectus excavatum. The whole procedure was filmed start to finish at our Harley Street, London clinic.
Alex's sunken breastbone made his chest look far more prominent than either condition would on its own. Below, we explain how we planned his surgery, what we found and how we treated it.
Why pectus excavatum makes gynecomastia look worse
Pectus excavatum is a sunken breastbone that creates a dip in the centre of the chest. When gynecomastia sits either side of that dip, the contrast makes the chest tissue look larger and more pronounced.
That is why Alex's chest looked more severe than his gynecomastia alone would suggest. Treating the gynecomastia properly, with liposuction and total gland removal, was key to giving him a flatter, more even contour.
Pre-op marking and ultrasound: gland or fat?
Before surgery, Dr Nurein marks Alex's chest to map exactly where tissue needs to be removed. He then uses ultrasound to check how much of the swelling is glandular tissue and how much is fat.
This step matters because it shapes the surgical plan. Clinically, Alex's chest was grade 2 gynecomastia. The ultrasound showed only a small gland behind the nipple, with the rest of the fullness made up of fat.
The surgery: liposuction and total gland removal
Alex's surgery combined two techniques, both carried out under local anaesthetic.
Local anaesthetic and a tiny incision. The chest is numbed and a small incision is made at the edge of the areola, where the scar is easy to hide.
Liposuction. Dr Nurein removes the excess fat to flatten and reshape the chest.
Total gland removal. The firm glandular tissue behind the nipple is removed through the same incision. Liposuction alone cannot remove gland tissue, so taking it out fully helps achieve a flat result.
The immediate result, and will the areola shrink?
The video shows Alex's chest contour before and straight after surgery, so you can see the difference total gland removal and liposuction make on the operating table.
Many patients ask whether they also need an areola reduction. Most don't. In the video, Dr Nurein explains how the areola responds once the tissue beneath it has been removed.
Local anaesthetic vs sedation or general anaesthetic
Alex's surgery was performed under local anaesthetic, meaning he was awake but his chest was fully numbed. In the video, Dr Nurein explains how local anaesthetic compares with sedation and general anaesthetic, and which option may suit different patients.
The right choice depends on your grade of gynecomastia, your health and your preference. Dr Nurein will discuss this with you at your consultation.
Recovery and aftercare
After surgery, Alex was fitted with a compression garment to support the chest as it heals. At the end of the video, Dr Nurein covers:
How long to wear your compression garment
When you can return to exercise
How to look after your chest in the weeks after surgery
Every patient receives personalised aftercare instructions and follow-up from our team.
Frequently asked questions
What is total gland removal in gynecomastia surgery? Total gland removal means excising the firm glandular breast tissue that sits behind the nipple. It is usually combined with liposuction, which removes fat but cannot remove gland tissue.
Can you have gynecomastia surgery if you have pectus excavatum? Yes. Alex had both conditions. Pectus excavatum can make gynecomastia look more prominent, so careful planning is important to get an even chest contour.
Can gynecomastia surgery be done under local anaesthetic? Yes. Alex's total gland removal and liposuction were performed under local anaesthetic, and he was awake throughout.
Will I need an areola reduction? Most patients don't. Dr Nurein will assess this at your consultation.
How do you know if it's gland or fat? We use a clinical examination and ultrasound to see how much of the swelling is gland and how much is fat. This guides the surgical plan.
Book a free gynecomastia consultation
Dr Hassan Nurein is a gynecomastia specialist who has performed over 7,000 procedures, treating all grades of gynecomastia at his clinics on 82 Harley Street, London and Sheffield. If you have gynecomastia, with or without pectus excavatum, book a free consultation to discuss your options.
Email: clinic@drhassannurein.com
Call: 020 7175 1850
Learn more: About Dr Nurein · Gynecomastia surgery results · Patient reviews · FAQs
Disclaimer: This video and article are for educational purposes only and should not be used as a substitute for professional advice. If you are concerned about gynecomastia, your healing, or surgery, please seek medical advice. Results may vary from patient to patient.