Abstract Background Gynecomastia is defined clinically as generalized enlargement of the male breast tissue, with the presence of a rubbery or firm mass extending concentrically and symmetrically from the nipple, accompanied by histopathological benign proliferation of the glandular male breast tissue. It usually occurs bilaterally and is the most common breast condition in males. Aim of the Work To review the differentiate between Inverted U shaped incision & round block technique used in management of grade II & III gyencomastia according to results, complications and patient satisfaction for operation. Patients and Methods This is a prospective clinical trial that conducted on thirty two (32) patients presented to Ain Shams University Hospital & Um El Masyreen General Hospital with gynecomastia grade II & III. Study period was One year, including (operation and 3-6 months follow up). Results In our study, statistics shows to some extent the preference of inverted U shaped incision over round block technique according to operation time, but verses according to post-operative Drain duration. However, there is no significant difference between the two approaches in incidence of seroma, hematoma, nipple areola complex complications, patient satisfaction and Aesthetic outcome. Conclusion Surgical management of high grades gynecomastia is a big challenge and there is no single approach is recommended between surgeons.