Gynecomastia refers to the presence of a female-like mammary gland in a male. Persistence and severity of this disorder can lead to significant psychological stress and self-consciousness.This study consists of a chart review of 174 patients treated surgically between 7/1/76 to 2/27/01. We looked at our complications and revision rates between grades and surgical procedure. Results: Distribution of procedures were: 43 % excision , 38.1% excision with suction assisted lipectomy (SAL), 5% SAL, 8.4% skin excision and 5.6% skin excision with SAL. Overall complication rate was 20%. No significant difference in complication rates was found between grades or procedure used. Revision rates between grades were; I =10.3%, II = 14.5% and III = 34.8% (p< 0.001). In grade III gynecomastia revision rates for excision +/- SAL was 29.6% and skin +/- SAL was 38.1%; p=0.644. Of the 8 revisions in the skin sparring procedure, 6 (75%) were revised with a scar forming procedure. Seventy-seven percent of patients with grade III gynecomastia were adequately treated with a skin sparring procedure. Conclusion: treatment of gynecomastia comes with high rates of minor complications and revisions. Skin sparring operations should be the initial procedure chosen for most grade III gynecomastia patients.