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Objective To explore the characteristics, mechanism and surgical treatment of prepubertal gynecomastia (PPGM). Methods The clinical data of 9 PPGM patients underwent surgical treatment from 2003 to 2018 were collected and retrospectively analyzed. Seven patients underwent the liposuction and mammary gland excision through an incision along the lower edge of mammary areola, 1 patient underwent the mammary gland excision through an incision along the lower edge of areola and 1 patient underwent the unilateral mammary gland excision through an incision along the lower edge of areola, liposuction and fat grafting of contralateral breast. The excised tissues were sent to pathological examination. Results No complications such as infection and hematoma occurred. The pathological examination results were consistent with the diagnosis of PPGM. No recurrence was found during the follow up from 1 to 16 years. Conclusion PPGM is a rare type of gynecomastia. The surgical method should be reasonably selected based on the clear etiological diagnosis and drug control. For patients with obvious gland development and psychiatric symptoms, surgical treatment of PPGM can achieve satisfactory efficacy. [ABSTRACT FROM AUTHOR]