Single-stage Management of High-grade Gynecomastia: Combined Circumareolar Skin Excision, Liposuction and Glandular Resection with Fat Grafting for Optimal Aesthetic Outcomes

High-grade gynecomastia (Simon grades IIIB) presents significant challenges due to skin redundancy, nipple-areolar complex (NAC) displacement and ptosis. Traditional techniques such as mastectomy with free nipple grafting or breast reduction-style approaches often result in visible scarring and suboptimal aesthetic outcomes. This study evaluates a combined approach of circumareolar skin excision, liposuction, glandular resection and fat grafting to optimise chest contouring in a single stage. Twenty patients (aged 13–52 years) with high-grade gynecomastia underwent combined doughnut skin excision, liposuction and glandular pull-through excision. NAC repositioning, high-definition liposculpturing and fat grafting enhanced pectoral definition. Patient-reported outcomes and independent observer assessments evaluated chest appearance, NAC aesthetics, symmetry and pectoral definition. Postoperative assessments significantly improved all parameters (mean scores: chest appearance 4.0, NAC appearance 4.2, symmetry 4.3, pectoral definition 4.6). No major complications or revisions were required. This technique offers a reproducible, single-stage solution for high-grade gynecomastia, minimising scarring while optimising aesthetic outcomes through NAC repositioning, fat grafting and high-definition liposculpturing.