Key Points of Endoscopic Minimally Invasive Surgery for Gynecomastia Based on Refined Anatomy: A Case Series

Abstarct Background Traditional surgical approaches for gynecomastia are associated with significant trauma and insufficient protection of anatomical structures. Currently, endoscopic glandular excision has emerged as the primary treatment modality. A refined anatomical approach for endoscopic minimally invasive surgery is proposed, with evaluation of postoperative complications and aesthetic outcomes. Methods This study is a single-center, single-arm prospective investigation that collected and analyzed clinical data from patients who underwent endoscopic mastectomy at The First Hospital of Hebei Medical University, aiming to evaluate postoperative complications and patient recovery outcomes with an emphasis on the refined anatomical approach. Results A total of 786 patients were included. The mean operative time was 117.8 ± 20.0 minutes, and the mean discharge time was 3.0 ± 0.7 days. Major complications included hematoma ( n = 4, 0.5%) and nipple-areolar complex ischemia ( n = 54, 6.9%). Among these, 52 cases of nipple-areolar complex ischemia resolved during follow-up, while 2 case progressed to necrosis (0.3%). Nipple-areolar complex sensation scores were 8.5 ± 2.0 (unilateral) and 8.0 ± 1.8 (bilateral). All procedures were completed without conversion to open surgery or significant intraoperative bleeding. Conclusion Endoscopic glandular excision, through meticulous vascular and neural preservation, effectively restores the natural contour of the male chest while minimizing complications. This approach offers a safe and aesthetically favorable solution for gynecomastia patients. Level of Evidence III 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .