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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

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Abstract

Background

Currently, a standard, optimal surgical procedure is still lacking for gynecomastia. Despite the development of a variety of surgical interventions, these techniques were often limited to patients with Simon I and II. The present study aimed to introduce a novel technique for all types and grades of gynecomastia, and reported the preliminary results.

Methods

Patients who received single axillary incision reverse sequence endoscopic nipple-sparing mastectomy (R-E-NSM) from March 2021 to March 2023 were enrolled at a single institution. The data from 3-month follow-up cut-off were collected prospectively and analyzed to determine the short-term esthetic and safety results of this technique, as well as the learning curve.

Results

A total of 159 single axillary incision reverse sequence endoscopic nipple-sparing mastectomy procedures were performed in 81 gynecomastia patients. Among these 81 patients, 7 patients (8.6%) were classified as Simon grade I, 29 patients (35.8%) as grade IIa, 24 patients (29.6%) as grade IIb, and 21 patients (25.9%) as grade III. In the patient-reported cosmetic results, the overall satisfaction score was 8.4 ± 1.4. A total of 74.1% of patients were highly satisfied, and 25.9% were satisfied. The overall complication rate was 10.1%, and only 1 patient had a major complication. According to the cumulative sum plot analysis, approximately 12 cases were needed for surgeon B and 11 cases for surgeon C to decrease their operation time significantly.

Conclusions

R-E-NSM is safe and effective for all Simon grade gynecomastia patients, with excellent cosmetic results and a short learning curve. However, a long-term follow-up assessment is still needed.

Level of Evidence IV

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Funding

The article was supported by Health Commission of Sichuan Province, (21PJ042), Zhenggui Du, West China Hospital, Sichuan University, (2022HXFH004), Zhenggui Du, Natural Science Foundation of Sichuan Province, (22NSFSC2361), Zhenggui Du, Department of Science and Technology of Sichuan Province, (2021YFS0104), Faqing Liang.

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Author notes

  1. Zhenggui Du

    Present address: Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China

Authors and Affiliations

  1. Breast Centre, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China

    Huanzuo Yang, Faqing Liang, Yu Feng, Mengxue Qiu, Kawun Chung, Qing Zhang & Zhenggui Du

  2. Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China

    Huanzuo Yang, Faqing Liang, Yu Feng, Mengxue Qiu, Kawun Chung & Qing Zhang

  3. Department of General Surgery, The Fourth People’s Hospital of Sichuan Province, 12 Chengshoudong Street, Jinjiang District, Chengdu, 610016, China

    Yu Feng

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Correspondence to Zhenggui Du.

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The authors declare that they have no conflict of interest.

Ethical Approval

The study was approved by the Biomedical Ethics Committee of West China Hospital, Sichuan University (No. 2021-477).

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Written informed consent to use the clinical records was obtained from participants.

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Huanzuo Yang is the sole first author of this study.

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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. Aesth Plast Surg (2023). https://doi.org/10.1007/s00266-023-03727-y

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