The goal of this observational study is to compare the clinical outcomes, safety, and patient satisfaction of endoscopic versus conventional open surgical techniques in adult male patients undergoing surgery for gynecomastia.

The main questions it aims to answer are:

• Does endoscopic gynecomastia surgery provide better aesthetic outcomes and patient satisfaction compared with conventional open surgery?
• Does endoscopic surgery reduce postoperative complications, sensory changes of the nipple-areola complex, and visible scarring compared with conventional open surgery?

Researchers will compare patients undergoing endoscopic nipple-areola complex-preserving mastectomy with patients undergoing conventional open nipple-areola complex-preserving mastectomy to evaluate differences in surgical outcomes, complications, cosmetic results, and quality of life.

Participants will:

• Undergo gynecomastia surgery as part of their routine clinical care using either an endoscopic or conventional open technique.
• Attend routine postoperative follow-up visits for up to 12 months.
• Complete patient-reported outcome assessments, including pain and satisfaction questionnaires.
• Undergo evaluation of scar quality, nipple-areola complex sensation, and postoperative complications during follow-up.

Inclusion Criteria:

• Male patients aged 18 to 60 years.
• Clinically and/or ultrasonographically confirmed primary gynecomastia with palpable glandular tissue ≥2 cm.
• Simon Grade II or Grade III gynecomastia.
• Patients requesting surgical treatment because of cosmetic and/or psychosocial concerns.
• Eligible for either endoscopic or conventional open nipple-areola complex-preserving mastectomy according to routine clinical practice.
• Ability to provide written informed consent.
• Willingness and ability to comply with the 12-month follow-up schedule.

Exclusion Criteria:

• Secondary gynecomastia caused by endocrine disorders, medications, hypogonadism, thyroid disease, or suspected malignancy.
• Pseudogynecomastia (lipomastia without glandular proliferation).
• Age younger than 18 years or older than 60 years.
• Severe uncontrolled comorbidities that may increase surgical risk.
• Previous chest or breast surgery, chest irradiation, or significant chest trauma.
• Active infection or coagulation disorder.
• Immunodeficiency disorders.
• Inability to provide informed consent.
• Inability to complete the planned follow-up period.

The study population consists of adult male patients with primary gynecomastia (Simon Grade II-III) who undergo surgical treatment at Antalya City Hospital and Istanbul Bagcilar Training and Research Hospital. Participants will undergo either endoscopic or conventional open nipple-areola complex-preserving mastectomy as part of routine clinical care and will be followed for 12 months to evaluate clinical outcomes, complications, aesthetic results, sensory outcomes, patient satisfaction, and quality of life.