Introduction: The surgical treatments of mild to moderate gynecomastia has evolved towards less invasive techniques, such as power-assisted liposuction, suction-assisted lipectomy or ultrasound-assisted liposuction. Excisional techniques are still indicated for the most severe cases characterized by skin excess and ptosis. The aim of this study was to present a method of using power-assisted liposuction combined with gland resection to treat gynecomastia with severe hypertrophy. Materials and Methods: We conducted a chart review of 27 consecutive patients treated for massive gynecomastia between 2014 and 2018. Power-assisted liposuction was performed to remove the fatty breast tissue. Incisions for liposuction were placed at lateral inframammary fold and upper anterior axillary pillar. An inferior hemiperiareolar incision was then performed to allow direct resection of fibroglaundular breast tissue. A final liposuction in all directions was performed again to recontour the breast. No skin was resected and drains were always inserted in each breast. Compression vest was worn for 6 weeks after surgery. Results: In average, 749 mg of fat and fibroglandular tissue were removed from each breast. No complications were reported. At 1 year follow-up, ideal aesthetic results, with minimal scars, adequate virilization of the chest contour and full satisfaction of surgeon and patient were observed in 24 patients, while 3 patients presented residual skin excess. Conclusion: In average, 749 mg of fat and fibroglandular tissue were removed from each breast. No complications were reported. At 1 year follow-up, ideal aesthetic results, with minimal scars, adequate virilization of the chest contour and full satisfaction of surgeon and patient were observed in 24 patients, while 3 patients presented residual skin excess.