To compare the therapeutic effect of three-port total laparoscopic subcutaneous gland resection in the treatment of moderate to severe gynecomastia (GYN).

According to the inclusion and exclusion criteria, we enrolled a total of 103 GYN patients in the Department of Breast Surgery, the First Affiliated Hospital of Harbin Medical University from June 2022 to June 2023, including 40 patients who underwent open surgery (open surgery group) and 63 patients who underwent three-port total endoscopic surgery. In order to reduce the bias, 40 patients were selected from 63 patients receiving three-port total endoscopic surgery using random number table as endoscopic surgery group. Patient satisfaction was assessed 6 months after surgery. The independent-sample t test was used to compare surgery-related parameters, patient satisfaction and postoperative gland-related parameters between two groups.

The incision length in endoscopic surgery group was significantly lower than that in open surgery group (t=-3.538, P<0.001), but there were no significant differences in BMI, operation time, blood loss and drainage duration between two groups (t=0.943, -1.425, 0.102, 0.116, all P>0.050). The patient satisfaction, physician satisfaction, third-party satisfaction, overall satisfaction and weighted satisfaction in endoscopic surgery group were significantly higher than those in open surgery group (t=4.065, 3.141, 3.953, 4.405, 4.400, all P<0.050). In terms of postoperative complications, nipple-areolar epidermal ischemia occurred in one case of endoscopic surgery group and 4 cases of open surgery group; numbness in surgical area was observed in one case of endoscopic surgery group and 3 cases of open surgery group; postoperative effusion occurred in one patient of each group; 2 cases had localized subcutaneous emphysemain in endoscopic surgery group. There were no significant differences in preoperative gland radius, radius of surgical resection, preoperative convexity and postoperative convexity between two groups (t=0.813, 0.822, 0.121, 0.153, all P>0.050).

Three-port total endoscopic surgery is a feasible surgical treatment for moderate to severe GYN, with the advantages of safety, effectiveness, good aesthetic effect and high patient satisfaction.