Role of Ultrasonography in Perioperative Management of Suction-Assisted Lipectomy for Gynecomastia: A Prospective Study.

BACKGROUND: Gynecomastia, with a prevalence of 40-60%, has gained increasing public recognition. Surgical correction is indicated when the condition persists beyond one year due to irreversible glandular fibrosis unresponsive to pharmacological or weight-reduction interventions. Limited intraoperative visualization remains a challenge; thus, accurate preoperative delineation of glandular characteristics is essential for guiding minimally invasive aspiration procedures. To address this, we implemented a novel triphasic perioperative ultrasound protocol to standardize evaluation and enhance surgical precision. METHODS: In this prospective cohort study, 54 patients (Rohrich grades I-IV) underwent glandular-adipose aspiration using a patented cannula system via an anterior axillary incision. Ultrasonography was integrated throughout the perioperative course: preoperatively for glandular mapping and pectoralis topography, intraoperatively for real-time assessment of residual tissue and resection plane accuracy, and postoperatively for quantification of thickness reduction and scar evaluation at 6 months. Primary outcomes included glandular-adipose reduction rate, BODY-Q satisfaction scores, and complications. RESULTS: Significant thickness reduction was observed (left: 13.87 ± 6.23 mm to 5.48 ± 2.35 mm; right: 13.39 ± 2.51 mm to 5.71 ± 2.51 mm; both p < 0.0001). BODY-Q chest satisfaction improved by + 31.6 points (p < 0.001), mean scar satisfaction was 86.12/100, and complication rate was low (1.85%; one case of steroid-responsive hypertrophic scar). CONCLUSION: This study is the first to systematically integrate ultrasonography across all perioperative stages of gynecomastia surgery. The triphasic ultrasound-guided protocol enables targeted glandular-adipose reduction with significant contour refinement, enhanced patient satisfaction, and objective outcome quantification, underscoring its potential as a standardized approach for optimized management. LEVEL OF EVIDENCE II: 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 .