Journal of Surgery Concepts & Practice >

2026 , Vol. 31 >Issue 03: 257 - 264

DOI: https://doi.org/10.16139/j.1007-9610.2026.03.12

Original article

Single axillary incision non-lipolysis reverse-sequence endoscopic nipple-sparing mastectomy in the management of gynecomastia: comparison with the traditional open surgery

  • FENG Yu ,
  • LUO Guilin ,
  • LIANG Faqing ,
  • ZHANG Donglin ,
  • DU Zhenggui
Expand
  • 1 Department of General Surgery, the Fourth People’s Hospital of Sichuan Province, Sichuan Chengdu 610016, China
    2 a.Department of General Surgery, b.Breast Disease Research Center, West China Hospital, Sichuan University, Sichuan Chengdu 610041, China

Received date: 2024-11-26

  Online published: 2026-08-11

Fold

Abstract

Objective To compare the surgical safety and cosmetic outcomes of single axillary incision non-lipolysis reverse-sequence endoscopic nipple-sparing mastectomy and traditional open surgery in the treatment of gynecomastia (GYN). Methods A retrospective cohort study was performed on 51 GYN patients who underwent mastectomy at West China Hospital and the Fourth People's Hospital of Sichuan Province from March 2021 to August 2024. The cohort was divided into the endoscopic group (39 cases) and the open group (12 cases). Baseline characteristics, surgical-related data, postoperative complications and cosmetic outcomes of two groups were collected and analyzed. Results There were no significant differences in age, body mass index (BMI), breast size, and the mean operation time between the two groups. The overall complication rate was 7.7% in the endoscopic group and 8.3% in the open group, with no significant difference (P=1.000. The unilateral resected gland in the endoscopic group was heavier than that in the open group (P=0.011). In the cosmetic outcomes reported by doctors, the endoscopic group showed advantages in improving chest flatness and reducing scars. In the body-Q scale reported by patients, the endoscopic group reported higher scar scores than that of the open group (91.1 ± 12.2 vs. 61.4 ± 4.0; P<0.001). In terms of satisfaction with chest module and nipple, there was no significant difference between the two groups. Due to the inability of the endoscopic group to remove excess skin, the endoscopic group had a lower score in evaluation of appraisal of excess skin than that of open group, but with no significant difference. Conclusions Compared with the traditional open surgery, the single axillary incision non-lipolysis reverse-sequence endoscopic nipple-sparing mastectomy has better postoperative cosmetic outcomes, and with no increased operation time, and postoperative complications. It is a safe and effective surgical option for treating GYN and is worthy of further promotion.

Key words： Gynecomastia(GYN); Endoscopy; Reverse-sequence; Traditional open surgery; Cosmetic outcome

Cite this article

FENG Yu , LUO Guilin , LIANG Faqing , ZHANG Donglin , DU Zhenggui . Single axillary incision non-lipolysis reverse-sequence endoscopic nipple-sparing mastectomy in the management of gynecomastia: comparison with the traditional open surgery[J]. Journal of Surgery Concepts & Practice, 2026 , 31(03) : 257 -264 . DOI: 10.16139/j.1007-9610.2026.03.12

References

[1] Koch T, Br?Uner E V, Busch A S, et al. Marked increase in incident gynecomastia: a 20-year national registry study, 1998 to 2017[J]. J Clin Endocrinol Metab, 2020, 105(10):dgaa440.
[2] Kanakis G A, Nordkap L, Bang A K, et al. EAA clinical practice guidelines-gynecomastia evaluation and management[J]. Andrology, 2019, 7(6):778-793.
[3] Nordt C A, Divasta A D. Gynecomastia in adolescents[J]. Curr Opin Pediatr, 2008, 20(4):375-382.
[4] Ordaz D L, Thompson J K. Gynecomastia and psychological functioning: a review of the literature[J]. Body Image, 2015, 15:141-148.
[5] Mcnamara C T, Nuzzi L C, Firriolo J M, et al. Complications and quality of life following gynecomastia correction in adolescents and young men[J]. Plast Reconstr Surg, 2022, 149(6):1062e-1070e.
[6] Hoyos A E, Perez M E, DomíNguez-MilláN R. Gynecomastia treatment through open resection and pectoral high-definition liposculpture[J]. Plast Reconstr Surg, 2021, 147(5):1072-1083.
[7] Petty P M, Solomon M, Buchel E W, et al. Gynecomastia: evolving paradigm of management and comparison of techniques[J]. Plast Reconstr Surg, 2010, 125(5):1301-1308.
[8] Varlet E, Esposito C, Scalabre A, et al. Pediatric endoscopic subcutaneous mastectomy (pesma) with liposuction in adolescents with gynecomastia[J]. Surg Endosc, 2023, 37(1):766-773.
[9] Shang F, Zhao Z, Li Z, et al. The combination of endoscopic subcutaneous mastectomy and liposuction (Liu and Shang's 2-hole 7-step method) as the treatment of gynecomastia[J]. Surgery, 2023, 174(2):159-165.
[10] Yang Y, Mu D, Xu B, et al. Endoscopic subcutaneous mastectomy plus liposuction via a single axillary incision for gynecomastia in Asian patients: a report of 45 cases[J]. Surgery, 2021, 170(1):39-46.
[11] Yang H, Liang F, Feng Y, et al. Single axillary incision reverse sequence endoscopic nipple-sparing mastectomy in the management of gynecomastia: short-term cosmetic outcomes, surgical safety, and learning curve of the preliminary 156 consecutive procedures from a prospective cohort study[J]. Aesthetic Plast Surg, 2024, 48(16):3120-3127.
[12] Klassen A F, Cano S J, Alderman A, et al. The BODY-Q: a patient-reported outcome instrument for weight loss and body contouring treatments[J]. Plast Reconstr Surg Glob Open, 2016, 4(4):e679.
[13] Klassen A F, Kaur M, Poulsen L, et al. Development of the BODY-Q chest module evaluating outcomes following chest contouring surgery[J]. Plast Reconstr Surg, 2018, 142(6):1600-1608.
[14] Courtiss E H. Gynecomastia: analysis of 159 patients and current recommendations for treatment[J]. Plast Reconstr Surg, 1987, 79(5):740-753.
[15] Prasetyono T O H, Andromeda I, Budhipramono A G. Approach to gynecomastia and pseudogynecomastia surgical techniques and its outcome: a systematic review[J]. J Plast Reconstr Aesthet Surg, 2022, 75(5):1704-1728.
[16] Rohrich R J, Ha R Y, Kenkel J M, et al. Classification and management of gynecomastia: defining the role of ultrasound-assisted liposuction[J]. Plast Reconstr Surg, 2003, 111(2):909-923,discussion924-925.
[17] Prasetyono T O H, Budhipramono A G, Andromeda I. Liposuction assisted gynecomastia surgery with minimal periareolar incision: a systematic review[J]. Aesthetic Plast Surg, 2022, 46(1):123-131.
[18] Asal M, Ewedah M, Bassiony M, et al. Liposuction and port site nipple sparing mastectomy: an alternative method for the operative treatment of gynecomastia at Alexandria main university hospital[J]. BMC Surgery, 2023, 23(1):244.
[19] Lee Y K, Lee J H, Kang S Y. Gynecomastia: glandular-liposculpture through a single transaxillary one hole incision[J]. J Plast Surg Hand Surg, 2017, 52(2):117-125.
[20] Simon B E, Hoffman S, Kahn S. Classification and surgical correction of gynecomastia[J]. Plast Reconstr Surg, 1973, 51(1):48-52.
[21] Innocenti A, Tarantino G. Endoscope-assisted minimally invasive surgery for the treatment of glandular gynecomastia[J]. Aesthetic Plast Surg, 2023, 47(Suppl 1):103-104.
[22] Yao Y, Yang Y, Liu J, et al. Vacuum-assisted minimally invasive surgery-an innovative method for the operative treatment of gynecomastia[J]. Surgery, 2019, 166(5):934-939.
[23] Chen D, Chen J, Huang Y, et al. Comparative analysis of surgical modalities for the gynecomastia treatment: efficiency and aesthetic outcomes[J]. Andrology, 2024, 12(6):1398-1407.
Options
Outlines

/

〈 〉