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

Abstract 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. Level of Evidence: 4 (Therapeutic)