Single Axillary Incision Versus Triple Lateral Chest Wall Incisions in Endoscopic Mastectomy for Gynecomastia: A Single-Center Retrospective Analysis with Propensity Score Matching

Background: Endoscopic mastectomy has gradually become an important surgical modality for the treatment of breast diseases, and is the preferred procedure for gynecomastia. However, endoscopic mastectomy presents challenges such as a steep learning curve, prolonged surgical duration, increased hospitalization costs, and high technical difficulty. This study aimed to evaluate the clinical efficacy and patient satisfaction of endoscopic mastectomy using a single axillary incision versus a triple lateral chest wall incision for gynecomastia.

Methods: Patients were stratified into a single-port group and a three-port group based on the surgical approach. Propensity score matching was used for the nearest neighbor matching, adjusting baseline data differences at a 1:1 ratio, with a caliper value set at 0.2 to ensure comparability between the two groups. Clinical efficacy and patient satisfaction were compared after propensity score matching.

Results: A total of 36 pairs of patients were successfully matched after propensity score matching, with no differences in baseline characteristics (P > 0.05). Notably, the three-port group experienced longer surgical durations compared to the single-port group, alongside higher hospitalization costs (P < 0.05). There were no differences in surgical bleeding volume, postoperative drainage volume, extubation time, postoperative hospitalization time , surgical complications, visual analog scale pain scores, and recurrence rate (P > 0.05). After a 6-month follow-up, the vancouver scar scale assessment showed no differences in scar color, thickness, vascularity, softness, and total score (P > 0.05). Based on the BODY-Q questionnaire chest module scores, the single-port group showed better overall satisfaction in appearance (P = 0.038), especially in the smoothness of the chest wall, with significantly higher scores than the three-port group (P = 0.001). No differences were found in nipple symmetry, nipple sensation, and skin redundancy (P > 0.05).

Conclusion: The single axillary incision endoscopic mastectomy demonstrated advantages in shorter surgical duration and lower hospitalization costs, while providing a smoother chest wall appearance, thereby enhancing overall patient satisfaction. Consequently, this surgical approach may arise as one of the preferred procedures for gynecomastia.

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