Use of anabolic steroids is one of many possible causes for gynecomastia. Optimal surgical treatment for this entity involves a combination of liposuction and direct excision. A series of 20 patients treated for anabolic steroid-induced gynecomastia presented. Postoperative complications included two hematomas, one seroma (bilateral), and three recurrences. Recurrence may be related hormonally active retained subareolar tissue.