Ten-Year Single-Center Experience in the Surgical Management of Gynecomastia: Comparative Outcomes of Four Techniques.

BACKGROUND: Gynecomastia is the most common benign breast condition in men. Although multiple surgical options exist, the optimal technique that minimizes complications while maximizing patient satisfaction remains debated. METHODS: We retrospectively reviewed 128 patients (239 breasts) who underwent gynecomastia surgery between 2013 and 2023 at a university hospital. Techniques included glandular excision alone, liposuction alone, combined excision with liposuction, and mastectomy with free nipple-areola grafting. Primary endpoints were postoperative complications, while secondary endpoints included patient-reported satisfaction and pain scores (telephone survey, 0-10 scale). RESULTS: The mean age was 27.3 years. Procedures were distributed as excision 39.8%, combined 42.2%, liposuction 5.5%, and grafting 12.5%. Overall, 24 of 128 patients (18.8%) developed complications: 31.4% after excision, 0% after liposuction, 3.7% after the combined technique, and 37.5% after grafting (p = 0.0002). Major complications (4.7%) consisted exclusively of hematomas requiring reoperation. Among 43 respondents (33.6%), mean satisfaction scores were high (8.6/10 for excision, 8.5/10 for combined technique), while pain was lowest in the combined group (2.8/10). CONCLUSIONS: The combined excision-liposuction technique provided the best balance between safety and patient satisfaction, with significantly fewer complications than excision alone. It should be considered the preferred first-line surgical option for most gynecomastia cases, whereas free nipple-areola grafting remains indicated for advanced presentations. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .