To compare the clinical efficacy between axillary liposuction combined with single-port endoscopic subcutaneous mastectomy and traditional periareolar subcutaneous mastectomy in the treatment of gynecomastia （GM），and assess postoperative satisfaction.

A retrospective analysis was conducted on the clinical data of 55 patients with GM who underwent surgical treatment in the Changzhou First People's Hospital from January 2023 to August 2024. According to the surgical approach，the patients were divided into the endoscopic surgery group （receiving axillary liposuction combined with single-port endoscopic subcutaneous mastectomy，23 cases） and the traditional surgery group （receiving traditional periareolar subcutaneous mastectomy，32 cases）. The two groups were compared in terms of incision length，intraoperative blood loss，operation duration，extubation time，hospital stay and complication rate. At 3 months postoperatively，the BODY-Q scale was adopted to assess postoperative satisfaction from six dimensions，including chest，nipple，scar，body image，social interaction，and appearance-related distress. For the comparison of normally distributed continuous data between groups，the independent sample t test was used. For the comparison of non-normally distributed continuous data between groups，nonparametric test was adopted. For the comparison of categorical data between groups， χ² test or Fisher's exact test was employed.

The incision length in the endoscopic surgery group was significantly shorter than that in the traditional surgery group ［3.0 （3.0，3.0） cm vs 4.0 （3.5，4.0） cm，Z=-5.574，P<0.001］.The endoscopic surgery group had significantly less intraoperative blood loss ［unilateral： （11.7±2.9） ml vs （24.3±7.3） ml，t=-2.813，P=0.023； bilateral： （20.4±6.5） ml vs （32.2±8.3） ml，t=-5.206，P<0.001］，and significantly shorter extubation time compared with the traditional surgery group ［（3.4±0.6） d vs （4.0±0.8） d，t=-2.969，P=0.004］，while the operation time was significantly longer ［unilateral： （100±20） min vs （50±16） min，t=4.228，P=0.003； bilateral： （215±31） min vs （94±27） min，t=13.957，P<0.001］. there were no significant differences in hospital stay or complication incidence between the two groups ［（3.9±0.9） d vs （3.7±1.3） d，t=0.695，P=0.490； 17.4%（4/23) vs 9.4%（3/32），P=0.435］. The results of BODY-Q scale assessment showed the scar score was 77±13 in the endoscopic surgery group and 66±12 in the traditional surgery group，indicating a significant difference （t=3.130，P=0.003），and no significant difference was observed in scores of chest，nipple，body image，social interaction，and appearance-related distress dimensions between the two groups （all P>0.05）.

Axillary liposuction combined with single-port endoscopic subcutaneous mastectomy brings better clinical outcome and postoperative patient satisfaction in GM patients compared with traditional periareolar subcutaneous mastectomy.