Eliminating Liposuction Port Scars in Gynaecomastia Surgery: A Refined Single-incision Trans-nipple Technique for Nearly Scar-less Correction in a Select Subgroup: A Prospective Case Series

Background: Despite advancements in gynaecomastia surgery, liposuction access scars over the chest or anterior axillary fold remain one of the few visible signs of previous surgical correction. While these scars are acceptable to most patients, they are often unacceptable in a specific subgroup of patients who are otherwise physically fit, muscular, and frequently expose their upper torso. Objective: To describe and evaluate a refined trans-nipple technique that eliminates liposuction port incisions, thereby achieving nearly scarless gynaecomastia correction without external liposuction access incisions in a carefully selected subgroup. Materials and Methods: A prospective case series of 48 fit male patients with Simon Grade 1, predominantly glandular gynaecomastia was conducted between August 2015 and February 2026. All patients were lean, athletic, and highly conscious about visible scarring. Written informed consent for surgery and publication of photographs was obtained from all the patients. Both liposuction and glandular excision were performed through a single trans-nipple criss-cross incision. Continuous saline irrigation was used during liposuction to prevent friction thermal injury. Mean follow-up was 8.2 ± 2 months (range 5–14 months) Results: Forty-six out of 48 (95.8%) rated their satisfaction as excellent and two (4.2%) as good on a 5-point satisfaction scale, with absence of liposuction port scars. One minor complication (friction thermal injury) occurred early in the series and resolved completely. No major complications were observed. Conclusion: This technique addresses the last unresolved aesthetic limitation of gynaecomastia surgery—visible liposuction scars—and provides a reliable scarless solution in appropriately selected patients.