Gynecomastia, also known as gynecomastia or gynecomastia, is an abnormal development of enlarged male breast tissue with or without pain, which is caused by an imbalance of sex hormones in the body and can occur temporarily or permanently. In recent years, along with the improvement of living standards and lifestyle changes, the incidence and consultation rate of this disease has increased significantly and it has become one of the common diseases in plastic surgery. Patients seek treatment not only to remove the gland, but to obtain a satisfactory postoperative male thoracic profile. The surgical method of glandular excision alone has failed to satisfy the patients. We treated a total of 40 patients of each type from March 2003 to September 2006 using different methods according to the results of preoperative breast ultrasound and Cohen’s typing, and achieved good surgical results. According to the ultrasound findings, the extent of the gland was marked on the chest wall and the nature of the hyperplastic tissue was determined, and the patients were divided into three subtypes: glandular, fatty and glandular-fatty according to the Cohen typing method. A small semi-circular incision, about 2-3 cm long, was made at the lower edge of the areola, and anesthesia was localized with 0.5% lidocaine at the incision and swelling anesthesia with 0.06% lidocaine in the rest of the area. 3-0 silk sutures were used to intermittently close the subcutaneous tissues of the incision to ensure good alignment, and then the skin was glued with no-sew tape. If intraoperative fat aspiration is performed, drainage is placed through the aspiration point. After surgery, oral antibiotics are given for 3 days, and the area is bandaged with cotton pads and chest straps for 7 days, and after 3 days, a stretchy undershirt is worn for 1 month. In case of glandular type, the breast tissue is routinely removed. At this time, although the incision is small and the surgical field is not well exposed, the marking line of the patient’s chest wall can be a good guide for the intraoperative operation. Intraoperative attention is paid to the appropriate preservation of the glandular tissue under the nipple areola to prevent destruction of the nipple areola blood supply and local sunken deformity after surgery. No negative pressure drainage needs to be placed postoperatively. In the case of fatty type, the patient is placed in a standing position and the extent of fat aspiration is marked. Fat aspiration is performed in the lower outer quadrant of the breast, at the edge of the fat aspiration area, and fat aspiration is routinely performed with an electric suction device until the chest wall is flat. In case of glandular fat type, the fat aspiration area should also be marked. Our experience is that the aspiration level should be two layers, the superficial fat aspiration level is between the subcutaneous tissue and the surface of the gland, and the deep fat aspiration level is the posterior gap of the gland, through such aspiration, a cavity is formed between the breast and the surrounding tissue in advance, and then the breast tissue is removed by separating along these two levels respectively. After removal of the gland, the shape of the chest wall was observed again and if necessary, fat aspiration could be performed again until a satisfactory appearance was obtained. 2. Results The unilateral mastectomy gland was 30-180 g, the total volume of fat tissue aspirated was 200 to 800 ml, and the intraoperative bleeding was 20-80 ml. The areolar incision was about 2-3 cm long, and all healed in one stage. Except for 3 patients who were hospitalized, the rest of the patients completed the surgery on an outpatient basis and left the hospital directly after surgery with drains, which were removed after 2-3 days, depending on the nature of the drainage flow. There were no postoperative complications such as hematoma, seroma, nipple areola necrosis, infection, etc. Six patients had mild loss of nipple areola sensation, but all recovered well after 6-12 months, and no sensory changes were found in the remaining patients. Postoperative pathological examination showed normal breast tissue in all patients. The postoperative follow-up period was 6-36 months, and there was no recurrence. All patients had a flat chest wall appearance, no nipple areola depression deformity, and minimal wound scarring, and the surgical results were satisfactory.