Background <p>While gender-based disparities in coronary artery bypass grafting (CABG) outcomes are well established, there is limited evidence on the influence of gender on the selection and outcomes of bilateral internal mammary artery (BIMA) grafts, particularly in Indian populations. Aim of the study was to evaluate whether gender influences the use of BIMA in CABG, and to assess short-term outcomes including postoperative complications and re-hospitalization rates across genders.</p> Methods <p>A prospective observational study included 280 patients undergoing elective off-pump CABG at a tertiary cardiac center. Patients were grouped by gender and type of graft received. Comparative analysis was conducted between males and females receiving BIMA, and between females receiving BIMA versus those receiving single internal mammary artery (SIMA) with vein grafts. Key perioperative variables, including inotropic support, infection, and hospital stay, were evaluated over a two-month follow-up.</p> Results <p>Among 39 female patients, 51.28% received BIMA grafts compared to 31.54% of 241 male patients (<i>p</i> = 0.016). Female BIMA recipients had higher rates of diabetes (70% vs. 42.11%, <i>p</i> = 0.026), hypothyroidism (30% vs. 2.63%, <i>p</i> &lt; 0.001), and osteoporosis (25% vs. 1.32%, <i>p</i> &lt; 0.001). Re-hospitalization within two months was more common in females (15% vs. 1.32%, <i>p</i> = 0.006). No significant difference in mortality or echocardiographic improvement was observed.</p> Conclusion <p>In this study, females were significantly more likely to receive BIMA grafts than males. Despite a higher burden of comorbidities, short-term outcomes were comparable across genders.</p> Graphical Abstract <p></p>