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Updated: Oct 25, 2026

Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Gynecomastia Donut Excision Technique Description and Review of Literature
Khalid Arab1, Abdulaziz Alsuhaim2, Lama A Alkhwildi3
1Division of Plastic surgery, Department of surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Background:
Gynecomastia is benign enlargement of male breast tissue that may cause psychological distress and aesthetic concerns. Surgical correction can be complicated by scarring, contour irregularities, and nipple-areolar complex (NAC) deformity.
Methods:
This article presents a narrative review and describes a surgical technique involving preoperative marking, VASER-assisted liposuction, circumferential de-epithelialization, controlled glandular excision, preservation of dermoglandular tissue beneath the NAC, and staged closure.
Results:
The described approach combines contouring with preservation of NAC support and a staged closure intended to distribute tension. The photographs illustrate preoperative and postoperative appearances; comparative effectiveness, complication rates, and long-term outcomes have not been established.
Conclusions:
Donut excision with dermoglandular preservation and staged closure is a described approach to gynecomastia correction. Comparative studies with longer follow-up and standardized patient-reported outcomes are needed to evaluate its safety and aesthetic benefits.
Level Of Evidence V:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
