# Gynecomastia Outpatient Surgical Treatment in Children Without Closed-Suction Drain Placement: Is It Safe and Effective?

## TL;DR

This study shows that outpatient surgery for adolescent gynecomastia without drains is safe and effective, with minimal complications and no need for hospital stays.

## Contribution

The study introduces a drain-free outpatient surgical approach for adolescent gynecomastia and evaluates its safety and effectiveness.

## Key findings

- Outpatient gynecomastia surgery without drains had no intraoperative complications and allowed same-day discharge.
- Only two patients (9.5%) developed mild seroma, which resolved without further intervention.
- The approach minimizes patient discomfort and avoids hospital admission.

## Abstract

Introduction: Idiopathic gynecomastia is a common diagnosis among adolescents. Closed-suction drain placement after breast resection is traditionally performed to prevent complications such as seroma or hematoma, although its effectiveness remains controversial. Drains are also associated with patient discomfort and may require prolonged wound care. The aim of the present study is to describe our experience with the outpatient surgical treatment of adolescent gynecomastia without closed-suction drain placement and to assess its short- and long-term outcomes. Methods: We conducted a retrospective single-center cohort study including male patients under 18 years of age operated on for idiopathic gynecomastia between 2019 and 2023. Demographic data, clinical features (grade of gynecomastia according to Simon’s classification before surgery), intraoperative variables, and postoperative outcomes were collected. Patients were followed in the outpatient setting, with assessment of early (<30 days) and late complications. Results: A total of 21 consecutive patients were included, with a median age of 14.5 years (range 13.6–17.4). Sixteen patients (76.2%) underwent bilateral mastectomies, and five (23.8%) underwent unilateral subtotal mastectomies. Gynecomastia grade was I in 6 cases (28.6%), II in 12 (57.1%), and III in 3 (14.3%). No intraoperative adverse events occurred. Compressive chest bandaging was performed without closed-suction drainage. All patients were discharged on the same day. Two patients (9.5%) developed mild seroma during follow-up, both resolving spontaneously without aspiration or surgery. Conclusions: Our preliminary findings suggest that outpatient gynecomastia surgery without closed-suction drains appears to be a safe and effective option in adolescents, minimizing discomfort and avoiding hospital admission. However, larger, multicenter comparative studies are warranted to confirm these results and to further evaluate patient satisfaction and long-term cosmetic outcomes.