Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Surgery. 2021 Jul;170(1):39-46. doi: 10.1016/j.surg.2021.01.046. Epub 2021 Mar 11.
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.
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.
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).
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.
大多数乳房缩小术的技术都是通过前侧和/或外侧胸部切口进行的，呈现出“手术”的外观。我们最初的经验是在男性乳房发育症中采用内窥镜下皮下乳房切除术和腋窝单切口吸脂术相结合的方法。
在 2018 年 9 月至 2019 年 7 月期间，我们纳入了 45 例西蒙 I 级或 II 级男性乳房发育症患者。详细记录了患者的人口统计学、手术数据和术后并发症。4 位独立观察者根据术前和术后照片，对 6 个主要美学方面进行 1 到 5 分的评分，对 6 个主要美学方面进行评分。
所有病例均成功完成经腋窝单切口内窥镜下皮下乳房切除术联合吸脂术。每侧手术时间平均为 82.6 分钟（37.5-132.5 分钟）。89 个乳房切除的腺体组织重量为 26 至 130 克，抽吸量为 60 至 700 毫升。3 例单侧皮下血清肿（3.3%）、5 例单侧血肿（5.6%）和 1 例双侧轻微皮肤冗余（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、轮廓规则性和整体外观等方面的美学效果明显优于 IIb 级（P <.001）。IIa 级男性乳房发育症患者在乳头形状、轮廓规则性和整体外观方面的改善也优于 IIb 级（P <.05）。
经腋窝单切口内窥镜下皮下乳房切除术联合吸脂术是一种治疗男性乳房发育症的可行微创技术。对于西蒙 I 级和 IIa 级男性乳房发育症，联合方法在获得满意的美学效果方面是有效的，对于 IIb 级也可以作为一种替代选择。
