Weight loss

[Dave_8]

I've heard different answers to the same question and was wondering what is the real medical "answer". Is it really necessary to lose weight (fat) before surgery? And if so, then why? I'm still plannin on losing weight before surgery but I was just curious.

[DrCALOCA]

When a patient losses weight, all fat reduces in volume. The main advantage with respect to breast reucti is that there will be less blood loss during surgery and less volume to remove (although the number of fat cells removed and the end result can basically be the same in either case). When fat has a greater volume, there is more blood flow and therefore more possibility of blood loss.

Blood loss is not the only factor that is considered when recommending breast reduction surgery before or afer weight loss. There are other factors such as main component of Gynecomasita (gland or fat), patient age, cause of the gynecomastia and underlying patient illneses.

All patients must be indivdually studied to determine if he should have surgery before or after.

In my opinion, ideal patent weight is best for breast reduction in a patient (as with most plastic surgery procedures), but it can safely be performed if a patient is not able to acheive ideal weight before surgery.

Less blood loss, justifies surgery after weight loss. Recovery will surely be better with patients at their ideal weight.

[Dave_8]

Thanks for the info doc.

[George Pope, M.D.]

I think it's a good idea to get to your ideal body weight prior to gynecomastia.  After chest contouring, your chest should be in balance with the remainder of your trunk.  If a guy is obese, you need to leave sufficient chest wall fat to keep him looking normal.  Even if you're only a little overweight, it looks strange to have a totally flat chest with little body fat, along with fat around the mid-section like a spare tire or love handles.  I often perform liposuction on the abdominal wall and flanks when I do gynecomastia surgery, provided of course that the patient wants that.  I did a case last week where a 45 year old man came in for lipo of his abdominal wall and flanks, and I recommended he have lipo of his chest for his pseudogynecomastia.  It really helped him.  He hadn't thought about it, but he had a pretty fatty chest, and that would have really stood out after suctioning the other areas if the chest hadn't been treated.

So, it's good to lose weight first, but it's not mandatory. 

I hope this answers your question.

[Dave_8]

Yes it does.

[Dr. Elliot Jacobs]

This is a controversial topic and I am sure you will receive answers across the entire spectrum.

I agree with my colleagues that ideally you should be at your lowest, most comfortable and stable weight.  This will make you a better candidate for this (or any other) surgery.

Unfortunately, many men with gyne are caught in a catch-22 situation:  they are so embarrassed by their gyne that they are reluctant to go to a gym and yet they need the gym to lose weight in order to be better candidates for their gyne surgery.  What to do?

I think this should be an individual decision between the doctor and the patient.  If the patient believes he can honestly lose a significant amount of weight (5-10 lb weight loss is insignificant), then he should do it first before surgery is done.  On the other hand, if a patient says he really can't lose much weight because of embarrassment, etc, then I am willing to operate on the patient as long as he realizes all that this entails.  In particular, the breasts will be made smaller and there will probably be some skin contracture and shrinkage.  But will he have a flat, tight, contoured chest (as tight as a drum head)?  No!  He will, however, be more comfortable and perhaps more confidant about going to the gym and commencing a weight loss program.  And if one loses more weight after the gyne surgery, the results will spontaneously improve as well.  However, there may still be a problem of residual skin laxity to deal with.  This may require additional surgery to tighten the skin after the patient has gone down to the weigh that he desires.

As you can see, there are no easy answers to the overweight patient with gyne.

Dr Jacobs

[Dave_8]

Thanks for the info. I've always thought to myself that if one were to not lose weight before surgery, he will have skin tightening problems post op.

[DrBermant]

I've heard different answers to the same question and was wondering what is the real medical "answer". Is it really necessary to lose weight (fat) before surgery? And if so, then why? I'm still plannin on losing weight before surgery but I was just curious.

Weight loss before gynecomastia surgery is typically better than weight loss after.  Losing weight is a coarse tool.  You cannot pick where the fat comes from, or for that matter where the fat goes onto. Men tend to put fat first on the belly and breast.  This extra fat hides the natural contour of the muscle and results in big breasts that just does not sale "male."

Weight loss after surgery is a gamble how it will come off.  Men tend to put fat first on the chest and abdomen.  We take it off those regions last.  If your surgeon contours you to your general body fat, and then you lose the weight, and like most it does not come off the chest as much, then it may look like the gynecomastia has come back!  For my patients I typically recommend using weight loss as the coarse tool and reserving the plastic surgery for refinement.  Plastic Surgery is not a good tool to "jump start" the process.  But it is you who would be gambling. 

Plastic surgery will not make an obese person not look obese because of the global fat problem.  Reducing the chest fat beyond the global fat also looks terribly distorted.  In compromise surgery, a fat person's breast can be made smaller, but the global fat will still not look as good as when the patient actually is able to work on the coarser weight loss issues.  The main advantage to the weight loss, is that my patients have told me they feel better, have more energy, and are happier with their lives.   However, weight loss will not help with gland and may leave loose skin as a component.

After Major Weight Loss Male Chest Drooping and Sagging may be a factor.   Male Mastopexy Chest Lift Surgery can tighten and lift a loose skin component.  Weight loss after chest lift may result in further sagging, drooping, and loose skin.  If the skin did not tighten with the original weight loss, why should it tighten after surgery with more weight loss?

Actually when we loosely speak of weight loss, we are really talking about losing fat.  You can use a Body Mass (BMI) Calculator to see where your height and weight factor.  However, BMI does not distinguish between fat, muscle, bone or other tissue.  A Body Fat Analyzer can help better understand the fat issue.

How much weight makes a difference?  Major weight loss is fairly obvious, however even a smaller weight loss can make a significant different.  I just saw a patient 6' 1'' tall who over 2 months dropped from 216 to 205 pounds.  His body fat went from 19.4 to 15.6.  His weight only changed 11 pounds, but he put on muscle while taking off  fat.  His breasts were much smaller.  His areola diameter shrank from a long axis of 48mm to 40mm (at the same room temperature).  The main factor is that he felt better about himself.  This is typical for many of my patients who have described their weight loss experiences.  The most he ever weighed was 245 pounds, so there was a loose skin component, but not areola sagging.  His weight loss helped define my surgical recommendation.

When the body fat is already low, further weight loss tends to show remaining gland even more.  I work with many Bodybuilders with Gynecomastia and other competition athletes who have subtle gynecomastia and very low body fat.   For this patient population, I rather sculpt them at their off season weight: so I have resources to work with for my surgery.

For those frustrated with their contours while waiting for weight loss, No Surgery Body Shaping Garments are a temporary measure that can be valuable.  Check how tissues bounce and move with a very good garment in these movies with and without garments during activity.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction