What causes gynecomastia?
Gynecomastia is usually a benign (noncancerous) condition. It may be linked to many different causes of hormone changes. In many cases, the cause isn’t known.

Gynecomastia is often caused by changes in levels of the female hormone (estrogen) and the male hormone (testosterone). But it can be caused by other things as well.

Gynecomastia can be a side effect of certain medicines, such as antidepressants, antibiotics, chemotherapy, prostate cancer medicines, ulcer or cardiovascular medicines. Illegal drugs, such as anabolic steroids, heroin, or marijuana can also cause gynecomastia.

Some diseases and medical conditions may also cause gynecomastia. These include:

Liver diseases
Kidney disease
Lung cancer
Testicular cancer
Tumors of the adrenal glands or pituitary gland
Some conditions that a baby is born with (congenital disorders)
Thyroid disorders
Injury or trauma

Surgical resection:
The technique used depends on the degree of gynecomastia and the skin elasticity. The percentage of patients that benefit from open surgical resection to optimize the final results has continued to increase. The authors have found that surgical open resection is required in most cases. If the gynecomastia requires surgical resection, the Webster intra-areolar incision is typically the most appropriate. Prior to surgical resection, the breast is infiltrated with tumescent solution and liposuction is performed.

Liposuction-assisted mastectomy:
Liposuction-assisted mastectomy is the most popular method used for pseudogynecomastia. The liposuction cannulas are inserted through a 3-4mm areolar incision or an incision in the anterior axilla along the pectoralis major tendon. The surgeon the removes fatty and minimal glandular tissues. For small and moderate gynecomastia, suction lipectomy is extended to the clavicle, to the sternum, to 2 cm below the inframammary crease, and to the axilla. For moderate to large gynecomastia, suction lipectomy is extended to the postaxillary fold. In the overwhelming majority of cases, liposuction is performed in conjunction with excision.
Compression garments are applied for at least 4 To 6 weeks. A small amount of blood, injection fluid, and liquified fat may leak from the incision sites for approximately 24 to 48 hours. The patient may resume his physical activities within few days. Exercise is resumed a few days after surgery and is gradually increased over time. Patients return to work typically after 1-2 days. Drains may or may not be used, depending on the experience of the surgeon and the patient presentation. we prefer to use drain for 24hrs.