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Furthermore, there is insufficient evidence that surgical removal is more effective than conservative management for pain due to gynecomastia.

The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast.

The surgeon removes excess tissue, fat and skin before adjusting the placement of the nipple and areola appropriately.

In a liposuction-only reduction mammoplasty, a small access incision is made in one of the following locations: axillary (under the arm), periareolar (around the nipple) or in the inframammary fold (under the breast).

Anesthesia may be injected along with saline solution until the tissue is firm, and a suction cannula is used to extract fat from the breast.

: Aetna considers breast reduction surgery cosmetic unless breast hypertrophy is causing significant pain, paresthesias, or ulceration (see selection criteria below).