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Background: Gynecomastia is defined as an excessively developed male breast to the extent it resembles the female one. Emotional discomfort and social embracement motivate the patients to seek a medical advice, to restore the masculine breast shape. In high grade gynecomastia, the contributing factors are excess redundant skin, fibro-glandular tissue and abundant adiposity, each component should be considered separately in the patient's surgical plan. Various surgical procedures were succeeded to correct this deformity but with drawbacks such as residual unsightly scar, or contour irregularities. Objectives: Were to treat high grades of gynecomastia with a multifaceted procedure; by combining liposuction, glandular excision together with excess skin resection through circumareolar concentric approach. Aim: This study has evaluated that procedure as regard technical refinements, early and late complications and aesthetic outcome. Method: In this case series, eighteen healthy male patients who had bilateral gynecomastia, had undergone correction of their breast deformity with that multifaceted procedure between January 2016 and June 2017, their ages ranged from [1761years old, with mean ± 30.94]. Results: All patients were satisfied with the results except one patient who had undergone reoperation. The early complication rate was 27.7%; it was consistent with other series. The follow-up aesthetic evaluation scale showed that 65% of patients with very good result, 22% of patients with good result, 17% patients with average result, and only one patient had poor result. Conclusion: This combination had succeeded to address the contributing causes of severe gynecomastia. The problems of excess and displaced tissues were properly dealt with through circumareolar approach to achieve a pleasant scar confined to the areola with flat male chest.

Surgical Management of High Grade Gynecomastia: Combination of Liposuction, Glandular Resection and a Circumareolar Skin Reduction