Proactive fat grafting from the breast area in gynecomastia surgery: Impact on the prevention of contour irregularities and patient satisfaction.

Abstract

Objective: Contour irregularities are among the most significant complications that may occur after gynecomastia surgery and they can adversely affect aesthetic outcomes. This study evaluated the use of proactively harvested autologous fat grafts from the same surgical field prior to gynecomastia surgery for the treatment of intraoperative contour deformities, as well as the impact of this approach on patient satisfaction.

Material and methods: A retrospective evaluation was conducted on 24 male patients who were diagnosed with gynecomastia between April 2023 and March 2025 through physical examination, endocrinology consultation, and breast ultrasonography, who subsequently underwent surgical treatment. Prior to surgery, autologous fat grafts were harvested from the breast area in all patients. Intraoperatively identified contour irregularities were treated with same-session fat injection using the previously harvested grafts. All patients were followed up with ultrasonography and digital photography. Additionally, patient satisfaction was assessed using BODY-Q chest module and the chest satisfaction questionnaire.

Results: Of the 24 patients, 83% (n=20) presented with pseudogynecomastia and were treated with liposuction alone, while 17% (n=4) had gynecomastia and underwent liposuction combined with gland excision. Intraoperative contour irregularities were detected in 9 patients (37.5%), in whom an average of 8 cc (interquartile range 7-10) of fat was injected. Over a mean follow-up of 12.4 months, no statistically significant difference in aesthetic satisfaction was observed between patients with and without fat grafting (p>0.05). Both groups reported high satisfaction, and intraoperative contour deformities were successfully corrected.

Conclusion: Proactively harvesting autologous fat from the breast tissue during gynecomastia surgery may be a safe and practical method for immediate correction of intraoperative contour irregularities. This approach avoids additional donor site morbidity and provides a readily available graft source. While satisfaction outcomes were high in all patients, larger prospective studies are needed to confirm the long-term efficacy and broader applicability of this technique.