Innovative Surgical Concept for Simon's Grade 2B Gynecomastia: A Systematic Integration of Circumareolar Mastectomy, Interlocking Suture, Inframammary Fold Detachment, and Waterjet-Assisted Liposuction for Superior Long-term Outcomes.

Abstract

Background: Gynecomastia, particularly Simon's Grade IIb, poses aesthetic and psychological challenges due to glandular excess and skin redundancy. Standard circumareolar mastectomy (CM) often leads to hypertrophic scarring, areolar widening, and suboptimal contouring.

Objectives: To evaluate a combined surgical approach integrating Circumareolar Mastectomy (CM), Circumareolar Interlocking Suture (CIS), Inframammary Fold Detachment (IFD), and Waterjet-Assisted Liposuction (WAL) in achieving improved aesthetic and functional outcomes for Simon's Grade IIb gynecomastia.

Methods: A retrospective analysis was conducted on 95 patients (176 breasts) treated between April 2017 and December 2023. Of these, 72 patients (130 breasts) received the combined CM+CIS+IFD+WAL approach. Key outcomes included complication rates, nipple-areola complex (NAC) sensitivity, areolar diameter, and patient satisfaction assessed via the BODY-Q Chest and Nipples Scale. Mean follow-up was 17 months, with a subset followed up to 91 months.

Results: The mean operative time was 85.1 minutes, and average hospital stay was 2.75 days. The overall complication rate was 7.7%, with no cases of complete NAC necrosis. Areolar diameter significantly decreased postoperatively (p < 0.001). At 12 months, 71.2% of patients were "very satisfied" with scarring, and BODY-Q scores showed significant improvements in both chest and nipple domains. NAC sensation was preserved in 88.4% of cases.

Conclusions: The CM+CIS+IFD+WAL technique offers a safe, effective, and aesthetically superior option for treating Simon's Grade IIb gynecomastia, with low complication rates and high patient satisfaction. Follow-up data suggest stable long-term outcomes, supporting the method's broader clinical relevance.