Puffy Nipples is among the most common forms of gynecomastia. This glandular tissue accumulation is concentrated under and typically confined to the areola, or can be slightly extended outside the areola forming a dome shaped appearance to the areola. The surgical excision through peri-areolar incision or more recently through a barely visible trans-nipple incision is the treatment of choice and leads to rapid recovery and least scar.

Pure Glandular: In bodybuilders, this may be a result of the use of anabolic steroids. Due to excess testosterone levels from steroids, which are converted to estrogen, bodybuilders and other athletes are sometimes afflicted with gynecomastia in its purest form. Gynecomastia in lean men is usually only a breast tissue gland with little to no adipose tissue. Proper treatment of pure gynecomastia can be done only by excision of the breast tissue through practically invisible trans-nipple incision in selected group of patients.

Adolescent : Congenital or Hereditary Gynecomastia is typically evident by the ages of 12 to 18 in boys. Thirty percent to sixty percent of young boys suffer from large male breasts. As many as thirty percent may live with enlarged male breasts for the rest of their lives, but in other cases the gynecomastia will recede with age. However, severe forms of adolescent gynecomastia may require an intervention, in consultation with the patient, the parents.

Adult: This is the most common form of gynecomastia. Gynecomastia in most adults is composed of glandular tissue and varying quantities of adipose and fibrous tissue. Liposuction provides effective solution to this form of gynecomastia.

Pseudogynecomastia : This is also known as “false Gynecomastia” and is often attributed by obesity. It is composed not of glandular tissue, but of adipose tissue mainly. Exercise and diet may be effective in combating pseudogynecomastia. Liposuction (using two tiny holes of 2-mm size) of excessive fat is the mainstay of treatment with very minimal scarring. You need to wear a pressure garment for 2-3 months after liposuction of the area.

Severe Gynecomastia is characterized by excess and/or saggy skin and severely enlarged breast. This is itself determined in part by age, as older persons suffering from gynecomastia tend to have less skin elasticity and thus will have a greater abundance of excess skin related to gynecomastia. Experienced plastic surgeons will perform as much of the surgical treatment of severe gynecomastia as possible through a combination of Liposuction to remove most of the fatty tissue and a peri-areolar incision to remove the glandular part & excess skin, so as to avoid extensive scarring. However, some scarring may be unavoidable when treating extreme cases of gynecomastia, where the skin is loose & hanging.