Surgical management of gynecomastia under endoscope

Comparative analysis of surgical modalities for the gynecomastia treatment: efficiency and aesthetic outcomes

This retrospective study rigorously compares the clinical efficacy of three surgical methodologies for treating gynecomastia while providing guidance for future surgical modality selection. We analyzed records of 77 gynecomastia patients treated between January 2015 and October 2022. Patients were categorized into three groups: Group A (subcutaneous gland resection via areola incision), Group B (liposuction combined with single-hole endoscopic gland resection), and Group C (liposuction combined with three-hole endoscopic gland resection). Parameters assessed included patient demographics, intraoperative bleeding, surgical duration, hospitalization duration, costs, postoperative drainage, complications, and patient satisfaction. Group A had significantly shorter operation time and lower cost than Groups B and C (P < 0.05). There were no significant differences in postoperative drainage (P > 0.05). Group A had a higher incidence of subcutaneous fluid complications. All groups achieved 100% overall postoperative efficiency. Group B demonstrated superior outcomes for scarring and patient satisfaction. All three surgical modalities effectively treat gynecomastia. Circumareolar incision subcutaneous gland resection is optimal for mild to moderate cases due to reduced operation time and cost. Liposuction with single-hole endoscopic gland resection and three-hole endoscopic gland resection offers fewer complications and discreet incisions. Notably, the liposuction and single-hole endoscopic approach yielded superior postoperative patient satisfaction, aligning with minimally invasive principles and warranting broad clinical application.

A Novel Surgical Technique for Gynecomastia: Air-Assisted Minimally Invasive Surgery With Single Axillary Incision

BACKGROUND

Gynecomastia is a benign condition that develops due to the proliferation of breast tissue in men. Surgical excision is the most effective treatment method. Minimally invasive techniques can be used to avoid visible scarring. We evaluated the efficacy and safety of air-assisted subcutaneous mastectomy in the treatment of gynecomastia.

PATIENT AND METHODS

10 patients with gynecomastia underwent air-assisted subcutaneous mastectomy and liposuction through a single axillary incision, between June 2022 and February 2023. Demographic and clinical data of the patients, duration of surgery, and complications were recorded. The satisfaction levels of the patients regarding physical appearance, mental status, and social environment were measured. The body Q questionnaire was performed preoperatively and in the postoperative third month.

RESULTS

The median age was 26 (range, 18-54). Surgical excision was measured as a median of 69 gr (range, 41-177), and liposuction volume was measured as a median of 210 ccs (range, 63-400). The median operation time was 50 minutes (range, 21-60) for excision and 21 minutes (range, 20-75) for liposuction. Body, chest, and nipples related appearance satisfaction levels were measured preoperatively as a median of 44 (range, 36.5-52), 31 (range, 27.5-39), and 51.5 (range, 21-69.8) points vs postoperatively as 92 (range, 92-100), 93 (range, 93-94.8) and 90 (range, 90-100) points, respectively. The patients had a median follow-up of 6 months (range, 3-11). No complications were observed during the follow-up period.

CONCLUSION

Air-assisted subcutaneous mastectomy and liposuction is a feasible technique that may provide good cosmetic outcomes by avoiding anterior chest wall scarring.

Single axillary incision endoscopic surgery and liposuction for gynecomastia

Gynecomastia is a common type of breast tissue hypertrophy in men. Surgical excision is the most effective treatment for this condition. Minimally invasive surgical techniques can be used to avoid visible chest scarring. In this study, we evaluated the efficacy and safety of single-axillary-incision endoscopic mastectomy and liposuction for the treatment of gynecomastia. Nipple-sparing mastectomy via a single-port axillary incision was successfully performed in all patients. Twenty-four bilateral procedures were performed in total. Twenty patients underwent liposuction concomitantly. The median weight of the mastectomy pieces was 88.5 g (range: 42.5-440 g), and the median amount of liposuction was 262.5 cc (range: 25-350 cc). The median duration of surgery was 120 minutes (range, 73-195 minutes). Two patients developed a seroma, and 1 patient developed a hematoma in the early postoperative period. The mean satisfaction levels related to physical appearance, mental status, and social environment were 8.75 (standard deviation [SD]: 1.19), 9.17 (SD: 1.44), and 9.33 (SD: 0.76) points, respectively, on a 10-point visual analog scale. Endoscopic single-port nipple-sparing mastectomy combined with liposuction is a technically feasible method to avoid anterior chest wall scarring with good cosmetic results. Between June 2021 and June 2022, 30 patients underwent endoscopic single-port nipple-sparing mastectomy through a small axillary incision, while 20 underwent concomitant liposuction. The demographic information of the patients, duration of surgery, amount of tissue removed, and complications were recorded. Patients' levels of satisfaction with their physical appearance, mental status, and social environment were measured.

Incidence of Complications for Different Approaches in Gynecomastia Correction: A Systematic Review of the Literature

Background

Gynecomastia is nowadays a very common disease, affecting a large cohort of patients with different ages. The aim of this literature review is to assess the incidence of complications with all proposed techniques and for combined procedures versus single approach procedures in gynecomastia correction.

Materials and Methods

A systematic review of the literature was performed to identify all reported techniques for gynecomastia correction covering a period from January 1, 1987 to November 1, 2020. For all selected papers, demographic data, proposed technique, and complications’ incidence have been recorded.

Results

A total number of 3970 results was obtained from database analysis. A final total number of 94 articles was obtained for 7294 patients analyzed. Patients have been divided into three groups: aspiration techniques, consisting in 874 patients (11,98%), surgical excision techniques, consisting in 2764 patients (37,90%), and combined techniques, consisting in 3656 patients (50,12%). Complications have been recorded for all groups, for a total number of 1407, of which 130 among “Aspiration techniques” group (14,87%), 847 among “Surgical excision techniques” group (30,64%), and 430 in “Combined techniques” group (11,76%).

Conclusions

Several techniques have been proposed in the literature to address gynecomastia, with the potential to greatly improve self-confidence and overall appearance of affected patients. The combined use of surgical excision and aspiration techniques seems to reduce the rate of complications compared to surgical excision alone, but the lack of unique classification and the presence of several surgical techniques still represents a bias in the literature review.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Endoscopic subcutaneous mastectomy plus liposuction via a single axillary incision for gynecomastia in Asian patients: A report of 45 cases

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.

Single-incision surgery for gynecomastia using TriPort: A case report

Gynecomastia is a common benign condition of the male breast, frequently observed in newborns, adolescents and the elderly. Surgical excision remains one of the most effective methods for the management of patients with gynecomastia, particularly those with fibrosis or a course of >1 year. The present study describes two cases of patients with gynecomastia and presents a novel method of treatment, combining endoscopic surgery and liposuction using a TriPort, which may effectively remove breast tissue and shorten hospitalization time compared with a direct excision method.

Management of Adolescent Gynecomastia: An Update

Gynecomastia refers to an enlargement of the male breast caused by benign proliferation of the glands ducts and stromal components including fat. It is the most common form of breast swelling seen in adolescent males. During pubertal development, gynecomastia can develop as a result of transient relative imbalances between androgens and estrogens. Pubertal gynecomastia is self-limited in 75 to 90% of adolescents and regresses over 1 to 3 years. However it may cause significant psychological stress and depression in adolescents. For boys with persistent gynecomastia that is causing substantial tenderness or embarrassment a tailored approach of close follow-up and use of anti-estrogen drugs may be recommended. These drugs block the effects of estrogens in the body and can reduce the size of the breasts somewhat. It appears that pharmacological therapy of persistent adolescent gynecomastia is reasonable effective if given early in the course of the disease and more successful in cases with small or moderate breast enlargement. However, neither of these drugs is universally approved for the treatment of gynecomastia because the risks and benefits have not been studied completely. Surgical approach may be needed under special conditions for cosmetic reasons. In this update, we review the different published trials for managing adolescent gynecomastia. (www.actabiomedica.it)

Electrothermal bipolar vessel sealer in endoscope-assisted latissumus dorsi flap harvesting

LigaSure™ is a new bipolar vascular sealing system commonly used in various fields of surgery. However, no reports have been published about its use in plastic surgery, particularly for endoscopic flap harvesting. In this study, we present the use of LigaSure in endoscope-assisted latissimus dorsi (LD) flap harvesting for breast reconstruction. Between 2006 and 2008, 11 female patients with the mean age of 33.4 (range, 20-49 years) who had previously undergone mastectomy operations were included in the study. First stage of reconstruction was performed with the ipsilateral LD harvested by the help of LigaSure and a tissue expander placed beneath the LD and pectoralis major muscles. Secondary reconstruction was done by a definitive silicon gel-filled implant placed after an average of 6.6 months of expansion (range, 6-9 months). Data concerning the hospitalization and operation times, drainage amounts, complications, etc., were recorded. Mean follow-up was 13 months (range, 8-18 months). Mean flap harvesting time was recorded as 74.2 minutes (range, 50-125 minutes), which shortened as the surgeon got used to the procedure. Patients were hospitalized for 3-7 days, with a mean hospitalization period of 5.5 days. The total mean drainage amount postoperatively was found to be 950 mL (range, 725-975 mL), which is relatively lower than the previously reported values. LigaSure use in endoscope-assisted LD harvesting is easy, safe, and time sparing with almost no complications observed in this small initial series. Although more controlled studies with larger number of patients need to be done to verify its effectiveness in terms of hospitalization, drainage amounts, etc., it holds promise for a wide spectrum of operations in the field of plastic surgery.

Gynecomastia: pathophysiology, evaluation, and management

Gynecomastia, defined as benign proliferation of male breast glandular tissue, is usually caused by increased estrogen activity, decreased testosterone activity, or the use of numerous medications. Although a fairly common presentation in the primary care setting and mostly of benign etiology, it can cause patients considerable anxiety. The initial step is to rule out pseudogynecomastia by careful history taking and physical examination. A stepwise approach that includes imaging and laboratory testing to exclude neoplasms and endocrinopathies may facilitate cost-effective diagnosis. If results of all studies are normal, idiopathic gynecomastia is diagnosed. The evidence in this area is mainly of observational nature and lower quality.