Gyno & Droopy Nipples-Need Advice

[sfaquaboy]

I've lived with gyno since I was 13. Eleven years ago when I was 45 I had lipo done on my chest. I was moderately satisfied with the results but had some saggy skin. I've never been overweight and am in pretty good health. Today, at 56, I'm looking to have another procedure done. One surgeon said removal of fat & glandular tissue should work, the skin should tighten on its own. I doubt it will because it didn't after the last procedure. The second surgeon suggested fat/glandular tissue removal and possibly a donut lift. No skin removal would be necessary. I have another consultation next week with someone else. Attached are some pics. I'm not sure what is the best procedure for this. I'm not looking for miracles. I just don't want to feel self conscious anymore being out in public shirtless. Any advice on what procedure would give me the best outcome. Thanks.

[Miguel Delgado MD]

sfaquaboy,
Your case is very straight forward.  Gland excision with liposuction to blend in the area is perfect.  You are a grade 2 gynecomastia with good quality skin.  A peri-areolar lift is a wrong thing to do! Go to a gynecomastia specialist and you should have no issues.  Half of my gynecomastia practice are revisions and the most common reason is liposuction only performed the first time. Good Luck

[sfaquaboy]

Thank you very much. This helps immensely.

[Dr. Schuster]

Unfortunately I cannot view the photo very well. I would be a bit concerned that your skin will not shrink tightly for several reasons. First, as you said, it didn't shrink down the first time. Now you are older and skin elasticity never gets better as we age. A donut excision does in fact "cheat" skin shrinkage by removing a small amount around the areola. I think this would be the most you should need so this is a reasonable consideration. The scar usually heals very well. Some surgeons will recommend doing it ass a secondary procedure, but if you can tell the skin won't shrink, there's no reason not to do it at the first procedure. An exam is really needed to better advise. Good luck.

[Dr. Elliot Jacobs]

One more opinion for you.

Male nipples are normally low on the chest and just above the fold under the muscle.  Yours appear to be appropriately placed.  I daresay that your first operation (lipo only) may not have been aggressive enough with the lipo and so there was some residual tissue afterwards.  There is also (probably) some gland under the areolas.

I have had many many patients such as yourself.  My approach has always been to perform aggressive liposuction (in a wide area) with gland excision (if needed).  When the skin has been widely undermined with lipo it has more ability to self-tighten.  As a result, the nipples will usually diminish in diameter and rise slightly on the chest -- which should be sufficient to please you.  I don't think any skin excision  or nipple elevation would be needed

Good luck!

Dr Jacobs