PURPOSE: Gynecomastia can cause severe emotional phobia for breast cancer in elderly male and physical distress in young men. To select the appropriate cosmetic surgical approach for gynecomastia, I evaluated the usefulness of performing ultrasound-guided vacuum-assisted device excision of it. METHODS: Twenty-two cases of gynecomastia in 18 male were treated by vacuum-assisted biopsy device excision from November 2005 to June 2007. Their age range was 14-72 years old (mean, 34). The vacuum-assisted biopsy device excision was performed by 11G needle in 7 cases and 8G needle in 15 cases. I checked the number of extracted tissue pieces, the duration time of the procedure, immediate complications, and breast ultrasound after 3 months. RESULTS: The mean number of extracted tissue pieces was 69, and the average procedure duration was 25 minutes. There were no significant immediate complications such as bleedings and skin necrosis, and there were no clinically serious complications on 3 months follow-up examinations. During operation under local anesthesia, all patients tolerated the procedure. After vacuum-assisted biopsy device procedure, the cosmetic results were good to excellent for all the patients. CONCLUSION: Vacuum-assisted biopsy device excision was an effective surgical option, especially for small and glandular gynecomastia. I suggest this is a useful alternative procedure to surgery and liposuction, or it could be used effectively as a co-operative procedure with liposuction.