Background: Gynecomastia is a benign condition refers to enlargement of the male breast either due to proliferation of ductal, stromal or fatty tissue. The causes may be idiopathic, congenital, physiological, drug induced, oncological and systemic diseases. There are many methods of liposuction as conventional, power assisted, ultrasound assisted and laser assisted liposuction. The surgical management of high grades gynecomastia is considered a problematic issue as liposuction and conventional subcutaneous mastectomy without skin excision are not sufficient in most cases and need another session for redundant skin excision. Aim of Study:To compare the surgical outcome of peripheral liposuction with central disk excision versus subcutaneous mastectomy round block technique for different grades of gynecomastia according to results, complications and patient satisfaction for operation.Patients and Methods: This is comparative randomized prospective clinical trial that conducted on (40) patients presented to Ain Shams University Hospital & Um El Masyreen General Hospital with gynecomastia grade II &III within a period of one year, including (operation and 3-6 months follow-up). Male patients above 18 year old who have gynecomastia grade II & III, which were divided into 2 groups with closed envelop method according to the used techniques.Results: Statistics shows to some extent the preference of liposuction with disk excision over round block technique according to incidence of hematoma, wound infection, dehiscence and patient satisfaction but Versus according to incidence of seroma. However, there is no significant difference between the two approaches in operation time and drain time.Conclusion: Surgical management of high grades gynecomastia is a big challenge and there is no single approach is recommended between surgeons.