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Gynecomastia is the commonest clinical breast conditionin males. This study had described surgical approaches donefor different grades of gynecomastia. Eighty seven cases hadbeen operated for gynecomastia were analyzed in this studyfrom 2016 to 2019. One hundred and sixty three breasts, theclinical data regarding patients' satisfaction, breast size, breastssymmetry, shape and symmetry of the nipple areola complexand shape of their scars were evaluated. All cases were satisfiedabout the results of surgery; however patients with grade IVshowed concerns about scars. Plastic surgeons treat manymale patients that complain of breast enlargement and ask forsurgical correction of their deformities. A surgical algorithmis needed for management of different grades of gynecomastia.Breast size, glandular ptosis and skin redundancy are thecritical factors for the choice of the surgical technique