Introduction <p>Gynecomastia is characterized by enlarged breast tissue in men and is often caused by genetic or endocrinological disorders, cancer, or medication use, with idiopathic causes being the most common. If no clinically treatable cause is identified and the condition persists for more than two years, surgical treatment is indicated. This typically involves adenectomy with or without liposuction and resection of excess skin when necessary. Major complications include hematoma, seroma, infection, and dehiscence. Quilting sutures, as previously described in abdominoplasty, can minimize dead space and reduce hematoma and seroma formation.</p> Objective <p>This study aimed to compare the efficacy of quilting sutures and suction drains in preventing hematoma and seroma formation after adenectomy for gynecomastia.</p> Methods <p>Thirty-eight gynecomastia patients eligible for adenectomy were randomized into two groups: one with intraoperative quilting sutures (Group 1) and another with vacuum drains (Group 2). The patients were followed up postoperatively using clinical examinations and ultrasonography. Fluid collection &gt; 10&#xa0;mL was drained when necessary.</p> Results <p>Eight patients in Group 1 (40%) and five in Group 2 (28%) developed fluid collections, with no significant difference between the groups. No surgical correction was required for hematoma or seroma. Suction drains seem to give better results regarding seroma, but with no statistical difference.</p> Conclusion <p>This study showed no difference in the use of drains or quilting sutures to prevent seromas or hematomas in the correction of gynecomastia.</p> Level of Evidence II <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>