{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T08:20:53Z","timestamp":1792225253890,"version":"4.4.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T00:00:00Z","timestamp":1661990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100007195","name":"Universit\u00e0 degli Studi di Napoli Federico II","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007195","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Surgical techniques for treatment of gynecomastia are increasingly less invasive. We described technical standardization of pediatric endoscopic subcutaneous mastectomy (PESMA) with liposuction.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>All adolescents with primary gynecomastia, operated using PESMA with liposuction over the period June 2014\u2013July 2021, were included. The video recording of procedures was analyzed to standardize the operative technique. After patient installation, 3 trocars were placed on the mid-axillary line. The technique included 5 steps: (1) subcutaneous injection of lipolysis solution and liposuction; (2) creation of working space using an inflated balloon; (3) gland dissection using 5-mm sealing device; (4) specimen extraction through the largest trocar orifice; and (5) placement of suction drainage tube.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Twenty-four male adolescents, operated for Simon\u2019s grade 2B and 3 gynecomastia using PESMA with liposuction over the study period, were included. Mean patient age was 16\u00a0years (range 15\u201318). Gynecomastia was bilateral in 19\/24 (79.2%) and unilateral in 5\/24 (20.8%). One (4.1%) conversion to open was reported. The mean operative time was 87\u00a0min (range 98\u2013160) for unilateral and 160\u00a0min (range 140\u2013250) for bilateral procedure. The mean length of stay was 2.2\u00a0days (range 1\u20134). Patients wore a thoracic belt for 15 up to 30\u00a0days postoperatively. Post-operative complications occurred in 5\/24 (20.8%): 2- or 3\u00a0mm second-degree burns in 4 (16.7%) and subcutaneous seroma in 1 (4.1%). All complications were Clavien 2 grade and did not require further treatment. Aesthetic outcomes were very good in 21\/24 (87.5%). Three (12.5%) boys had persistent minimal breast asymmetry but did never perceive it negatively.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>PESMA combined with liposuction was feasible and safe for surgical treatment of gynecomastia in this selected cohort of patients. Although challenging, this procedure provided good aesthetic results, with no scars on the anterior thoracic wall. Standardization of the operative technique was a key point for successful outcome.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00464-022-09550-x","type":"journal-article","created":{"date-parts":[[2022,9,1]],"date-time":"2022-09-01T18:02:58Z","timestamp":1662055378000},"page":"766-773","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Pediatric endoscopic subcutaneous mastectomy (pesma) with liposuction in adolescents with gynecomastia"],"prefix":"10.1007","volume":"37","author":[{"given":"Fran\u00e7ois","family":"Varlet","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciro","family":"Esposito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurelien","family":"Scalabre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetta","family":"Lepore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Vermersch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Escolino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,9,1]]},"reference":[{"key":"9550_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 (2008) Gynecomastia in prepubertal and pubertal men. Curr Opin Pediatr 20:465\u2013470","journal-title":"Curr Opin Pediatr"},{"issue":"2","key":"9550_CR2","doi-asserted-by":"publisher","first-page":"150","DOI":"10.4103\/2230-8210.129104","volume":"18","author":"N Cuhaci","year":"2014","unstructured":"Cuhaci N, Polat SB, Evranos B, Ersoy R, Cakir B (2014) Gynecomastia: Clinical evaluation and management. Indian J Endocrinol Metab 18(2):150\u2013158","journal-title":"Indian J Endocrinol Metab"},{"key":"9550_CR3","first-page":"145","volume":"7","author":"RE Johnson","year":"2011","unstructured":"Johnson RE, Kermott CA, Murad MH (2011) Gynecomastia - evaluation and current treatment options. Ther Clin Risk Manag 7:145\u2013148","journal-title":"Ther Clin Risk Manag"},{"issue":"2","key":"9550_CR4","first-page":"204","volume":"88","author":"AT Soliman","year":"2017","unstructured":"Soliman AT, De Sanctis V, Yassin M (2017) Management of adolescent gynecomastia: an update. Acta Biomed 88(2):204\u2013213","journal-title":"Acta Biomed"},{"issue":"1","key":"9550_CR5","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1097\/SMJ.0000000000000033","volume":"107","author":"B Ladizinski","year":"2014","unstructured":"Ladizinski B, Lee KC, Nutan FN, Higgins HW 2nd, Federman DG (2014) Gynecomastia: etiologies, clinical presentations, diagnosis, and management. South Med J 107(1):44\u201349","journal-title":"South Med J"},{"key":"9550_CR6","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1056\/NEJMcp070677","volume":"357","author":"GD Braunstein","year":"2007","unstructured":"Braunstein GD (2007) Clinical practice. Gynecomastia N Engl J Med 357:1229\u20131237","journal-title":"Gynecomastia N Engl J Med"},{"issue":"1","key":"9550_CR7","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1007\/s12020-016-0975-9","volume":"55","author":"A Sansone","year":"2017","unstructured":"Sansone A, Romanelli F, Sansone M, Lenzi A, Di Luigi L (2017) Gynecomastia and hormones. Endocrine 55(1):37\u201344","journal-title":"Endocrine"},{"key":"9550_CR8","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/j.bodyim.2015.08.004","volume":"15","author":"DL Ordaz","year":"2015","unstructured":"Ordaz DL, Thompson JK (2015) Gynecomastia and psychological functioning: a review of the literature. Body Image 15:141\u2013148","journal-title":"Body Image"},{"issue":"3","key":"9550_CR9","doi-asserted-by":"publisher","first-page":"498","DOI":"10.9758\/cpn.2021.19.3.498","volume":"19","author":"SC Arslan","year":"2021","unstructured":"Arslan SC, Esin IS, Cay\u0131r A, Orbak Z, Dursun OB (2021) The Relationship between psychopathology, self-esteem, body perception and serum sex steroids in pubertal gynecomastia. Clin Psychopharmacol Neurosci 19(3):498\u2013506","journal-title":"Clin Psychopharmacol Neurosci"},{"key":"9550_CR10","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1097\/00006534-197301000-00009","volume":"51","author":"BE Simon","year":"1973","unstructured":"Simon BE, Hoffman S, Kahn S (1973) Classification and surgical correction of gynecomastia. Plast Reconstr Surg 51:48\u201352","journal-title":"Plast Reconstr Surg"},{"key":"9550_CR11","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/S0002-9610(99)00108-7","volume":"178","author":"M Colombo-Benkmann","year":"1999","unstructured":"Colombo-Benkmann M, Buse B, Stern J, Herfarth C (1999) Indications for and results of surgical therapy for male gynecomastia. Am J Surg 178:60\u201363","journal-title":"Am J Surg"},{"key":"9550_CR12","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1007\/s00383-014-3508-8","volume":"30","author":"S Fischer","year":"2014","unstructured":"Fischer S, Hirsch T, Hirche C, Kiefer J, Kueckelhaus M, Germann G, Reichenberger MA (2014) Surgical treatment of primary gynecomastia in children and adolescents. Pediatr Surg Int 30:641\u2013647","journal-title":"Pediatr Surg Int"},{"key":"9550_CR13","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 (2010) Treatment of adolescent gynecomastia. J Pediatr Surg 45:650\u2013654","journal-title":"J Pediatr Surg"},{"key":"9550_CR14","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1308\/003588410X12628812458815","volume":"92","author":"O Qutob","year":"2010","unstructured":"Qutob O, Elahi B, Garimella V, Ihsan N, Drew PJ (2010) Minimally invasive excision of gynecomastia\u2013a novel and effective surgical technique. Ann R Coll Surg Engl 92:198\u2013200","journal-title":"Ann R Coll Surg Engl"},{"key":"9550_CR15","doi-asserted-by":"publisher","first-page":"e85","DOI":"10.1097\/SLE.0b013e3181a2fdbd","volume":"19","author":"L Fan","year":"2009","unstructured":"Fan L, Yang X, Zhang Y, Jiang J (2009) Endoscopic subcutaneous mastectomy for the treatment of gynecomastia. A report of 65 cases. Surg Laparosc Endosc Percutan Tech 19:e85\u2013e90","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"key":"9550_CR16","doi-asserted-by":"publisher","first-page":"1683","DOI":"10.3892\/etm.2013.1032","volume":"5","author":"H Cao","year":"2013","unstructured":"Cao H, Yang ZX, Sun YH, Wu HR, Jiang GQ (2013) Endoscopic subcutaneous mastectomy: a novel and effective treatment for gynecomastia. Exp Ther Med 5:1683\u20131686","journal-title":"Exp Ther Med"},{"issue":"1","key":"9550_CR17","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, Li H (2021) Endoscopic subcutaneous mastectomy plus liposuction via a single axillary incision for gynecomastia in Asian patients: a report of 45 cases. Surgery 170(1):39\u201346","journal-title":"Surgery"},{"issue":"8","key":"9550_CR18","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1089\/lap.2019.0256","volume":"29","author":"F Varlet","year":"2019","unstructured":"Varlet F, Raia-Barjat T, Bustangi N, Vermersch S, Scalabre A (2019) Treatment of gynecomastia by endoscopic subcutaneous mastectomy in adolescents. J Laparoendosc Adv Surg Tech A 29(8):1073\u20131076","journal-title":"J Laparoendosc Adv Surg Tech A"},{"issue":"5","key":"9550_CR19","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1089\/109264202320884045","volume":"12","author":"DD Gaur","year":"2002","unstructured":"Gaur DD, Gopichand M, Dubey M, Jhunjhunwala V (2002) Mini-access for retroperitoneal laparoscopy. J Laparoendosc Adv Surg Tech A 12(5):313\u2013315","journal-title":"J Laparoendosc Adv Surg Tech A"},{"key":"9550_CR20","doi-asserted-by":"publisher","first-page":"8364824","DOI":"10.1155\/2018\/8364824","volume":"2018","author":"PR Costanzo","year":"2018","unstructured":"Costanzo PR, Pacenza NA, Aszpis SM, Su\u00e1rez SM, Pragier UM, Usher JGS, V\u00e1squez Cayoja M, Iturrieta S, Gottlieb SE, Rey RA, Knoblovits P (2018) Clinical and etiological aspects of gynecomastia in adult males: a multicenter study. Biomed Res Int 2018:8364824","journal-title":"Biomed Res Int"},{"key":"9550_CR21","first-page":"797","volume":"16","author":"J Liu","year":"2018","unstructured":"Liu J, Han Y, Cheng K, Wang XH, Guo F, Yang ZL (2018) Single-incision surgery for gynecomastia using TriPort: a case report. Exp Ther Med 16:797\u2013801","journal-title":"Exp Ther Med"},{"key":"9550_CR22","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 (2011) Single incision endoscopic surgery for gynaecomastia. J Plast Reconstr Aesthet Surg 64:e231\u2013e236","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"9550_CR23","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1007\/s004649900895","volume":"13","author":"TN Tsangaris","year":"1999","unstructured":"Tsangaris TN, Trad K, Brody FJ, Jacobs LK, Tsangaris NT, Sackier JM (1999) Endoscopic axillary exploration and sentinel lymphadenectomy. Surg Endosc 13:43\u201347","journal-title":"Surg Endosc"},{"key":"9550_CR24","doi-asserted-by":"publisher","first-page":"187s","DOI":"10.1016\/S0753-3322(02)00206-8","volume":"56","author":"Y Tamaki","year":"2002","unstructured":"Tamaki Y, Tsukamoto F, Miyoshi Y, Tanji Y, Taguchi T, Noguchi S (2002) Overview: video-assisted breast surgery. Biomed Pharmacother 56:187s\u2013191s","journal-title":"Biomed Pharmacother"},{"key":"9550_CR25","doi-asserted-by":"publisher","first-page":"S324","DOI":"10.1067\/msy.2002.120120","volume":"131","author":"K Kitamura","year":"2002","unstructured":"Kitamura K, Ishida M, Inoue H, Kinoshita J, Hashizume M, Sugimachi K (2002) Early results of an endoscope-assisted subcutaneous mastectomy and reconstruction for breast cancer. Surgery 131:S324\u2013S329","journal-title":"Surgery"},{"key":"9550_CR26","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/j.breast.2016.10.009","volume":"31","author":"A Toesca","year":"2017","unstructured":"Toesca A, Peradze N, Manconi A, Galimberti V, Intra M, Colleoni M, Bonanni B, Curigliano G, Rietjens M, Viale G, Sacchini V, Veronesi P (2017) Robotic nipple-sparing mastectomy for treatment of breast cancer: feasibility and safety study. Breast 31:51\u201356","journal-title":"Breast"}],"container-title":["Surgical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-022-09550-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00464-022-09550-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-022-09550-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T20:15:27Z","timestamp":1673640927000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00464-022-09550-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,1]]},"references-count":26,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1]]}},"alternative-id":["9550"],"URL":"https:\/\/doi.org\/10.1007\/s00464-022-09550-x","relation":{},"ISSN":["0930-2794","1432-2218"],"issn-type":[{"value":"0930-2794","type":"print"},{"value":"1432-2218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,1]]},"assertion":[{"value":"21 May 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 August 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 September 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Drs Fran\u00e7ois Varlet, Ciro Esposito, Aurelien Scalabre, Benedetta Lepore, Sophie Vermersch, and Maria Escolino have no conflicts of interest or financial ties to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}