Transaxillary suspension endoscopic-assisted subcutaneous gland excision: clinical outcomes and significance in gynecomastia management.

BACKGROUND

Gynecomastia (GM) is the most common male breast condition, often leading to psychological distress despite its benign nature. Surgical treatment is typically required for moderate to severe cases. Traditional subcutaneous mastectomy via midaxillary incision, while cosmetically concealed, may increase the risk of bleeding due to limited access. Endoscopic-assisted approaches offer better cosmetic and recovery outcomes but often require pneumoperitoneum, which carries physiological risks. To address these issues, a novel suspension endoscopic-assisted technique without pneumoperitoneum has been developed. This study aims to evaluate its safety, efficacy, and aesthetic outcomes compared to the conventional open approach.

METHODS

This single-center, non-randomized, retrospective comparative study analyzed 103 male patients with GM who underwent surgical treatment between January 2021 and March 2024. Patients were divided into two groups: 43 underwent lipolysis-free suspension endoscopic-assisted subcutaneous mastectomy (observation group), while 60 received conventional subcutaneous mastectomy via midaxillary incision (control group). Primary endpoints included perioperative parameters and complications. Secondary endpoints comprised a composite patient-reported satisfaction score assessed at the 180-day follow-up. Psychological parameters were evaluated using instruments at baseline and postoperatively to assess treatment-related psychological improvements.

RESULTS

Baseline demographic characteristics were comparable between the two groups (P>0.05). The observation group demonstrated significantly reduced intraoperative blood loss [32.00 (27.00-43.00) vs. 57.00 (41.00-65.00) mL; P<0.001], lower postoperative drainage volume [27.00 (24.50-30.00) vs. 35.12 (33.00-37.50) mL; P<0.001], and shorter drain duration [3.00 (3.00-3.00) vs. 4.00 (4.00-5.00) days; P<0.001], albeit with longer operative time [123.00 (109.00-135.00) vs. 35.00 (32.00-37.00) min; P<0.001]. Complication rates, including nipple-areola necrosis and postoperative bleeding, did not differ significantly between groups (P>0.05). Patient satisfaction scores were consistently higher in the observation group across multiple domains: self-perception (P<0.001), skin incision appearance (P<0.001), and bilateral symmetry (P<0.001). Nipple sensation was also slightly better (P=0.011). Psychological assessments revealed greater postoperative improvement in interpersonal sensitivity in the observation group (P<0.001), with no significant group differences in obsessive-compulsive or depression-anxiety symptoms.

CONCLUSIONS

This retrospective study demonstrated that transaxillary suspension endoscopic-assisted subcutaneous mastectomy significantly reduced intraoperative blood loss, postoperative drainage volume, and drainage duration, albeit with a longer operative time. While the incidence of postoperative complications was comparable between groups, the endoscopic approach was associated with significantly higher patient-reported satisfaction across multiple aesthetic domains and yielded greater improvement in postoperative psychological adaptation, particularly in interpersonal sensitivity.