A New Alternative Technique to Breast Amputation in Grade 3 Gynecomastia

Severe gynecomastia with ptosis and skin excess presents surgical challenges. Standard procedures including free nipple grafting and reduction mammoplasty may result in complications like necrosis or unwanted bulkiness. This report describes a novel single-stage technique preserving the nipple–areola complex (NAC) on an inferior flap while excising excess tissue en bloc. A 38-year-old male with Grade 3 gynecomastia underwent excision via inferior flap-based NAC transposition. The design included a semicircular superior flap and an ellipsoid excision zone, maintaining 1 cm flap thickness for viability. The NAC was repositioned anatomically using suprasternal notch measurements, avoiding dog ears. Postoperatively, the NAC survived completely with satisfactory contour. This technique offers a viable alternative to free grafting, particularly in resource-limited settings. It addresses ptosis and bulk without de-epithelialisation or liposuction, though scars remain unavoidable. Suitable for select gynecomastia and transgender cases, it balances aesthetics and surgical practicality.