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目的:探讨男性乳腺发育症的核磁共振(MRI)特点，改进并优化Simon Ⅰ级和Ⅱ级男性乳房发育症的手术策略。方法:2017年1月至2023年1月，北京协和医院整形美容外科收治男性乳房发育症患者190例并行改良手术，年龄12～56(26.7±8.6)岁。对44例男性乳房发育症患者的87侧乳房的MRI图像进行测量，计算腺体与整个乳房在经乳头横截面上的面积比，获得男性乳腺发育症结构分布的规律，改进手术治疗策略。190例患者均用脂肪抽吸联合改良小切口技术切除腺体治疗男性乳房发育症。记录患者手术时长、吸脂量、腺体切除量、术后并发症，通过问卷调查评估患者术后满意度。结果:87侧男性乳房的MRI显示，腺体占整个乳房经乳头横截面上的面积比为(10.9±12.5)%。男性乳房发育症最常见的MRI类型为分枝型40侧，占46.0%。190例患者中位手术时长为95(65～210) min，中位脂肪吸除量300(50～1 400) ml，中位腺体切除量19.9(1.5～157.0) g。88例患者(46.3%)术后随访时间>6个月，问卷调查总满意度(4.68±0.53)分，术后并发症19侧，占5.1%，再手术率1.3%。结论:男性乳房发育症的MRI特征以脂肪成分为主，纯腺体成分少，主要类型为分枝型。充分吸脂联合改良小切口技术可有效治疗Simon Ⅰ级和Ⅱ级男性乳房发育症。患者满意度高、术后并发症少。

Objective:To improve and optimize the modified surgical strategies for patents with Simon Ⅰ and Simon Ⅱ type of gynecomastia, based on their magnetic resonance imaging (MRI) features.Methods:Clinical data of 190 patients aged 12 to 56 years (mean age 26.7±8.6) with gynecomastia who underwent modified surgeries in the Department of Plastic Surgery of Peking Union Medical College Hospital from January 2017 to January 2023 were retrospectively analyzed. The study measured breast MRI images of 44 male patients to calculate the area ratio of the glands on the transverse plane via nipple. This provided insight into the physiological structure and the tissue distribution of gynecomastia for improving the modified surgical strategies. All 190 patients were treated with enhanced liposuction and " Pull-Through and Bottom-Up" techniques. The duration of operation, amount of liposuction and amount of glandular resection, postoperative complications were recorded, and postoperative satisfaction was investigated by questionnaire surveys.Results:MRI images of the 87-side male breast showed that the average area ratio of the glands on the transverse plane via nipple was (10.9±12.5) %. The most prevalent subtype of gynecomastia was branch pattern, accounting for 46.0%. The median surgical duration of 190 patients was 95 (65-210) minutes, the median liposuction volume was 300 (50-1 400) ml, and the median glandular removal was 19.9 (1.5-157.0) g. Eighty-eight patients (46.3%) went through followed up for more than 6 months post-posterative with an overall satisfaction score of 4.68±0.53. Postoperative complications occurred in 19 sides (5.1%), and the reoperation rate was 1.3%.Conclusions:The MRI imaging of gynecomastia shows that the component of patients′ breasts are mainly fat, with a small amount of glandular tissue and the dominant subtype is branch pattern. Enhanced liposuction combined with " Pull-Through and Bottom-Up" stab incision technique can be an effective treatment for Simon grades Ⅰ and Ⅱ gynecomastia. The method results in high patient satisfaction with fewer postoperative complications.