Background

Most techniques for surgical correction of gynecomastia are performed by anterior and/or lateral chest incisions, showing an “operated” appearance. Our initial experience was introduced in gynecomastia with a combination of endoscopic subcutaneous mastectomy and liposuction via an axillary single incision.

Methods

Between September 2018 and July 2019, a series of 45 male patients who had Simon grade I or II gynecomastia were enrolled in this study. The demographics, operative data, and postoperative complications were recorded in detail. Four independent observers gave their ratings by assigning scores of 1 to 5 for 6 main aesthetic aspects based on pre and postoperative photographs.

Results

Endoscopic subcutaneous mastectomy combined with liposuction via an axillary single incision was performed successfully in all cases. Mean operative duration was 82.6 minutes for each side (37.5–132.5 minutes). The weight of the resected glandular tissue of the 89 breasts was 26 to 130 g and the aspiration volume was 60 to 700 mL. Three unilateral subcutaneous seromas (3.3%), 5 unilateral hematomas (5.6%), and 1 bilateral minimal skin redundancy (2.2%) were encountered. Observer-reported outcomes indicated that patients with grade Ⅰ gynecomastia had significantly better aesthetic results than those with grade Ⅱb in the aspects of symmetry, shape of nipple, shape of areola, contour regularity, and overall appearance (P < .001). Patients with grade Ⅱa gynecomastia also witnessed better improvement than grade Ⅱb in shape of nipple, contour regularity, and overall appearance (P < .05).

Conclusion

Endoscopic subcutaneous mastectomy combined with liposuction via an axillary single incision is a feasible minimally invasive technique for the treatment of gynecomastia. The combined method is effective in achieving satisfied aesthetic results for Simon grades I and Ⅱa gynecomastia, and it can also be an alternative choice for grade Ⅱb.

中文翻译：

---

亚洲男性女性型乳房内镜皮下切除联合腋窝单切口吸脂45例报告

背景

大多数男性乳房发育手术矫正技术是通过前部和/或侧部胸部切口进行的，显示出“手术”外观。我们最初的经验是通过内窥镜皮下乳房切除术和腋窝单切口吸脂术结合男性乳房发育术。

方法

在 2018 年 9 月至 2019 年 7 月期间，一系列 45 名患有西蒙 I 级或 II 级男性乳房发育症的男性患者参加了这项研究。详细记录人口统计学、手术数据和术后并发症。四位独立观察员根据术前和术后照片对 6 个主要美学方面的评分进行了 1 到 5 分的评分。

结果

所有病例均成功进行内镜下皮下乳房切除术联合腋窝单切口吸脂术。每侧平均手术时间为 82.6 分钟（37.5-132.5 分钟）。89 例乳房切除的腺体组织重量为 26 ～ 130 g，抽吸量为 60 ～ 700 mL。遇到 3 例单侧皮下血清肿 (3.3%)、5 例单侧血肿 (5.6%) 和 1 例双侧最小皮肤冗余 (2.2%)。观察者报告的结果表明，Ⅰ级男性乳房发育症患者在对称性、乳头形状、乳晕形状、轮廓规则和整体外观等方面的美学效果明显优于Ⅱb级患者（P< .001)。Ⅱa级男性乳房发育症患者在乳头形状、轮廓规则和整体外观方面也比Ⅱb级有更好的改善（P < .05）。

结论

内镜下皮下乳房切除术联合腋窝单切口吸脂术是治疗男性乳房发育症的一种可行的微创技术。联合方法对Simon I级和IIa级男性乳房发育达到满意的美学效果是有效的，也可以作为IIb级的替代选择。