Andreas Wolter, Sonia M Fertsch, Marc Daniels, Katrin Seidenstuecker, Beatrix Munder, Mazen Hagouan, Dirk Janku, Robert J Musmann, Christoph Andree, Dennis Hammond
{"title":"Simon's 2B级男性乳房发育症的创新手术理念：环形乳房切除术、联锁缝合、乳下折叠剥离和水喷射辅助吸脂术的系统整合，可获得卓越的长期疗效。","authors":"Andreas Wolter, Sonia M Fertsch, Marc Daniels, Katrin Seidenstuecker, Beatrix Munder, Mazen Hagouan, Dirk Janku, Robert J Musmann, Christoph Andree, Dennis Hammond","doi":"10.1093/asj/sjaf069","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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-areola 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.</p><p><strong>Results: </strong>The mean operative time was 85.1 min, 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 < .001). At 12 months, 71.2% of patients were \"very satisfied\" with scarring, and BODY-Q scores showed significant improvements in both chest and nipple domains. NAC sensation was preserved in 88.4% of cases.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Level of evidence: 4 (therapeutic): </strong></p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"786-798"},"PeriodicalIF":3.0000,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"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.\",\"authors\":\"Andreas Wolter, Sonia M Fertsch, Marc Daniels, Katrin Seidenstuecker, Beatrix Munder, Mazen Hagouan, Dirk Janku, Robert J Musmann, Christoph Andree, Dennis Hammond\",\"doi\":\"10.1093/asj/sjaf069\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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-areola 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.</p><p><strong>Results: </strong>The mean operative time was 85.1 min, 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 < .001). At 12 months, 71.2% of patients were \\\"very satisfied\\\" with scarring, and BODY-Q scores showed significant improvements in both chest and nipple domains. NAC sensation was preserved in 88.4% of cases.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Level of evidence: 4 (therapeutic): </strong></p>\",\"PeriodicalId\":7728,\"journal\":{\"name\":\"Aesthetic Surgery Journal\",\"volume\":\" \",\"pages\":\"786-798\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2025-07-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Aesthetic Surgery Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/asj/sjaf069\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Aesthetic Surgery Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/asj/sjaf069","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
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.
Background: 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.
Objectives: 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.
Methods: 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-areola 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.
Results: The mean operative time was 85.1 min, 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 < .001). At 12 months, 71.2% of patients were "very satisfied" with scarring, and BODY-Q scores showed significant improvements in both chest and nipple domains. NAC sensation was preserved in 88.4% of cases.
Conclusions: 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.
期刊介绍：
Aesthetic Surgery Journal is a peer-reviewed international journal focusing on scientific developments and clinical techniques in aesthetic surgery. The official publication of The Aesthetic Society, ASJ is also the official English-language journal of many major international societies of plastic, aesthetic and reconstructive surgery representing South America, Central America, Europe, Asia, and the Middle East. It is also the official journal of the British Association of Aesthetic Plastic Surgeons, the Canadian Society for Aesthetic Plastic Surgery and The Rhinoplasty Society.
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