Comprehensive Use of Combined Surgical Techniques Performing Liposuction, Round-Block Periareolar De-Epithelialization, and Complete Subcutaneous Breast Tissue Resection Approach in Grade Iii Gynecomastia: A Review of 82 Patients Publisher Pubmed



Soltani H ; Nikeghbalian Z ; Eskandari A ; Ahmadinejad M ; Dalvand S ; Karimi S ; Amadeh N ; Moradian F
Source: BMC Surgery Published:2026

Abstract

Background: Gynecomastia is associated with significant psychological and cosmetic concerns. Objective: Surgical approaches for gynecomastia that are minimally invasive, associated with few complications, allow for rapid recovery, and result in high patient satisfaction are highly valuable. This study aims to evaluate the aesthetic efficacy and complications of accumulated techniques for treating patients with grade III gynecomastia. Methods: The preferred strategy includes a combination of enhanced liposuction, round-block de-epithelialization, complete subcutaneous dissection of fibroglandular tissue, and reconstruction methods. Demographic characteristics, complications, satisfaction questionnaires with a 5-point Likert scale, and postoperative quality of life with WHO-QOL-BREF questionnaire were evaluated during follow-up. Results: This study included 82 male patients with gynecomastia grade III (including 3 transgender patients) with a mean age of 30.18 ± 7.60 and the mean BMI of 30.97 ± 3.96. The overall postoperative satisfaction of the patients was 78%. Most patients reported being satisfied or very satisfied with the breast appearance (65.8%), symmetry (75.6%), skin tightness (73.2%), excessive skin resection (64.6%), healing of the incision (62.2%), and contour irregularity (75.6%). Seroma (12.2%), and edema (31.7%) were the most reported postoperative complications which gradually resolved, whereas other complications were insignificant such as bleeding (2.4%), subcutaneous hematoma (3.7%), NAC necrosis (3.7%), and infection (2.4%). No evidence of hemo/pneumothorax, intrathoracic organ damage, and fat embolism, were observed. Regarding scar characteristics, 1.2% had prominent scars and 86.6% had small or hidden scars. Regarding incision characteristics, wound disruption occurred in 8.5% of the cases, whereas 89% of the patients had minimal and good length incisions. Conclusion: Enhanced liposuction, round-block periareolar de-epithelialization, and complete subcutaneous breast tissue resection approach in patients with grade III gynecomastia and severe ptosis is a feasible, and safe approach with rapid recovery, hidden scars and acceptable patient satisfaction. Trial registration: Not applicable. This study is a retrospective observational case series and does not require trial registration. © The Author(s) 2026.