{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:11:03Z","timestamp":1792782663040,"version":"4.5.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82372770"],"award-info":[{"award-number":["82372770"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"the Science and Technology Development Fund of Nanjing Medical University","award":["NMUB20230014"],"award-info":[{"award-number":["NMUB20230014"]}],"id":[{"id":"https:\/\/ror.org\/059gcgy73","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Aesth Plast Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gynaecomastia (GNY) is the most common benign proliferation of glandular breast tissues in males and is frequently associated with psychosocial distress and aesthetic concerns. Traditional open surgical approaches are associated with visible scarring and prolonged postoperative recovery. Minimally invasive techniques, including liposuction-assisted endoscopic procedures, may still result in visible scars and residual glandular tissue. In this study, we evaluated the safety, efficacy, and aesthetic outcomes of endoscopic subcutaneous mastectomy combined with cold-knife flap dissection through a single axillary incision for the treatment of GNY.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 51 male patients with GNY involving 102 breasts who underwent surgical treatment between August 2023 and October 2024 were enrolled. Patient demographics, operative data, postoperative complications, and satisfaction outcomes were systematically recorded. Four independent observers evaluated preoperative and postoperative photographs using a 1\u201315 scoring system based on six major aesthetic parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Endoscopic subcutaneous mastectomy combined with cold-knife flap dissection through a single axillary incision was successfully completed in all patients. The mean operative time was 46.84 \u00b1 15.04 per side (range 14\u201387) min. The mean thickness of the resected glandular tissues was 2.80 \u00b1 0.88 (range 1\u20135) cm. The mean postoperative drainage volume was 48.72 \u00b1 34.74 (range 10\u2013170) mL, and the mean hospital stay was 4.31 \u00b1 1.57 (range 2\u20138) days. Postoperative complications included hematoma in two breasts, seromas in one breast, and effusion in two breasts, whereas skin redundancy occurred in two patients with bilateral GNY. No patient developed severe pain, infection, nipple\u2013areolar complex necrosis, nipple retraction, or skin flap necrosis. All patients reported satisfaction with postoperative quality of life (100%), and no recurrence was observed during follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Endoscopic subcutaneous mastectomy combined with cold-knife flap dissection through a single axillary incision appears to be a safe and effective approach for GNY, offering minimal invasiveness, rapid postoperative recovery, and favourable aesthetic outcomes. This technique may improve patient satisfaction and may represent a promising treatment option owing to its favourable safety profile and cosmetic outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence IV<\/jats:title>\n                    <jats:p>\n                      This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.springer.com\/00266\" ext-link-type=\"uri\">www.springer.com\/00266<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00266-026-06274-4","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:56:27Z","timestamp":1792173387000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic Subcutaneous Mastectomy with Cold-Knife Flap Dissection Through a Single Axillary Incision for Gynaecomastia"],"prefix":"10.1007","author":[{"given":"Jinqiu","family":"Xue","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1499-6200","authenticated-orcid":false,"given":"Qiang","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"6274_CR1","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1097\/MOP.0b013e328305e415","volume":"20","author":"NS Ma","year":"2008","unstructured":"Ma NS, Geffner ME. Gynecomastia in prepubertal and pubertal men. Curr Opin Pediatr. 2008;20:465\u201370.","journal-title":"Curr Opin Pediatr"},{"key":"6274_CR2","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1097\/PRS.0000000000004807","volume":"142","author":"RC Caridi","year":"2018","unstructured":"Caridi RC. Defining the aesthetic units of the male chest and how they relate to gynecomastia based on 635 patients. Plast Reconstr Surg. 2018;142:904\u20137.","journal-title":"Plast Reconstr Surg"},{"key":"6274_CR3","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.1007\/s00266-018-1118-x","volume":"42","author":"I Abdelrahman","year":"2018","unstructured":"Abdelrahman I, Steinvall I, Mossaad B, Sjoberg F, Elmasry M. Evaluation of glandular liposculpture as a single treatment for grades I and II gynaecomastia. Aesthet Plast Surg. 2018;42:1222\u201330.","journal-title":"Aesthet Plast Surg"},{"key":"6274_CR4","first-page":"145","volume":"7","author":"RE Johnson","year":"2011","unstructured":"Johnson RE, Kermott CA, Murad MH. Gynecomastia - evaluation and current treatment options. Ther Clin Risk Manag. 2011;7:145\u20138.","journal-title":"Ther Clin Risk Manag"},{"key":"6274_CR5","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.surg.2021.01.046","volume":"170","author":"Y Yang","year":"2021","unstructured":"Yang Y, Mu D, Xu B, Li W, Zhang X, Lin Y, et al. Endoscopic subcutaneous mastectomy plus liposuction via a single axillary incision for gynecomastia in Asian patients: a report of 45 cases. Surgery. 2021;170:39\u201346.","journal-title":"Surgery"},{"key":"6274_CR6","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1038\/nrendo.2014.139","volume":"10","author":"HS Narula","year":"2014","unstructured":"Narula HS, Carlson HE. Gynaecomastia\u2013pathophysiology, diagnosis and treatment. Nat Rev Endocrinol. 2014;10:684\u201398.","journal-title":"Nat Rev Endocrinol"},{"key":"6274_CR7","doi-asserted-by":"publisher","first-page":"2655","DOI":"10.1007\/s00266-022-02807-9","volume":"46","author":"C Liu","year":"2022","unstructured":"Liu C, Tong Y, Sun F, Zhang C, Yu Z, Yu P, et al. Endoscope-assisted minimally invasive surgery for the treatment of glandular gynecomastia. Aesthetic Plast Surg. 2022;46:2655\u201364.","journal-title":"Aesthetic Plast Surg"},{"key":"6274_CR8","first-page":"215","volume":"39","author":"AK Leung","year":"1989","unstructured":"Leung AK. Gynecomastia. Am Fam Physician. 1989;39:215\u201322.","journal-title":"Am Fam Physician"},{"key":"6274_CR9","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1159\/000525096","volume":"17","author":"SL Herbert","year":"2022","unstructured":"Herbert SL, Ergezinger K, Sauer S, Kurz F, Schlaiss T, Wockel A, et al. Prepubertal idiopathic unilateral gynecomastia: case report and literature review. Breast Care (Basel). 2022;17:573\u20139.","journal-title":"Breast Care (Basel)"},{"key":"6274_CR10","doi-asserted-by":"publisher","first-page":"127","DOI":"10.2174\/1872214811666170301124033","volume":"10","author":"AKC Leung","year":"2017","unstructured":"Leung AKC, Leung AAC. Gynecomastia in infants, children, and adolescents. Recent Pat Endocr Metab Immune Drug Discov. 2017;10:127\u201337.","journal-title":"Recent Pat Endocr Metab Immune Drug Discov"},{"key":"6274_CR11","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.surg.2023.04.022","volume":"174","author":"F Shang","year":"2023","unstructured":"Shang F, Zhao Z, Li Z, Liu B. The combination of endoscopic subcutaneous mastectomy and liposuction (Liu and Shang\u2019s 2-hole 7-step method) as the treatment of gynecomastia. Surgery. 2023;174:159\u201365.","journal-title":"Surgery"},{"key":"6274_CR12","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1111\/tbj.13424","volume":"25","author":"Y Wang","year":"2019","unstructured":"Wang Y, Wang J, Liu L, Liang W, Qin Y, Zheng Z, et al. 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. 2019;25:1084\u20139.","journal-title":"Breast J"},{"key":"6274_CR13","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/0007-1226(76)90035-7","volume":"29","author":"RH Brown","year":"2015","unstructured":"Brown RH, Chang DK, Siy R, Friedman J. Trends in the surgical correction of gynecomastia. Semin Plast Surg. 2015;29:122\u201330.","journal-title":"Semin Plast Surg"},{"key":"6274_CR14","doi-asserted-by":"publisher","first-page":"e33020","DOI":"10.1097\/MD.0000000000033020","volume":"102","author":"M Tukenmez","year":"2023","unstructured":"Tukenmez M, Emiroglu S, Kozanoglu E, Akalin BE, Mollavelioglu B, Cabioglu N, et al. Single axillary incision endoscopic surgery and liposuction for gynecomastia. Medicine (Baltimore). 2023;102:e33020.","journal-title":"Medicine (Baltimore)"},{"key":"6274_CR15","doi-asserted-by":"publisher","first-page":"1704","DOI":"10.1016\/j.surg.2021.10.031","volume":"171","author":"R Kapoor","year":"2022","unstructured":"Kapoor R, Dharmalingam GC, Sonkar AA, Anand A, Agrawal MK, Gaurav K. Endoscopic subcutaneous mastectomy plus liposuction via a single axillary incision for gynecomastia: Views from developing world. Surgery. 2022;171:1704\u20137.","journal-title":"Surgery"},{"key":"6274_CR16","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1016\/j.jpedsurg.2009.11.016","volume":"45","author":"CA Laituri","year":"2010","unstructured":"Laituri CA, Garey CL, Ostlie DJ, St Peter SD, Gittes GK, Snyder CL. Treatment of adolescent gynecomastia. J Pediatr Surg. 2010;45:650\u20134.","journal-title":"J Pediatr Surg"},{"key":"6274_CR17","doi-asserted-by":"publisher","first-page":"e231","DOI":"10.1016\/j.bjps.2011.04.016","volume":"64","author":"G Jarrar","year":"2011","unstructured":"Jarrar G, Peel A, Fahmy R, Deol H, Salih V, Mostafa A. Single incision endoscopic surgery for gynaecomastia. J Plast Reconstr Aesthet Surg. 2011;64:e231-236.","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"6274_CR18","doi-asserted-by":"publisher","first-page":"766","DOI":"10.1007\/s00464-022-09550-x","volume":"37","author":"F Varlet","year":"2023","unstructured":"Varlet F, Esposito C, Scalabre A, Lepore B, Vermersch S, Escolino M. Pediatric endoscopic subcutaneous mastectomy (PESMA) with liposuction in adolescents with gynecomastia. Surg Endosc. 2023;37:766\u201373.","journal-title":"Surg Endosc"},{"key":"6274_CR19","doi-asserted-by":"publisher","first-page":"4648","DOI":"10.1007\/s00266-025-04872-2","volume":"49","author":"B Atieh","year":"2025","unstructured":"Atieh B, Baajour J, El Merkabaoui H, Makkawi K. Literature review and evidence-based comparative analysis of traditional suction-assisted lipectomy (SAL) vs. ultrasound-assisted liposuction (UAL) reported outcomes. Aesthetic Plast Surg. 2025;49:4648\u201355.","journal-title":"Aesthetic Plast Surg"},{"key":"6274_CR20","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1016\/j.jpra.2024.09.011","volume":"42","author":"G Frigerio","year":"2024","unstructured":"Frigerio G, Serre A, Engels PE, Kalbermatten DF, Andre-Levigne D. Available techniques to minimize scars in surgical management of gynecomastia\u2014a comprehensive review. JPRAS Open. 2024;42:256\u201367.","journal-title":"JPRAS Open"},{"key":"6274_CR21","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1016\/j.asj.2009.02.020","volume":"29","author":"J Benito-Ruiz","year":"2009","unstructured":"Benito-Ruiz J, Raigosa M, Manzano M, Salvador L. Assessment of a suction-assisted cartilage shaver plus liposuction for the treatment of gynecomastia. Aesthet Surg J. 2009;29:302\u20139.","journal-title":"Aesthet Surg J"},{"key":"6274_CR22","doi-asserted-by":"publisher","first-page":"S10","DOI":"10.1093\/asj\/sjae152","volume":"45","author":"AE Hoyos","year":"2025","unstructured":"Hoyos AE, Perez Pachon ME, Vranis NM. Body contouring finesse: dynamic definition liposculpture and bipolar radiofrequency microneedling. Aesthet Surg J. 2025;45:S10\u201322.","journal-title":"Aesthet Surg J"},{"key":"6274_CR23","doi-asserted-by":"publisher","DOI":"10.1093\/bjsopen\/zraf011","author":"A Carroll","year":"2025","unstructured":"Carroll A, Robles C, Lai HW, Blay L, Pluta P, Rathat G, et al. Oncological, surgical, and cosmetic outcomes of endoscopic versus conventional nipple-sparing mastectomy: meta-analysis. BJS Open. 2025. https:\/\/doi.org\/10.1093\/bjsopen\/zraf011.","journal-title":"BJS Open"},{"key":"6274_CR24","doi-asserted-by":"publisher","first-page":"1366877","DOI":"10.3389\/fonc.2024.1366877","volume":"14","author":"K Chung","year":"2024","unstructured":"Chung K, Xie Y, Liang F, Qiu M, Yang H, Zhang Q, et al. Reverse-sequence endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction: an improvement of conventional minimal access breast surgery. Front Oncol. 2024;14:1366877.","journal-title":"Front Oncol"},{"key":"6274_CR25","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1007\/978-981-32-9620-6_30","volume":"1187","author":"H Shin","year":"2021","unstructured":"Shin H. Current trends in and indications for endoscopy-assisted breast surgery for breast cancer. Adv Exp Med Biol. 2021;1187:567\u201390.","journal-title":"Adv Exp Med Biol"},{"key":"6274_CR26","first-page":"818","volume":"38","author":"Y Liu","year":"2024","unstructured":"Liu Y, Li M, Hu Y, Dong X, Meng H, Liu B. Analysis of preoperative assessment of glandular mass in gynecomastia. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024;38:818\u201322.","journal-title":"Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi"},{"key":"6274_CR27","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1007\/BF01571474","volume":"13","author":"AC Abramo","year":"1989","unstructured":"Abramo AC, Viola JC. Liposuction through an axillary incision for treatment of gynecomastia. Aesthet Plast Surg. 1989;13:85\u20139.","journal-title":"Aesthet Plast Surg"},{"key":"6274_CR28","doi-asserted-by":"publisher","first-page":"4443","DOI":"10.1007\/s00266-024-04269-7","volume":"48","author":"N Wang","year":"2024","unstructured":"Wang N, Wei S, Qiang S, Wang J, Zeng X, Zhang Z. Liposuction through an axillary fold incision combined with a small areola incision to treat gynecomastia. Aesthet Plast Surg. 2024;48:4443\u201351.","journal-title":"Aesthet Plast Surg"},{"key":"6274_CR29","doi-asserted-by":"publisher","first-page":"3049","DOI":"10.1007\/s00266-025-04666-6","volume":"49","author":"C Xu","year":"2025","unstructured":"Xu C, Diao Y, Chen R, Chen M, Lai B. Single axillary incision versus triple lateral chest wall incisions in endoscopic mastectomy for gynecomastia: a single-center retrospective analysis with propensity score matching. Aesthet Plast Surg. 2025;49:3049\u201360.","journal-title":"Aesthet Plast Surg"},{"key":"6274_CR30","first-page":"28","volume":"15","author":"CA Riccio","year":"2015","unstructured":"Riccio CA, Zeiderman MR, Chowdhry S, Brooks RM, Kelishadi SS, Tutela JP, et al. Plastic surgery of the breast: keeping the nipple sensitive. Eplasty. 2015;15:28.","journal-title":"Eplasty"}],"container-title":["Aesthetic Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-026-06274-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00266-026-06274-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-026-06274-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:56:28Z","timestamp":1792173388000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00266-026-06274-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":30,"alternative-id":["6274"],"URL":"https:\/\/doi.org\/10.1007\/s00266-026-06274-4","relation":{},"ISSN":["0364-216X","1432-5241"],"issn-type":[{"value":"0364-216X","type":"print"},{"value":"1432-5241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,16]]},"assertion":[{"value":"6 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no conflicts of interest pertaining to the products or concepts addressed in this investigation.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The principles outlined in the Declaration of Helsinki have been followed. This study was approved by the Ethics Committee of the Second Affiliated Hospital of Nanjing Medical University.","order":2,"name":"Ethics","label":"Ethical Approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from all participants before the operation.","order":3,"name":"Ethics","label":"Informed Consent","group":{"name":"EthicsHeading","label":"Declarations"}}]}}