Gynaecomastia: beyond scar placement

For someone considering surgery for enlarged male breast tissue, where the scar sits is a meaningful concern. It is not the whole outcome. A less conspicuous incision still has to be considered alongside contour, complications, sensation and recovery. A recent study of an underarm approach illustrates why those questions need separate evidence.

Jinqiu Xue, Hua Zhu and Qiang Ding reported their experience in Aesthetic Plastic Surgery on 16 October 2026. The technique removes glandular tissue endoscopically through an axillary incision, with cold-knife flap dissection and without liposuction. Its aesthetic rationale is to place the incision away from the visible front of the chest. That rationale is not proof that it outperforms other operations.

Fifty-one patients, not 102 independent outcomes

The retrospective, single-center series considered 56 patients operated on between August 2023 and October 2024. Five were lost to follow-up, leaving 51 patients with bilateral surgery, or 102 breasts. Ages ranged from 14 to 46 years. The study therefore includes adolescents as well as adults and should not be described as an adult-only cohort.

The procedure was completed in all analyzed patients without conversion to open surgery. The mean hospital stay was 4.31 days, and follow-up lasted three to six months. Without a comparison group, neither the admission duration nor the incision position establishes faster recovery. No recurrence was reported during that short observation period; this is not a long-term recurrence estimate.

Complications and satisfaction need clearer denominators

Hematomas and fluid collections did occur. The abstract reports hematoma in two breasts, seroma in one and effusion in two; the full narrative also describes events per patient, including bleeding managed by drainage. These entries cannot safely be added into one overall complication rate. Two patients with bilateral disease were reported to have residual excess skin.

The paper reports 100% satisfaction for quality of life, but the attribution is not consistent: the abstract presents it as patient-reported, while the results describe four observers and label the assessment as observer-reported. It should not be treated as a clean, independently validated patient quality-of-life endpoint. No infection or nipple–areolar necrosis was reported, but a small series cannot exclude uncommon harms.

The full text makes the procedure's practical feasibility visible while leaving the comparative question unanswered. The limited follow-up, missing patients and reporting ambiguities matter as much as the favorable photographs or scores. For decisions about gynaecomastia surgery, the useful next evidence would compare approaches in similar patients and separately measure scar visibility, patient-reported outcomes, complications and durability. A scar hidden near the armpit is a feature of the plan, not a guarantee of a better overall result.