One very important yet understated post-surgical advice is about the massage. Massage is advised starting 3 weeks after the surgery and may need to continue for 6 weeks to 6 months. The duration depends on the grade of gynecomastia. The main factors being the amount of skin laxity and skin tone. The purposes of massage are:

1. To help decrease the swelling faster 
2. To smooth out any minor irregularities
3. Reduce the chances of fluid collection
4. Reduce spasms of the underlying muscles

Massage is done to stimulate and augment the natural action of the lymphatic system. The lymphatic system is one of the important aspects of the reduction in post-procedure swelling. It is often not given its due importance. For effective lymphatic massage, it is necessary to massage and pump in a specific direction, at a specific pace. Most of the steps advised below are a combination of UHN (University Health Network) and Vodder School guidelines

The massage has two parts:

1. Steps to stimulate the local lymphatic system
2. Steps to reduce chest swelling through chest massage

Steps to stimulate and activate the local lymphatic system

1.Deep breathing helps to stimulate the lymphatic system in the whole
body. The steps are
• Place the palms or flats of your hands on your stomach
• Slowly, breathe in deeply through your nose, and let your stomach expand
• Breathe out slowly through pursed lips (as if you were about to blow out a candle), and let your stomach flatten
• Repeat 5 times. Take a short rest between each breath so you do not
get dizzy

2. Stretch and release the skin at the front of your neck. This step helps lymph fluid drain back to your heart. You can massage one side at a time, or do both sides together by crossing your hands.
• Place the flats of your 2nd and 3rd fingers on either side of your neck, just above your collarbone
• Massage down and inwards towards your collarbone. Always keep your fingers above your collarbone. Gently stretch the skin just as far as it naturally goes and release.
• This massage will look like two “J” strokes facing one another.
• Repeat 15 times.

3. Stretch and release the skin at the side of your neck
You can massage one side at a time, or do both sides together.
• Place your flat hands on either side of your neck, just under your ears.
• Gently stretch the skin back (away from your face) and down, then release.
• Try to massage your neck in a slow, gentle way, following a rhythm.
• Repeat 10 to 15 times.
Remember: Keep your pressure light and your hands soft and relaxed.

4. Stretch and release the skin on the back of your neck
• Place your flat hands on the back of your neck, just below your hairline on either side of your spine.
• Stretch the skin towards your spine and then down towards the base of your neck and release.
• Repeat 10 to 15 times.

Steps to reduce chest swelling through chest massage

Lymphatic Chest Massage is fairly easy to learn. A pumping movement is used wherein the chest is moved using some light pressure and then released allowing it to return to the normal position.

Each move and return counts as one pump. Using the lymphatic breast massage model, the most important idea is to keep the lymphatic fluid moving in this area.

Step 1: Put your hand in your armpit and push inward and upward. Go deep into the armpit. Pump upward and release. Do this ten to twenty times.

Step 2: Grab one side of your chest and move it upward toward the armpit. Do this ten times.

Step 3: Holding your chest stable, pump the upper inner quadrant of one side up toward your neck. Do this five times.

Step 4: You can do the pumping more than the recommended number of times if you like.

Step 5: Massage the operated area in circular motions using any moisturizing lotion or massage oil with hands. Massage should be done twice a day for 20-30 minutes. Moderate pressure is used when massaging. For the first week, the pressure on the stitches needs to be lesser. Following the first week, the pressure can be equally moderate in all the areas. While massaging the patient may sometimes notice areas of hardness or even have areas that seem filled with liquid. Unless it is extensive, it will reduce gradually with massage. Some patients hire a massage therapist two to three times per week but that may be unnecessary. Massage is best done before a shower as the patient will be able to wash off the lotion/oil and lessen the chances of blocking skin pores.