An Algorithmic Approach to Intraoperative Contour Deformity During Gynaecomastia Correction: A Single Surgeon Series of 220 Cases

Background: The intraoperative contour deformity is a recognised complication of gynaecomastia surgery arising from over-resection of glandular tissue or overzealous liposuction, producing a concave contour defect across the surgical field. This deformity is typically identified only after wound healing, by which time the window for primary correction has passed. Literature addressing intraoperative identification and immediate correction is available but unorganised and does not provide a definitive step-by-step approach to correct it. This study presents a systematic six-step algorithmic approach to prevention, recognition and intraoperative correction of contour deformity during primary gynaecomastia surgery. Methods: This is a review of 220 consecutive patients undergoing gynaecomastia correction by a single surgeon (January 2019-December 2024). Patients were classified using the Simon grading system. Three intraoperative corrective techniques were employed by the author based on deformity type: T1, bi-digital ironing for deformities of excess; T2, fat/glandular pillar suturing using 4–0 Ethilon as the primary response to deformities of deficit; and T3, autologous lipofilling for persistent deficit following T2. Outcomes were assessed by the author and an independent observer at 3, 6 and 12 months. Results: Intraoperative contour deformity was identified in 38 of 220 patients (17.3%). Incidence increased with Simon grade from 5.0% (Grade 1) to 31.6% (Grade 3). Deformity occurred across the entire surgical field, not exclusively at the nipple-areolar complex. Full intraoperative correction was achieved in 34 of 38 cases (89.5%). Residual deformity requiring secondary intervention occurred in four cases (10.5%), all of which were in the severe subgroup. Mean patient satisfaction was 4.1 ± 0.7 in the deformity group versus 4.6 ± 0.5 in the non-deformity group ( P = .004). Conclusions: Intraoperative contour deformity is more prevalent than traditionally described. In this study the authors believe a structured algorithmic approach incorporating preventive measures, bi-digital flap assessment, deformity-type-based technique selection and sequential correction resolves a majority of cases at the primary operative encounter itself, avoiding secondary correction.