Surgical management of primary gynaecomastia: outcomes of a peri-areolar round-block approach with absorbable barbed suture closure

Background: Gynaecomastia is a common benign condition in males that may cause physical discomfort and significant psychological distress. Surgical management remains the definitive treatment for persistent disease, particularly in the presence of glandular tissue, skin excess, or ptosis. Scar quality is a key determinant of patient satisfaction, and refinement of closure techniques may influence long-term outcomes. Methods: A retrospective analysis was conducted of 265 male patients who underwent surgical correction of primary gynaecomastia between June 2005 and December 2023 in a single private centre. Outcomes were compared with a pre- 2005 cohort of 108 patients treated using braided non-absorbable sutures. Surgical management was guided by the Simon classification and included liposuction alone, liposuction with glandular excision, or combined approaches with peri-areolar round-block skin resection. From 2005 onwards, peri-areolar closure was performed using absorbable bidirectional barbed sutures. Primary outcomes were post-operative scar quality and patient-reported satisfaction at 12 months. Secondary outcomes included complication rates and the need for revision surgery. Results: Early post-operative complications were uncommon in both cohorts. Rates of seroma, haematoma, infection, and partial nipple–areolar complex necrosis were low and comparable between groups. Scar enlargement occurred significantly less frequently in the post-2005 cohort following the introduction of barbed suture closure. Hypertrophic scarring and wound dehiscence rates were similar between cohorts. At 12 months, most patients in the post-2005 group reported satisfaction with their aesthetic outcome and scar quality, with dissatisfaction being uncommon. Conclusions: The peri-areolar round-block approach with absorbable barbed suture closure is a safe and reproducible technique for the surgical management of primary gynaecomastia. Refinement of the closure technique was associated with improved scar-related outcomes without increased complication rates, contributing to high levels of patient satisfaction.