Purpose: We reviewed the senior surgeon’s experience for the surgical treatment of gynecomastia. By using suction-assisted lipectomy with a cross-chest tunneling technique performed alone or with direct excision, recontouring is customized based on degree of gynecomastia.

Methods: Of 34 patients in this series, 12 were treated with cross-chest SAL alone, 16 with SAL and direct excision, and 6 with excision. Wetting solution is infiltrated using a 2.0 mm cannula through an access site at the medial border of the contralateral nipple-areolar complex. Next, a 4.0 mm Mercedes tip cannula is tunneled across the sternum to liposuction the contralateral pre-pectoral fatty breast. Patients with composite fatty and glandular tissue first underwent SAL followed by direct excision through a periareolar incision and those with only glandular tissue underwent direct excision alone.

Results: All patients with SAL alone and SAL combined with excision had satisfactory aesthetic results with no reported postoperative complications. A hematoma occurred in one patient who had undergone excision only.

Conclusion: Despite newer technologies, traditional suction-assisted lipectomy with a unique cross-chest technique and direct excision is a valuable approach providing predictable success. This approach offers a sculpted reduction of the retroareolar glandular and fatty elements for a smooth breast contour.