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Changes in Cervical Sagittal Alignment after Subcutaneous Mastectomy in Adolescents with Gynecomastia
Sung Ryul Lee1, Sang Soo Choi2,3, Hyok Jo Kang4
1Department of Surgery, Damsoyu Hospital, Hakdong-ro, Gangnam-gu, 234, Seoul, Republic of Korea. kingsoss@naver.com.
Background:
Adolescent gynecomastia may lead to altered posture, such as forward head posture, caused by a prominent anterior chest wall and related behavioral adaptations to concealment. While surgical correction is performed for cosmetic and psychological reasons, its impact on cervical sagittal alignment remains unclear. We aimed to assess changes in cervical sagittal alignment following subcutaneous mastectomy in adolescents with gynecomastia.
Methods:
We retrospectively reviewed 316 adolescents (mean age, 17.7 ± 1.5 years) who underwent subcutaneous mastectomy for persistent gynecomastia between January 2020 and March 2025. C2-C7 lordosis (Cobb angle) and cervical sagittal vertical axis (cSVA), among other cervical sagittal alignment parameters, were measured from standardized lateral cervical spine radiographs obtained preoperatively and at 1 year postoperatively and compared using paired t-tests.
Results:
A total of 316 adolescents were included in the analysis. Preoperative radiographs showed relatively reduced cervical lordosis and increased anterior head translation. At the 1-year follow-up, the mean C2-C7 lordosis significantly increased from 5.0° to 9.2° (P < 0.001), whereas the mean cervical sagittal vertical axis decreased from 24.2 to 19.2 mm (P < 0.001), indicating significant postoperative changes in cervical sagittal alignment, with moderate-to-large effect sizes.
Conclusion:
The results of this study suggest an association between subcutaneous mastectomy in adolescents with gynecomastia and favorable radiographic changes in cervical sagittal alignment. However, the clinical significance and mechanisms underlying these changes remain uncertain and require further prospective investigation.
Level Of Evidence Iv:
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 .
