{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:26:23Z","timestamp":1787012783599,"version":"build-2736575974"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100011827","name":"Guangxi Medical University \u201cFour New\u201d Project","doi-asserted-by":"publisher","award":["SX202403"],"award-info":[{"award-number":["SX202403"]}],"id":[{"id":"10.13039\/501100011827","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011828","name":"Guangxi Zhuang Autonomous Region Health Commission Scientific Research Project","doi-asserted-by":"publisher","award":["Z-A20220428"],"award-info":[{"award-number":["Z-A20220428"]}],"id":[{"id":"10.13039\/501100011828","id-type":"DOI","asserted-by":"publisher"}]},{"name":"China Undergraduate Innovation and Entrepreneurship Training Program","award":["X202210598301"],"award-info":[{"award-number":["X202210598301"]}]},{"name":"the Future Academic Star of Guangxi Medical University program","award":["WLXSZX22095"],"award-info":[{"award-number":["WLXSZX22095"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Macromastia, characterized by excessive breast tissue growth, causes physical symptoms, psychosocial distress, and diminished quality of life. Despite the effectiveness of reduction mammaplasty, progress remains limited by inconsistent diagnostic criteria and incomplete mechanistic understanding. We combined bibliometric analysis with transcriptomic profiling to map research evolution and identify candidate molecular pathways. Bibliometric analysis of 499 macromastia publications from the Web of Science Core Collection (Clarivate Analytics, Philadelphia, PA) employed keyword co-occurrence, thematic clustering, and temporal trend analysis. Complementarily, transcriptomic sequencing was performed on breast tissue from 3 severe macromastia patients (unilateral specimen &amp;gt;500\u2005g) and 4 controls undergoing mammoplasty for benign conditions, with standardized preprocessing, differential expression analysis, and functional enrichment. Bibliometric mapping revealed a paradigm shift from subjective assessments toward quantitative evaluation in diagnosis, surgical planning, and quality-of-life measurement. Emerging terms (2021-2025) including 3-dimensional imaging, digital modeling, and inframammary fold measurements reflected a growing emphasis on objective standards. Core themes centered on surgical outcomes, complications, and patient satisfaction. Mechanistic keywords increasingly highlighted hormonal regulation\u2014particularly estrogen metabolism (aromatase\/CYP19A1) and prolactin-related dysfunction\u2014alongside emerging interest in cell communication and stem cells. Transcriptomic profiling identified differential expression patterns consistent with endocrine and growth signaling, with pathway enrichment implicating immune regulation, extracellular matrix remodeling, and oxidative stress. Downregulated pathways were enriched for DNA repair and transcriptional regulation. By integrating bibliometrics with transcriptomics, this study synthesizes 2 decades of macromastia research, documents the transition toward quantitative standards, and nominates molecular pathways warranting further validation.<\/jats:p>\n                  <jats:p>Level of Evidence: 3 (Therapeutic) For image description, please refer to the figure legend and surrounding text.<\/jats:p>","DOI":"10.1093\/asj\/sjag030","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T12:46:02Z","timestamp":1769690762000},"page":"993-1006","source":"Crossref","is-referenced-by-count":0,"title":["Twenty Years of Macromastia Research: A Comprehensive Analysis of Diagnostic Standardization, Surgical Technique Optimization, and Exploration of Molecular Mechanisms"],"prefix":"10.1093","volume":"46","author":[{"given":"Ke-Jun","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong-Quan","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di-Yuan","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Jie","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian-Di","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Qing","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi-Qiang","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"2026081719570870700_sjag030-B1","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1186\/s13046-015-0227-5","article-title":"Skin-reducing mastectomy and immediate breast reconstruction in patients with macromastia","volume":"34","author":"De Vita","year":"2015","journal-title":"J Exp Clin Cancer Res"},{"key":"2026081719570870700_sjag030-B2","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1097\/ALN.0b013e31822fd05a","article-title":"Gestational gigantomastia and anesthesia","volume":"116","author":"Gomez-Rios","year":"2012","journal-title":"Anesthesiology"},{"key":"2026081719570870700_sjag030-B3","doi-asserted-by":"publisher","first-page":"NP862","DOI":"10.1093\/asj\/sjae163","article-title":"Evaluation of the impact of physical therapy on patients with macromastia seeking breast reduction surgery","volume":"44","author":"McCranie","year":"2024","journal-title":"Aesthet Surg J"},{"key":"2026081719570870700_sjag030-B4","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1016\/j.spinee.2024.10.009","article-title":"Back pain in patients with macromastia: what a spine surgeon should know?","volume":"25","author":"Aref","year":"2025","journal-title":"Spine J"},{"key":"2026081719570870700_sjag030-B5","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1093\/asj\/sjae092","article-title":"Defining the ideal reduction mammaplasty: a crowdsourcing study","volume":"44","author":"Zibitt","year":"2024","journal-title":"Aesthet Surg J"},{"key":"2026081719570870700_sjag030-B6","doi-asserted-by":"publisher","first-page":"430e","DOI":"10.1097\/PRS.0000000000011493","article-title":"Three pedicle-based nipple-sparing skin-reducing mastectomy combined with prepectoral implant-based breast reconstruction","volume":"154","author":"La Padula","year":"2024","journal-title":"Plast Reconstr Surg"},{"key":"2026081719570870700_sjag030-B7","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1097\/PRS.0000000000006121","article-title":"Does staged breast reduction before nipple-sparing mastectomy decrease complications? 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