{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T05:12:57Z","timestamp":1793423577411,"version":"4.5.0"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T00:00:00Z","timestamp":1746144000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Gynecomastia, particularly Simon's Grade IIb, poses aesthetic and psychological challenges because of glandular excess and skin redundancy. Standard circumareolar mastectomy (CM) often leads to hypertrophic scarring, areolar widening, and suboptimal contouring.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The authors of this study aim to evaluate a combined surgical approach integrating CM, circumareolar interlocking suture (CIS), inframammary fold detachment (IFD), and waterjet-assisted liposuction (WAL) in achieving improved aesthetic and functional outcomes for Simon's Grade IIb gynecomastia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A retrospective analysis was conducted on 95 patients (176 breasts) treated between April 2017 and December 2023. Of these, 72 patients (130 breasts) received the combined CM + CIS + IFD + WAL approach. Key outcomes included complication rates, nipple\u2013areola complex (NAC) sensitivity, areolar diameter, and patient satisfaction assessed through the BODY-Q Chest and Nipples Scale. Mean follow-up was 17 months, with a subset followed up to 91 months.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The mean operative time was 85.1\u2005min, and the average hospital stay was 2.75 days. The overall complication rate was 7.7%, with no cases of complete NAC necrosis. Areolar diameter significantly decreased postoperatively (P &amp;lt; .001). At 12 months, 71.2% of patients were \u201cvery satisfied\u201d with scarring, and BODY-Q scores showed significant improvements in both chest and nipple domains. NAC sensation was preserved in 88.4% of cases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The CM + CIS + IFD + WAL technique offers a safe, effective, and aesthetically superior option for treating Simon's Grade IIb gynecomastia, with low complication rates and high patient satisfaction. Follow-up data suggest stable long-term outcomes, supporting the method's broader clinical relevance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of Evidence: 4 (Therapeutic)<\/jats:title>\n                  <jats:p\/>\n               <\/jats:sec>","DOI":"10.1093\/asj\/sjaf069","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T05:05:08Z","timestamp":1746162308000},"page":"786-798","source":"Crossref","is-referenced-by-count":5,"title":["Innovative Surgical Concept for Simon's Grade IIb Gynecomastia: A Systematic Integration of Circumareolar Mastectomy, Interlocking Suture, Inframammary Fold Detachment, and Waterjet-Assisted Liposuction for Superior Long-term Outcomes"],"prefix":"10.1093","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2483-5219","authenticated-orcid":false,"given":"Andreas","family":"Wolter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia 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