Patient-reported satisfaction after ultrasound-assisted liposuction with infra-areolar excision for gynecomastia: a ''retrospective cross-sectional study from Palestine

Background Gynecomastia can have significant psychosocial impacts. Ultrasound-assisted liposuction (UAL)
combined with glandular excision has emerged as a preferred technique for contour correction with minimal scarring.
This study evaluates surgical outcomes and patient satisfaction following UAL with glandular excision.
Methodology This was a retrospective cross-sectional study of male patients who underwent bilateral gynecomastia
correction using ultrasound-assisted liposuction with infra-areolar excision between September 2022 and June
2024 in Palestine. Clinical and perioperative variables were extracted from medical records, and outcomes were
supplemented with patient-reported satisfaction using the validated Arabic BODY-Q chest and nipple modules
collected via an online follow-up questionnaire. Nonparametric group comparisons, Spearman correlation, and
multivariable linear regression were used to identify predictors of satisfaction (SPSS v21).
Results A total of 133 patients were included (median age 28 years; median BMI 26 kg/m²). Most cases were
physiological and primarily Simon grade IIa/IIb. The median aspirated fat volume was 350 Ml. Postoperative
complications were generally infrequent; the most common were asymmetry, redundant skin, hematoma, and
contour irregularity, and 12% of patients underwent revision surgery. Overall satisfaction was high in both BODY-Q
domains. Chest satisfaction decreased with increasing gynecomastia grade and was independently lower in patients
with contour irregularity, undesirable scars, redundant skin, and recurrence. Nipple satisfaction was independently
lower with contour irregularity, undesirable scars, redundant skin, and nipple–areola complex adherence. Chest and
nipple satisfaction scores were positively correlated.
Conclusion Ultrasound-assisted liposuction with infra-areolar excision achieved high patient-reported satisfaction
with a low-to-moderate complication profile in this Palestinian cohort. Satisfaction was driven primarily by postoperative aesthetic factors—particularly contour quality, scarring, redundant skin, and recurrence, highlighting
key targets for surgical optimization and patient counselling.