Gynecomastia is a common disease in men, with a reported incidence rate of up to 60% in adolescent men and 57% in men over 50 years of age. Gynecomastia patients not only suffer from physical discomfort: enlarged and swollen breasts, nipple sensitivity, breast pain and tenderness, etc.; Gynecomastia also leads to emotional embarrassment, discomfort and loss of self-confidence. Gynecomastia also causes emotional embarrassment and weakens the patient’s self-confidence. Some patients may even deliberately avoid certain social activities and intimate relationships in order to hide their condition. Gynecomastia brings both physical and psychological distress to the patient, and correct and timely intervention can bring the greatest benefit to the patient. The causes of gynecomastia are believed to be physiologic, pathologic, pharmacologic, and idiopathic. 1, gynecomastia treatment options gynecomastia treatment medical methods are divided into: drug treatment and surgical treatment. But not all patients need medical intervention. Whether or not gynecomastia requires treatment also depends on the cause of the disease, the duration of its symptoms, its severity, and the distress it causes to the patient. In the newborn boy population, breast development is caused by transplacental acquisition of female hormones, resulting in breast development with mild symptoms. The symptoms are mild and usually resolve on their own within one to three weeks with conservative observation and treatment, occasionally lasting for months or even years. In adolescent boys, normal hormonal changes at this age may result in transient breast development in about 30% to 60% of males. The duration of this condition may range from a few months to 2 years, with most returning to normal within 1 year, but about 5% of adolescent gynecomastia does not resolve spontaneously. Occasionally, medications such as tamoxifen may be given to relieve pain and discomfort if the patient’s breasts are enlarging rapidly or if there is significant localized pain. In the adult male population, the cause of breast development is usually an associated disease or a drug. In these cases, treatment of the disease or cessation of the medication can usually cause the early abnormal breast development to resolve on its own. However, if the exact cause of breast development cannot be identified, tamoxifen may be given. If the cause of the breast development is not known, tamoxifen may be given. If the breast growth has persisted for more than a year, medications such as tamoxifen are usually ineffective. For these patients, surgery can be considered to reduce the size of the breasts. 2, gynecomastia surgical treatment indications Histological reasons for surgical treatment Different causes of gynecomastia have the same histological changes. The early stage of gynecomastia is usually the first six months after the onset of development, which is characterized by extensive ductal epithelial hyperplasia, proliferation and lengthening of ducts, increase in stroma and surrounding tissues connected to ducts, and proliferation of inflammatory cells of ducts, and conservative treatment or medication is usually effective at this stage. However, after 12 months or more, the breast tissue enters a late or quiescent phase. There is degeneration of epithelial proliferation, progressive fibrosis and hyaline degeneration, a decrease in the number of ducts, and mononuclear cell infiltration. When the disease has progressed to the stage of extensive fibrosis and hyaline degeneration, the abnormally developed mammary glands are unlikely to regress on their own, and surgical correction is an option. Surgery is recommended for adult patients with the following conditions: abnormal breast development that does not subside for 12 to 24 months; ineffective medication; swelling and pain in the breasts; suspected risk of malignant changes; psychological distress and request for surgery. Note: If the patient is an elderly male (>60 years old) and has a firm breast lump located lateral to the nipple instead of under the nipple as is usually the case, it is important to consult your doctor promptly. This is because the lump needs to be ruled out as breast cancer. Although male breast cancer is rare, it is still possible for men to develop breast cancer. 3, gynecomastia surgical correction method Plastic surgeon preoperative selection of specific surgical methods, not only to take into account the cause of the patient’s morbidity, the size of the breasts, hypertrophy of the breasts of the composition of the tissues, the presence of excess skin and so on, but also to take into account the patient’s requirements for the shape of the body aesthetics. Simon according to the size of the breast and the presence or absence of excess skin, gynecomastia is divided into three levels and four degrees: Class I: mild hypertrophy of the gland, no skin increase; Class Ila: moderate hypertrophy of the gland, no skin increase; Class llb: moderate hypertrophy of the gland, with skin increase; Class Ill: severe hypertrophy of the gland, with skin increase. Simon’s classification provides an important clinical reference for the selection of gynecomastia surgery. Surgical correction of gynecomastia can be categorized into three types: excision; liposuction; and liposuction+excision. Generally speaking, excision is preferred for patients with predominantly glandular hyperplasia or skin enlargement, and liposuction is preferred for patients with predominantly fatty components. In view of the fact that some gynecomastia is difficult to distinguish whether the proliferation of breast tissue or adipose tissue is predominant before surgery, some scholars have suggested that all gynecomastia patients can be treated with liposuction first, and then, according to the amount of breast tissue remaining after liposuction, decide whether it is necessary to use sharp excision to remove the remaining breast tissue or not; such a point of view is not only practical, but also in line with the principles of plastic surgery, and it can achieve a better post-surgical Male breast shape.