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

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.

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).

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).

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.

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