Gynecomastia can be treated in two ways. One method - conservative – is hormone therapy, the second leads to plastic surgery in which the enlarged breast is removed and liposuction carried out in the adjacent areas of the body.

Conservative therapy is the preferred therapy for short-term gynecomastia with diagnosed hormonal imbalance. Depending on the hormonal imbalance, various drugs are used such as antigonadotropines (block the synthesis of androgens, oestrogens), anti-oestrogens, aromatase inhibitors (block enzymes involved in the synthesis of oestrogen) und L-DOPA (block the secretion of prolactins) or a combination of drugs. If gynecomastia is due to the long-term use of medication, the first step is to stop using these drugs. If the condition does not improve, plastic surgery is usually the solution.
Surgical therapy for gynecomastia
Surgical therapy from the viewpoint of plastic- surgery for Types I-IV:
1.    Small enlargement of the gland under the areola
2.    Medium-sized enlargement without excess skin
3.    Medium-sized enlargement with excess skin
4.    Large gynecomastia, resembling female breasts, with significant excess skin
In the surgical therapy of gynecomastia there are many different methods with incisions around the areola. A small incision is ideal, resulting in an unobtrusive scar. This allows tumescence liposuction to be used to reduce the fatty tissue. The tumescence technique (wet/super-wet technique) involves first infiltrating the tissue with a special solution containing buffer substances, vasoconstringents and a low concentration of local anaesthetics, amongst others.
In addition to breaking up the tissue, bleeding is also drastically reduced. The areas suctioned off can be precisely shaped and the extent of subcutaneous traumatisation is significantly reduced. Liposuction basically combines two principles.
The suction reduces the number of fat cells mechanically, preventing a new local cushion of fat developing in the area treated. The creation of a subcutaneous wound covering a large area stimulates the skin to contract and shrink to fit the reduced subcutaneous volume. In the event that palpable breast gland tissue remains after liposuction, the incision can be extended in an arc and a subcutaneous mastectomy carried out. This procedure is suitable for gynecomastia of Types I and II.
The larger the area of excess skin, the more visible scar the patient must expect in the area of the breast and arm. When treating larger gynecomastia of Type IV, the areola and nipple are transplanted.  This procedure leaves an inverted T-shaped or anchor-shaped scar. In certain circumstances it may be necessary to transplant the areola and nipples. Surgical therapy is selected in cases where the patient does not react to hormone therapy, for long-term gynecomastia or after consultation with an endocrinologist who advises against conservative therapy as being unsuitable.
Anaesthesia
Gynecomastia can be operated under local anaesthetic, however the operation is usually carried out under full anaesthetic.