Would you recommend skin tightening in my case?

[Bobby - LAgyne]

Hello,

After many years of waiting, reading, studying gynecomastia and saving $ for the surgery, I'm finally ready to pursue. I followed your advise and consulted 3 gyne specialist in Southern California: 2 of which are currently on the Doctors' list here on this forum and frequently pop on the right-hand-side banner as Featured Doctors and the third one, as I remember, has been on the forum a few years ago but not any more. All 3 are well reviewed either here on this forum or elsewhere.

Anyway, two of the doctors told me there's no need for skin tightening and they will perform some lipo suction and gland excision via periareolar incision; pretty standard. One of these two doctors said, if there's skin laxity later on, we can do a revision procedure in at least 6 months postop; but he thought it may not happen. The other of the two said, he doesn't even think there will be skin laxity in my case what so ever.  However, the 3rd doctor's opinion was completely different.  He offered two options to me. He grabbed a marker and drew on my chest as he was explaining.  As you can see from the pictures, on my left side, his less invasive option consisted  of a wedge shape removal of skin and pulling the skin up from the bottom of areola.  On my right side, he explained a more invasive option of removing more skin and free nipple grafting; new proposed nipple location is drawn with dashed line. He recommended the free nipple grafting option as the skin will be tight for life.  I asked him about the standard periareolar method and he said: "no waayyy" it will work.

I am confused and frustrated.  I'm talking about three well known board certificated plastic surgeons specialized in gynecomastia surgery, each with 100's of gyne procedures under their belts. Assumingly, they all went through the same curriculum and tests and exams to be board certified plastic surgeons, why do we get such different opinions with different results?  One with huge scars across the chest, insisting that the periareola method will not work; and the other ones confident that there won't be skin laxity.

May I ask you the doctors of this forum to give me your opinion please?

Me: 38 yo, 5-10, 175 lbs - stable weight. Lost about 10 lbs of weight since the begging of 2014 by watching the diet and mild exercise.

Thank you in advance.
---Bobby

[Bobby - LAgyne]

A few more pictures...

[Dr. Elliot Jacobs]

Thanks for your photos.

I would agree that no skin tightening should be done at the initial operation.  Skin has an amazing capacity to self-tighten -- why not give it a chance?

In cases similar to yours, I have always opted for minimal scar surgery and then six months of observation.  Remember, during those six months, the skin will have had every opportunity to tighten by itself.  After six months, another conversation with your surgeon can determine whether any additional skin tightening need be done.  Most of my patients do not opt for it.  For those who do, there is less skin to tighten and hence smaller scars.

Good luck!

Dr Jacobs

[Bobby - LAgyne]

Thank you Dr. Jacobs for taking your time to answer my question.

What you said is exactly the same as what I think; why jump the gun on skin tightening?! If I'm not happy with the results 6 months or 1 years post-op, we can remove some of the skin then. We'll see...

I have 'listened' to my gut and decided to go with one of the two doctors that recommended periareolar incision and I feel more comfortable with.

Thanks again,
---Bobby

[Dr. Elliot Jacobs]

Have confidence in your decision and go for it! 

Best of luck!

Dr Jacobs

[Litlriki]

I would agree with Dr. Jacobs and not tighten the skin at the initial procedure.  I give patients up to a year before I intervene in most cases, since the spontaneous tightening related to the healing process continues with changes up to a year or beyond. 

Rick Silverman

[Bobby - LAgyne]

Thank you Dr. Silverman for your advice.

I have decided to pursue without skin tightening to begin with. If later on, skin is too loose to the point that I'm not happy enough with the outcome, I'll talk with my surgeon about a revision surgery.

In a few days, I need to go in, do the paperwork, put deposit and etc.  I'm very excited and naturally nervous.

---Bobby

[George Pope, M.D.]

LAGyne,

You are young enough that you should get a good bit of skin tightening over time with the standard procedure.  With that you'll have minimal scarring - just a periareolar scar.  The resulting scars from that procedure on the right side of the screen with the wedge excision of skin and tissue would I'm sure leave very noticeable scars that would no doubt keep you off your California beaches.

You're doing the right thing.  Best of luck!

Dr. Pope, MD

[Bobby - LAgyne]

Thank you Dr. Pope for your reply and assuring me that my decision for not opting the procedure with skin tightening is the right choice.

I have met with the surgeon for the second time for the pre-op consultation to discuss the risks, expectations and what to do post-op.  He has also sized the vest, I did the paper work and took care of financial part of it.

Surgery is scheduled for early January of 2015.

Thanks again for your time and replies.


---Bobby