Gynecomastia, a benign enlargement of male breast glandular tissue, is the most common breast condition in males, often caused by an imbalance between estrogen and androgen activity. Although it is frequently observed during puberty and later stages of life, persistent prepubertal bilateral gynecomastia without associated endocrine abnormalities is rare. We report a case of a 24-year-old male presenting with a decade-long history of bilateral breast swelling. Clinical evaluation, ultrasonography, and fine-needle aspiration cytology confirmed the diagnosis of gynecomastia. The condition was managed surgically using liposuction combined with gland excision. Postoperative care included antibiotics, pain management, and nutritional support, facilitating a smooth recovery. This case underscores the significance of surgical intervention for long-standing gynecomastia, especially when cosmetic and psychological distress are present. Liposuction combined with gland excision remains an effective approach, ensuring minimal complications and optimal outcomes for adult males with persistent gynecomastia.