Objective To investigate the clinical features, treatment and prognosis of Madelung’s disease (MD). Methods Clinical data of 28 MD patients admitted to the Affiliated Hospital of Southwest Medical University from 2013 to 2023 were retrospectively analyzed, and their demographic characteristics, clinical indexes, fat deposition sites, treatment methods and prognosis were summarized. Results Of the 28 patients with MD, 26 were male and 2 were female, aged from 27 to 68 years with an average age of 51.11. All patients were classified as type I MD according to Enzi’s typing system. Of all the patients, 85.71% had a long history of drinking alcohol, 67.86% had a history of smoking, and 82.14% fat deposits were mainly located in the anterior cervical region. Twenty-four patients received surgical treatment, and two died due to postoperative complications. After 1 to 110 months of postoperative follow-up, 3 cases were lost to follow-up, 8 cases recurred and 2 cases died. The recurrence rates at 1, 2 and 3 years were 31.59%, 42.11% and 42.11%, respectively. Among the patients with recurrence, 87.50% continued to drink after surgery. Conclusion MD occurs mainly in middle-aged men who have been drinking alcohol for a long time, and the main type of MD is type I. The most common site of fat deposition in MD is the anterior neck region. Open surgery to remove the fat deposits remains the main treatment modality. Continued postoperative alcohol consumption is an independent risk factor for recurrence of MD.