Periareolar Excision vs Pull-Through in Gynecomastia

A Randomized Controlled Trial Comparing Periareolar Excision Versus Pull-Through Techniques in Simon Grade I-IIb Gynecomastia: A Phenotype-Dependent Outcome Analysis

This prospective randomized controlled trial compares periareolar excision and pull-through techniques in 64 patients with Simon Grade I-IIb gynecomastia. Patients were randomized 1:1 and followed for 6 months. The primary outcome was total patient satisfaction measured using the Rasch-transformed BODY-Q Chest Module. Secondary outcomes included anthropometric measurements, recovery parameters, complication rates, and blinded aesthetic evaluation. A formal interaction analysis assessed whether surgical superiority differed according to disease severity.

Study Overview

• Status: Completed
• Conditions: Gynecomastia
• Intervention / Treatment: Procedure: Periareolar Excision; Procedure: Pull-Through Technique

Detailed Description

Gynecomastia is a benign proliferation of fibroglandular tissue in the male breast that alters chest contour and may significantly affect body image, confidence, and psychosocial well-being. Although many cases resolve spontaneously during adolescence, a proportion persist and require surgical correction. Multiple surgical techniques have been described, including traditional periareolar excision and minimally invasive approaches such as the pull-through technique combined with liposuction. However, consensus remains limited regarding the optimal surgical technique, particularly across different grades of gynecomastia severity.

This prospective randomized controlled trial was conducted at the Plastic Surgery Department, Faculty of Medicine, Kafr El-Sheikh University, Egypt, to compare outcomes between periareolar excision and the pull-through technique in patients with Simon Grade I-IIb gynecomastia. The study aimed to determine whether surgical effectiveness differs according to disease severity and tissue phenotype.

Sixty-four male patients aged 18-50 years with persistent gynecomastia were randomized in a 1:1 ratio to undergo either periareolar glandular excision or the pull-through technique following liposuction. Randomization was performed using a computer-generated sequence with allocation concealment through sealed opaque envelopes. All procedures were performed under general anesthesia on an outpatient basis.

The primary outcome was patient satisfaction measured at 6 months postoperatively using the Rasch-transformed BODY-Q Chest Module. Secondary outcomes included domain-level BODY-Q scores, objective anthropometric measurements, postoperative complications, recovery parameters (including time to return to work and hospital stay), glandular specimen weight, and blinded aesthetic evaluation based on standardized postoperative photographs assessed by independent plastic surgeons.

Statistical analysis included comparisons between groups and interaction analysis to determine whether treatment effects varied according to Simon grade. The study was designed to provide evidence supporting phenotype-based surgical decision-making in gynecomastia management.

This trial was retrospectively registered at ClinicalTrials.gov. The study was initiated prior to institutional establishment of a formal clinical trial registration pathway, and retrospective registration was completed to ensure transparency and compliance with international reporting standards.

• Study Type: Interventional
• Enrollment (Actual): 64
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Kafr el-Sheikh Governorate
    • Kafr ash Shaykh, Kafr el-Sheikh Governorate, Egypt, 33516
      • Kafr El-Sheikh University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Male patients aged 18 to 50 years
• Clinically diagnosed Simon Grade I-IIb gynecomastia
• Persistent gynecomastia for more than 18 months
• Candidates for surgical correction under general anesthesia
• Provided written informed consent to participate in the study

Exclusion Criteria:

• Simon Grade III gynecomastia requiring skin excision
• Gynecomastia secondary to untreated endocrine disorders
• Chronic hepatic or renal disease
• Suspected or confirmed breast malignancy
• Previous gynecomastia surgery
• Active infection
• Coagulopathy or bleeding disorders
• Contraindications to general anesthesia

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Periareolar Excision; Participants undergo gynecomastia correction using a semicircular inferior periareolar incision allowing direct glandular excision following liposuction. A thin subareolar tissue layer is preserved to prevent nipple depression.	Procedure: Periareolar Excision; Surgical correction of gynecomastia using a semicircular inferior periareolar incision to allow direct glandular excision following liposuction. A thin subareolar tissue layer is preserved to prevent nipple depression and maintain contour.
Active Comparator: Pull-Through Technique; Participants undergo minimally invasive gynecomastia correction using liposuction followed by glandular extraction through the liposuction incision using the pull-through technique with controlled traction and segmental excision.	Procedure: Pull-Through Technique; Minimally invasive surgical correction of gynecomastia using liposuction followed by glandular extraction through the liposuction incision using the pull-through technique with controlled traction and segmental excision.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total Patient Satisfaction (BODY-Q Chest Module)	Patient-reported satisfaction with chest appearance measured using the Rasch-transformed BODY-Q Chest Module questionnaire. Higher scores indicate greater satisfaction following gynecomastia surgery.	6 months postoperative

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Domain-level BODY-Q Scores	Assessment of specific BODY-Q domains including chest appearance, nipple aesthetics, and scar perception after gynecomastia surgery.	6 months postoperative
Change in Chest Anthropometric Measurements	Change from baseline in chest anthropometric parameters including chest circumference, nipple-to-suprasternal notch distance, nipple-to-acromion distance, nipple-to-midclavicular distance, and breast projection, measured in centimeters (cm).	Preoperative and 6 months postoperative
Number of Participants With Postoperative Complications	Number of participants experiencing postoperative complications including hematoma, seroma, infection, or need for revision surgery.	Within 6 months postoperative
Length of Postoperative Hospital Stay	Duration of hospital stay following gynecomastia surgery, measured in days.	Within 30 days postoperative
Postoperative Pain Score	Postoperative pain assessed using the Visual Analog Scale (VAS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates worst imaginable pain.	Postoperative day 1
Time to Return to Work	Time from surgery to return to normal work or daily activities, measured in days.	Up to 6 months postoperative
Blinded Surgeon Aesthetic Evaluation Score	Independent aesthetic evaluation of postoperative chest contour using standardized postoperative photographs assessed by board-certified plastic surgeons blinded to treatment allocation. Aesthetic outcome will be rated using a 5-point Likert scale, where 1 indicates a very poor aesthetic outcome and 5 indicates excellent aesthetic outcome.	6 months postoperative

Collaborators and Investigators

• Sponsor: Kafrelsheikh University
• Investigators: Principal Investigator: asem Elkot, MD, Plastic Surgery Department, Faculty of Medicine, Kafr El-Sheikh University

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2024
• Primary Completion (Actual): September 1, 2025
• Study Completion (Actual): September 1, 2025

Study Registration Dates

• First Submitted: March 12, 2026
• First Submitted That Met QC Criteria: March 16, 2026
• First Posted (Actual): March 20, 2026

Study Record Updates

• Last Update Posted (Actual): March 20, 2026
• Last Update Submitted That Met QC Criteria: March 16, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Gynecomastia Surgery; Periareolar Excision; Pull-through Technique; Simon Classification; BODY-Q; Chest Contouring
• Additional Relevant MeSH Terms: Skin Diseases; Breast Diseases; Skin and Connective Tissue Diseases; Gynecomastia
• Other Study ID Numbers: KFSIRB200-335

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be publicly shared. Data may be available from the corresponding investigator upon reasonable request and with appropriate institutional approval.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No