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Single axillary incision endoscopic surgery and liposuction for gynecomastia (2023)
Mustafa Tukenmez, MD, Selman Emiroglu, MD, Erol Kozanoglu, MD, Bora Edim Akalin, MD, Baran Mollavelioglu, MD, Neslihan Cabioglu, MD, Mahmut Muslumanoglu, MD
Abstract
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 88.5g (range: 42.5–440g), 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.
1. Introduction
Gynecomastia is a benign enlargement of the male breast due to the proliferation of the breast tissue. Physiologic gynecomastia is common in neonates, adolescents, and elderly men.[1] Even if gynecomastia is diffuse and asymptomatic, careful anamnesis, physical examination, and laboratory analysis should be performed to rule out any underlying breast tumor or endocrine or systemic disease. Gynecomastia often resolves spontaneously, and these cases require careful clinical observation. A small number of patients require treatment for cosmesis and analgesia. The earlier the medication is started, the more effective it becomes. Surgery is useful for patients who have been symptomatic for a long time, and for whom medical treatment has been ineffective.[1,2]
Many open surgical techniques are used to treat gynecomastia. Complications such as subtotal glandular resection, contour irregularity, nipple–areola complex collapse, nipple–areola complex distortion, ischemia, necrosis, and diffuse scarring can occur.[3–5] A minimally invasive approach has been used in breast surgery for both malignant and benign diseases such as gynecomastia.[6–9] Minimally invasive techniques for gynecomastia initially include the use of vacuum-assisted biopsy devices and liposuction from the anterior axillary line and inframammary fold.[10,11] Endoscopic mastectomy techniques have been explored over the last decade.[12–18]
This study aimed to investigate the efficacy of endoscopic mastectomy and liposuction through a single axillary incision, and its effects on patient satisfaction.
Discussion
*Although EM has many advantages over open surgery, such as small incisions, minimal tissue trauma, increased nipple viability, and early recovery, it also has limitations, such as a small surgical site, the use of rigid instruments, instrument collisions, and prolonged operative time. The limitation of this technique is that it cannot be used in cases that require skin excision. In the near future, the use of angulated flexible instruments closer to a single port and mobile 3-dimensional cameras will reduce instrument collisions and operative time.
5. Conclusions
Endoscopic nipple–areola-sparing mastectomy combined with liposuction with a single axillary incision is a safe and effective technique for the surgical treatment of gynecomastia, with high patient satisfaction in terms of physical appearance, mental status, and social environment. Although the operative time is long and the learning curve is steep, it can easily be performed by experienced surgeons as an alternative method for patients who do not require skin excision.
Mustafa Tukenmez, MD, Selman Emiroglu, MD, Erol Kozanoglu, MD, Bora Edim Akalin, MD, Baran Mollavelioglu, MD, Neslihan Cabioglu, MD, Mahmut Muslumanoglu, MD
Abstract
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 88.5g (range: 42.5–440g), 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.
1. Introduction
Gynecomastia is a benign enlargement of the male breast due to the proliferation of the breast tissue. Physiologic gynecomastia is common in neonates, adolescents, and elderly men.[1] Even if gynecomastia is diffuse and asymptomatic, careful anamnesis, physical examination, and laboratory analysis should be performed to rule out any underlying breast tumor or endocrine or systemic disease. Gynecomastia often resolves spontaneously, and these cases require careful clinical observation. A small number of patients require treatment for cosmesis and analgesia. The earlier the medication is started, the more effective it becomes. Surgery is useful for patients who have been symptomatic for a long time, and for whom medical treatment has been ineffective.[1,2]
Many open surgical techniques are used to treat gynecomastia. Complications such as subtotal glandular resection, contour irregularity, nipple–areola complex collapse, nipple–areola complex distortion, ischemia, necrosis, and diffuse scarring can occur.[3–5] A minimally invasive approach has been used in breast surgery for both malignant and benign diseases such as gynecomastia.[6–9] Minimally invasive techniques for gynecomastia initially include the use of vacuum-assisted biopsy devices and liposuction from the anterior axillary line and inframammary fold.[10,11] Endoscopic mastectomy techniques have been explored over the last decade.[12–18]
This study aimed to investigate the efficacy of endoscopic mastectomy and liposuction through a single axillary incision, and its effects on patient satisfaction.
Discussion
*Although EM has many advantages over open surgery, such as small incisions, minimal tissue trauma, increased nipple viability, and early recovery, it also has limitations, such as a small surgical site, the use of rigid instruments, instrument collisions, and prolonged operative time. The limitation of this technique is that it cannot be used in cases that require skin excision. In the near future, the use of angulated flexible instruments closer to a single port and mobile 3-dimensional cameras will reduce instrument collisions and operative time.
5. Conclusions
Endoscopic nipple–areola-sparing mastectomy combined with liposuction with a single axillary incision is a safe and effective technique for the surgical treatment of gynecomastia, with high patient satisfaction in terms of physical appearance, mental status, and social environment. Although the operative time is long and the learning curve is steep, it can easily be performed by experienced surgeons as an alternative method for patients who do not require skin excision.
