Innovative Surgical Concept for Simon's Grade IIb Gynecomastia: A Systematic Integration of Circumareolar Mastectomy, Interlocking Suture, Inframammary Fold Detachment, and Waterjet-Assisted Liposuction for Superior Long-term Outcomes.

[BACKGROUND] Gynecomastia, particularly Simon's Grade IIb, poses aesthetic and psychological challenges because of glandular excess and skin redundancy. Standard circumareolar mastectomy (CM) often leads to hypertrophic scarring, areolar widening, and suboptimal contouring.

[OBJECTIVES] The authors of this study aim to evaluate a combined surgical approach integrating CM, circumareolar interlocking suture (CIS), inframammary fold detachment (IFD), and waterjet-assisted liposuction (WAL) in achieving improved aesthetic and functional outcomes for Simon's Grade IIb gynecomastia.

[METHODS] A retrospective analysis was conducted on 95 patients (176 breasts) treated between April 2017 and December 2023. Of these, 72 patients (130 breasts) received the combined CM + CIS + IFD + WAL approach. Key outcomes included complication rates, nipple-areola complex (NAC) sensitivity, areolar diameter, and patient satisfaction assessed through the BODY-Q Chest and Nipples Scale. Mean follow-up was 17 months, with a subset followed up to 91 months.

[RESULTS] The mean operative time was 85.1 min, and the average hospital stay was 2.75 days. The overall complication rate was 7.7%, with no cases of complete NAC necrosis. Areolar diameter significantly decreased postoperatively (P < .001). At 12 months, 71.2% of patients were "very satisfied" with scarring, and BODY-Q scores showed significant improvements in both chest and nipple domains. NAC sensation was preserved in 88.4% of cases.

[CONCLUSIONS] The CM + CIS + IFD + WAL technique offers a safe, effective, and aesthetically superior option for treating Simon's Grade IIb gynecomastia, with low complication rates and high patient satisfaction. Follow-up data suggest stable long-term outcomes, supporting the method's broader clinical relevance.