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Your first consultation with a surgeon should clearly set out your expectations and whether this surgery can achieve the results that you want.
Careful and detailed discussions and exchange of information regarding your medical history are very important at this stage. You should have already discussed this with your G.P. to make sure that there is no possible cause of your Gynaecomastia, which could be treated before surgery.
The surgeon will examine your chest to discover the exact surgical procedure that may be best for you.
The surgeon should discuss where he or she is likely to make the incisions in your chest, and how the excess tissue will be removed. They will also check to make sure that there are no other medical reasons why you shouldn’t undertake this procedure. You would normally also be asked to sign a consent form which means that you have understood the potential benefits and risks associated with breast reduction surgery.
Photographs may also be taken by the practitioner for a “before and after” comparison at a later date.
The surgeon may wish to write to your GP giving details of the operation so that if there are any problems associated with surgery in the short- or long-term, the GP is aware of the procedure and can help with your recovery. 
Anaesthesia
Male breast reduction surgery is usually performed under local anaesthetic combined with a sedative to make you drowsy so that you remain awake but feel very little discomfort during the operation.
Depending on your health and the extent of the procedure, your surgeon may advise having the operation under a general anaesthetic.
Remember that any general anaesthetic has its own small risks attached to it and your surgeon should discuss them with you before any decisions about the operation are made.
The operation
The procedure is usually performed in an outpatient surgical centre, either independently operated by your surgeon, or as part of a hospital. The procedure usually takes about 1½ - 2 hours but, depending on the extent of the procedure, it could take longer. 
The technique used is dictated by the amount of excess skin present in the enlarged breast. Sometimes, however, the techniques are combined. These techniques are described below.
Liposuction is the preferred treatment when there is not much excess skin and where fatty tissue is the main cause of enlargement.
For liposuction procedures, several quarter-inch cuts are made in either the armpit or areola (the dark skin surrounding the nipples). Fluid is then injected to begin the process of tissue removal. A thin metal rod (or cannula) attached to a syringe or vacuum pump is then inserted to remove the tissue and the fatty tissue is sucked out through the cannula. When the fatty tissue is very thick, <a href="https://www.consultingroom.com/Treatments/Vaser-Lipo" rel="nofollow" target="_blank">Ultrasound Assisted Lipoplasty (UAL), </a>which uses ultrasound energy, may be needed to help break up the tissue
For more information on this procedure, please visit the <a title="Liposuction" href="https://www.consultingroom.com/Treatments/Liposuction" target="_self">liposuction</a> section of our site.
If there is a great deal of excess skin and glandular tissue, a more extensive procedure is required. Your surgeon will make the first incision around the dark pigmented area around the nipple so that it can be moved higher up the breast, but the nipple itself is usually not removed. A second incision is made horizontally in the crease line under the breast. The third cut runs down from the nipple to the crease line. Excess breast and fatty tissue is removed and the skin is trimmed away to reduce, tighten, and reshape the breasts. The cuts are then closed with stitches. 
A small drain tube may also be inserted to draw off blood and fluids for the first day or two.

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