Skip to main content
Top

17-06-2024 | Gynecomastia | Original Articles

The Scar-Hidden Surgery on Gynecomastia: Experiences from a Single-Institutional Large Case Series

Authors: Chengyu Luo, Shuqi Zhang, Changsheng Wei, Yang Guo, Yajing Zhang

Published in: Aesthetic Plastic Surgery

Login to get access

Abstract

Background

To summarize the experiences on the mastoscopic subcutaneous mastectomy for gynecomastia by “nine-step method” based on the “5S” goal and standardize this operation.

Patients and Methods

Between January 1, 2002, and October 31, 2021, a total of 2035 breasts of 1082 male patients with gynecomastia, of which 129 patients with one side, were underwent mastoscopic subcutaneous mastectomy. The follow-up endpoint was 3 months after surgery.

Results

All patients were successfully completed the operation, and none of them was transferred to open operation. The operation time for unilateral breast was 12–28 min, and the average time was 17.7 ± 6.2 min. The amount of bleeding during unilateral operation was very small, about 5–10 ml. The total drainage volume was 5–50 ml after the operation, and the drainage tube was removed in 3–5 days. The epidermal necrosis occurred in 0.3% nipple. 0.2% chest wall had a little ecchymosis in the supero-medial region of the breast. All patients had the normal feeling of nipples and areola, the smoothing and symmetrical chest wall, and the natural contour. There was no recurrence during the follow-up period.

Conclusions

The mastoscopic subcutaneous mastectomy for gynecomastia by “nine-step method” based on the “5S” goal has a short operation time, few surgical complications and good esthetics. It achieves the “5S” goals on the complete removal of glandular tissue (sweeping), small and scar-hidden incision are small (scarless), good symmetry of bilateral chest wall (symmetry), normal chest shape (shape), and smoothing chest wall (smoothing).

Level of Evidence III

The journal asks authors to assign a level of evidence to each article. For a complete description of Evidence-Based Medicine ratings, see the Table of Contents or the online Instructions for Authors at www.​springer.​com/​00266.
Appendix
Available only for authorised users
Literature
1.
go back to reference Lynn R, Cara Y, Tracie H et al (2015) A systematic review of literature on psychosocial aspects of gynecomastia in adolescents and young men. J Adolesc 43:206–212CrossRef Lynn R, Cara Y, Tracie H et al (2015) A systematic review of literature on psychosocial aspects of gynecomastia in adolescents and young men. J Adolesc 43:206–212CrossRef
2.
go back to reference Kasielska-Trojan A, Antoszewski B (2017) Gynecomastia surgery-impact on life quality: a prospective case-control study. Ann Plast Surg 78(3):264–268CrossRefPubMed Kasielska-Trojan A, Antoszewski B (2017) Gynecomastia surgery-impact on life quality: a prospective case-control study. Ann Plast Surg 78(3):264–268CrossRefPubMed
3.
go back to reference Ciancio F, Innocenti A, Parisi D et al (2017) Gynecomastia classification for surgical management: a systematic review and novel classification system. Plast Reconstr Surg 140(4):620–621CrossRef Ciancio F, Innocenti A, Parisi D et al (2017) Gynecomastia classification for surgical management: a systematic review and novel classification system. Plast Reconstr Surg 140(4):620–621CrossRef
4.
go back to reference Rasko YM, Rosen C, Ngaage LM et al (2019) Surgical management of gynecomastia: a review of the current insurance coverage criteria. Plast Reconstr Surg 143(5):1361–1368CrossRefPubMed Rasko YM, Rosen C, Ngaage LM et al (2019) Surgical management of gynecomastia: a review of the current insurance coverage criteria. Plast Reconstr Surg 143(5):1361–1368CrossRefPubMed
5.
go back to reference Wyrick DL, Roberts M, Young ZT et al (2018) Changing practices: the addition of a novel surgical approach to gynecomastia. Am J Surg 216(3):547–550CrossRefPubMed Wyrick DL, Roberts M, Young ZT et al (2018) Changing practices: the addition of a novel surgical approach to gynecomastia. Am J Surg 216(3):547–550CrossRefPubMed
6.
go back to reference Angarita FA, Castelo M, Englesakis M et al (2020) Robot-assisted nipple-sparing mastectomy: systematic review. Br J Surg 107(12):1580–1594PubMed Angarita FA, Castelo M, Englesakis M et al (2020) Robot-assisted nipple-sparing mastectomy: systematic review. Br J Surg 107(12):1580–1594PubMed
7.
go back to reference Chengyu L, Jian Z, Xiaoxin J et al (2008) Experience of a large series of mastoscopic axillary lymph node dissection. J Surg Oncol 98(2):89–93CrossRefPubMed Chengyu L, Jian Z, Xiaoxin J et al (2008) Experience of a large series of mastoscopic axillary lymph node dissection. J Surg Oncol 98(2):89–93CrossRefPubMed
8.
go back to reference Luo C, Guo W, Yang J et al (2012) Comparison of mastoscopic and conventional axillary lymph node dissection in breast cancer: long-term results from a randomized, multicenter trial. Mayo Clin Proc 87(12):1153–1161CrossRefPubMedPubMedCentral Luo C, Guo W, Yang J et al (2012) Comparison of mastoscopic and conventional axillary lymph node dissection in breast cancer: long-term results from a randomized, multicenter trial. Mayo Clin Proc 87(12):1153–1161CrossRefPubMedPubMedCentral
9.
go back to reference Luo C, Wei C, Guo W et al (2022) 17-year follow-up of comparing mastoscopic and conventional axillary dissection in breast cancer: a multicenter randomized controlled trial. Adv Ther 39:2961–2970CrossRefPubMed Luo C, Wei C, Guo W et al (2022) 17-year follow-up of comparing mastoscopic and conventional axillary dissection in breast cancer: a multicenter randomized controlled trial. Adv Ther 39:2961–2970CrossRefPubMed
10.
go back to reference Varlet F, Raia-Barjat T, Bustangi N et al (2019) Treatment of gynecomastia by endoscopic subcutaneous mastectomy in adolescents. J Laparoendosc Adv Surg Tech A 29(8):1073–1076CrossRefPubMed Varlet F, Raia-Barjat T, Bustangi N et al (2019) Treatment of gynecomastia by endoscopic subcutaneous mastectomy in adolescents. J Laparoendosc Adv Surg Tech A 29(8):1073–1076CrossRefPubMed
11.
go back to reference Yang Y, Mu D, Xu B et al (2021) Endoscopic subcutaneous mastectomy plus liposuction via a single axillary incision for gynecomastia in Asian patients: a report of 45 cases. Surgery 170(1):39–46CrossRefPubMed Yang Y, Mu D, Xu B et al (2021) Endoscopic subcutaneous mastectomy plus liposuction via a single axillary incision for gynecomastia in Asian patients: a report of 45 cases. Surgery 170(1):39–46CrossRefPubMed
12.
go back to reference Nuzzi LC, Firriolo JM, Pike CM et al (2018) The effect of surgical treatment for gynecomastia on quality of life in adolescents. J Adolesc Health 63(3):759–765CrossRefPubMed Nuzzi LC, Firriolo JM, Pike CM et al (2018) The effect of surgical treatment for gynecomastia on quality of life in adolescents. J Adolesc Health 63(3):759–765CrossRefPubMed
13.
go back to reference Wang Y, Wang J, Liu L et al (2019) Comparison of curative effects between mammotome-assisted minimally invasive resection (MAMIR) and traditional open surgery for gynecomastia in Chinese patients: a prospective clinical study. Breast J 25(6):1084–1089CrossRefPubMed Wang Y, Wang J, Liu L et al (2019) Comparison of curative effects between mammotome-assisted minimally invasive resection (MAMIR) and traditional open surgery for gynecomastia in Chinese patients: a prospective clinical study. Breast J 25(6):1084–1089CrossRefPubMed
14.
go back to reference Mustafa T, Baran M, Erol K et al (2024) A novel surgical technique for gynecomastia: air-assisted minimally invasive surgery with single axillary incision. Surg Innov 31(1):5–10CrossRef Mustafa T, Baran M, Erol K et al (2024) A novel surgical technique for gynecomastia: air-assisted minimally invasive surgery with single axillary incision. Surg Innov 31(1):5–10CrossRef
15.
go back to reference Choi BS, Lee SR, Byun GY et al (2017) The characteristics and short-term surgical outcomes of adolescent gynecomastia. Aesthet Plast Surg 41(5):1011–1021CrossRef Choi BS, Lee SR, Byun GY et al (2017) The characteristics and short-term surgical outcomes of adolescent gynecomastia. Aesthet Plast Surg 41(5):1011–1021CrossRef
16.
go back to reference Lee SR, Lee SG (2021) Reoperation because of dissatisfaction with the aesthetic results of gynecomastia surgery: technical considerations. Aesthet Plast Surg 45(4):1444–1450CrossRef Lee SR, Lee SG (2021) Reoperation because of dissatisfaction with the aesthetic results of gynecomastia surgery: technical considerations. Aesthet Plast Surg 45(4):1444–1450CrossRef
17.
go back to reference Hua C, Zhixue Y, Yihui S et al (2013) Endoscopic subcutaneous mastectomy: a novel and effective treatment for gynecomastia. Exp Ther Med 5(6):1683–1686CrossRef Hua C, Zhixue Y, Yihui S et al (2013) Endoscopic subcutaneous mastectomy: a novel and effective treatment for gynecomastia. Exp Ther Med 5(6):1683–1686CrossRef
18.
go back to reference Kanakis GA, Nordkap L, Bang AK et al (2019) EAA clinical practice guidelines—gynecomastia evaluation and management. Andrology 7(6):778–793CrossRefPubMed Kanakis GA, Nordkap L, Bang AK et al (2019) EAA clinical practice guidelines—gynecomastia evaluation and management. Andrology 7(6):778–793CrossRefPubMed
19.
go back to reference Innocenti A, Melita D (2021) Expected reduction of the nipple-areolar complex over time after treatment of gynecomastia with ultrasound-assisted liposuction mastectomy compared to subcutaneous mastectomy alone. Aesthet Plast Surg 45(3):1350–1351CrossRef Innocenti A, Melita D (2021) Expected reduction of the nipple-areolar complex over time after treatment of gynecomastia with ultrasound-assisted liposuction mastectomy compared to subcutaneous mastectomy alone. Aesthet Plast Surg 45(3):1350–1351CrossRef
20.
go back to reference Qu S, Zhang W, Li S et al (2021) The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. Aesthet Plast Surg 45(2):404–410CrossRef Qu S, Zhang W, Li S et al (2021) The vacuum-assisted breast biopsy system is an effective strategy for the treatment of gynecomastia. Aesthet Plast Surg 45(2):404–410CrossRef
21.
go back to reference François V, Ciro E, Aurelien S et al (2023) Pediatric endoscopic subcutaneous mastectomy (pesma) with liposuction in adolescents with gynecomastia. Surg Endosc 37(1):766–773CrossRef François V, Ciro E, Aurelien S et al (2023) Pediatric endoscopic subcutaneous mastectomy (pesma) with liposuction in adolescents with gynecomastia. Surg Endosc 37(1):766–773CrossRef
22.
go back to reference Hoyos AE, Perez ME, Domínguez-Millán R (2021) Gynecomastia treatment through open resection and pectoral high-definition liposculpture. Plast Reconstr Surg 147(5):1072–1083CrossRefPubMed Hoyos AE, Perez ME, Domínguez-Millán R (2021) Gynecomastia treatment through open resection and pectoral high-definition liposculpture. Plast Reconstr Surg 147(5):1072–1083CrossRefPubMed
Metadata
Title
The Scar-Hidden Surgery on Gynecomastia: Experiences from a Single-Institutional Large Case Series
Authors
Chengyu Luo
Shuqi Zhang
Changsheng Wei
Yang Guo
Yajing Zhang
Publication date
17-06-2024
Publisher
Springer US
Published in
Aesthetic Plastic Surgery
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-024-04111-0