IntroductionMixed-type gynecomastia is a benign male breast condition characterized by the proliferation of glandular and adipose tissues. Conventional open surgery has been the main approach for treating gynecomastia. However, this method has been associated with complications, including breast deformity, noticeable scar, nipple necrosis, and hypoesthesia. In contrast, Vacuum-assisted biopsy systems and liposuction have demonstrated significant advantages in minimal invasive breast surgery. AimsOur study aimed to investigate the effectiveness of combining vacuum-assisted mastectomy with power assistant liposuction (VAM+PAL) for patients with mixed-type gynecomastia compared to conventional open surgery. MethodsSixty patients with mixed-type gynecomastia, treated between January 2019 and June 2023, were included in this study. VAM+PAL was performed on 30 patients (59 breasts), while open excision with peri-areola approach was performed on another 30 patients (59 breasts). The efficacy, complications, outcomes, scar cosmesis, and patient satisfactions were assessed. ResultsCompared to open excision for gynecomastia, the VAM+PAL group demonstrated a substantial reduction in incision size (4.47±1.21cm vs. 0.97±0.74cm, p<0.001) and lower scores of Vancouver scar scale (3.23±2.27 vs. 1.10±1.47, p<0.001). No drainage tubes were required for postoperative hematoma/seroma prevention. The patients in the VAM+PAL group had a significantly lower complication rate (18.64% vs. 3.39%, p=0.008), particularly in bruise and hypoesthesia. All VAM+PAL patients reported superior satisfaction with the outcomes in breasts and nipples. ConclusionThe combination of vacuum-assisted mastectomy and power assistant liposuction can be used as an efficient minimally invasive method to treat mixed-type gynecomastia with acceptable complications, superior scar cosmesis, and satisfying outcomes.