Surgery is not the first-line treatment option for patients with gynecomastia. Surgery is usually reserved for patients with either psychological stresses, extensive gynecomastia or failure of medical treatment. The type of surgical technique depends on the extent of gynecomastia.

• Surgery is not the first-line treatment option for patients with gynecomastia.^[1]
• The aim of surgery is to achieve the normal appearance, with the smallest possible scar.^[2]
• The surgical techniques used for gynecomastia depends on the extent of gynecomastia and proportion of different breast components (parenchyma, fat, loose skin).
• Most commonly used surgical technique is subcutaneous mastectomy with or without liposuction.^[3]
• Extensive surgery, including skin resection, is done in patients with gynecomastia and excessive sagging of the breast tissue.^[4]
• Liposuction alone can be done for pseudo gynecomastia.^[4]

• Breast asymmetry
• Contour irregularity
• Hematoma
• Numbness of the nipple–areolar complex
• Nipple necrosis
• Shedding of tissue due to loss of blood supply

Surgery is usually reserved for patients with either:

• Psychological stress
• Cosmetic problems
• Failure of medical therapy
• Long standing gynecomastia
• Suspicion of malignancy
• Extensive skin sagging