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.