Why is weight loss important before surgery? If you are a little overweight?

[Needsomeadvice]

Hello.

I was wondering why weight loss was so important prior to surgery?

Does it have to do with seeing if the gyneco can be corrected by itself? If so, I have lost a lot of weight at one point to the point that people thought I was going to starve to death and the gyno was still there.

Is there any other reason you need to drop weight prior to surgery if you are just slightly overweight?

Thanks

[Paa_Paw]

There is a recent post by a man who had surgery (excision only) last year. This was followed by weight loss and he now is looking into the possibility of Lipo to refine the contour of the breast area.

If he had lost the weight first, there would be no need for a second procedure.

To get the best result from your surgery, you need to present yourself for surgery in good condition.

[DrBermant]

Hello.

I was wondering why weight loss was so important prior to surgery?

Does it have to do with seeing if the gyneco can be corrected by itself? If so, I have lost a lot of weight at one point to the point that people thought I was going to starve to death and the gyno was still there.

Is there any other reason you need to drop weight prior to surgery if you are just slightly overweight?

Thanks

Global body fat obscures the contour of muscles.  Male Body Fat tends to collect first on the chest and belly and comes off those areas last.  Have you ever seen a Sumo wrestler without breasts?  Weight loss is a coarse tool, you cannot pick where the fat comes from.  Plastic Surgery is not an alternative to losing weight.  Contouring an overweight body chest tends to leave about the same body fat layer as is located elsewhere.  Do the surgery first, and you are gambling that when when losing weight, it will come off the same on the chest (it often does not).  As a surgical sculptor, I prefer picking the coarse tool first, then the one of refinement.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia

[Needsomeadvice]

There is a recent post by a man who had surgery (excision only) last year. This was followed by weight loss and he now is looking into the possibility of Lipo to refine the contour of the breast area.

If he had lost the weight first, there would be no need for a second procedure.

To get the best result from your surgery, you need to present yourself for surgery in good condition.

Hi.

Thank you for the reply and Dr Bermant as well.

In both your examples the assumption was made that it would be a gland removal only and the fat portion of the gyno was to be taken care of with weight loss afterward( which may not come off that area as we would like correct) ?

I am referring to an operating that you get both LIPO and gland removal with being slightly overweight.

If all the fat were removed and gland removed while being slightly overweight, is there something negative that would happen if weight loss happened after the surgery? 

What would be the max weight you would suggest for someone 5'11 and 29 years old.

Thanks

[Paa_Paw]

Reread Dr Bermants post.

You want to be at a weight that you are comfortable with and can sustain. Yo-Yo weight loss and gain is not the condition you are after.

[Needsomeadvice]

Reread Dr Bermants post.

You want to be at a weight that you are comfortable with and can sustain. Yo-Yo weight loss and gain is not the condition you are after.

The main issue here is tryinig to fix the gynecomastia condition not overall weight loss.
It is using the lipo as a selective spot treatment on the breast area which is what it was intended for. I am not saying that it is being used for weight loss.

I am just wondering if the reason that weight loss is suggested before surgery simple to see if the gynecomasia can correct itself naturally before surgery is considered or if there was another reason?

What is your sustainable weight is slightly overweight, then would it be ok to get the surgery at the current weight ?

For example, why would it matter if you were 5'11 and  205 Lbs or 180 Lbs when you had the gynecomasia surgery done as long as it is your sustainable weight?

Alternatively, what happens if you get the surgery done at 205 Lbs and a year afterward, you weight is 180?  Does this cause some kind of problem?

Thanks.

[Grandpa Bambu]

Why would it matter if you were 5'11 and  205 Lbs or 180 Lbs when you had the gynecomasia surgery done as long as it is your sustainable weight?

Alternatively, what happens if you get the surgery done at 205 Lbs and a year afterward, you weight is 180?  Does this cause some kind of problem?

No...

All this talk of 'you must loose weight prior to surgery' is hog wash!!! We all know that exercising/loosing weight will not get rid of G. This is a fact! In many cases the G victim has tried exercise and a reduced diet, only to be disappointed/heart broken when he finds that after all the effort, the G still remains. Sure, if you are very obese, then loosing weight will help with managing the rigors of surgery and make the surgeons job at contouring a little easier. But if you are 10-20 above your ideal weight range then there should be no problem dude.

GB

[Grandpa Bambu]

There is a recent post by a man who had surgery (excision only) last year. This was followed by weight loss and he now is looking into the possibility of Lipo to refine the contour of the breast area. If he had lost the weight first, there would be no need for a second procedure.

Paw,

So what you are saying here is that all the G victim has to do is to loose weight first and that in turn will eliminate the need for a liposuction procedure? C'mon dude you've been on this site long enough to know that chest adipose tissue is very difficult, if not impossible to get rid of. The first rule of Gynecomastia is... Weight loss will not eliminate the condition!!!

GB

[wantnewlife]

For guys who are not over-weight,i thought it is better not to lose weight before surgery.. because if you lose weight before surgery, then after surgery you start putting on weight and won't the fat get accumulated in chest area again?

[mrpower33]

I don't understand why there is some much resistance here to getting in shape.  I thought the reason we are all here was because we are all on some level concerned with how our bodies look.  Just to be brutally honest, if you're overweight on this board you probably look like hell. 

The surgery will always be there as an option.  If you have gyne and you are overweight, getting in the best shape you possibly can will not only be good for your health and speed your post-op recovery, it will make you feel better about yourself and will also make the surgery easier to perform.  As I understand it, the lipo is what really damages your body and the less of it you have the better off you will be.  It has nothing to do with "getting rid of gyne through exercise", although frankly, I'm sure for many people it will really help, particularly if you're fat! 

Bottom line: getting is shape is good for you PERIOD.  So just quit you're whining, put down your pizza a fries, get off your ass and get to work!  Make a commitment to getting to your ideal weight in the next 6 months, then set a date for the surgery if you think you really need it then.  What's the point of getting rid of your boobs if you're still a fat ass?!?! 

[Dr. Elliot Jacobs]

I have a different take on weight loss prior to surgery.  First, surgery is better and safer if you are at a comfortable weight for yourself.  If a patient plans to lose lots of weight, then certainly it is better to take it off prior to surgery.

On the other hand, there are many men who have problems losing weight because their gyne is an embarrassment for them at the gym, pool, etc.  It then becomes a Catch-22 situation:  lose weight to get better surgery results but you need the surgery to feel comfortable to go to the gym to lose weight.  What to do?

I take a graduated approach with my patients.  If they are in reasonable shape, albeit a few pounds overweight, then I will perform the surgery, which always involves liposuction and frequently involves gland excision.  The goal of surgery is to provide a trim and contoured chest which is consistent with the general frame of the patient.  I will generally look at the pinch of skin/fat just under the collarbone and attempt to provide that same pinch all the way down the chest -- down to the lower ribs.  In a very thin patient, the pinch will be thin.  In a patient who is overweight (ie BMI up to around 30 or so), I will leave a slightly thicker pinch.  Then, once the gyne is removed (I call it an "excuse-ectomy"), the patient becomes more motivated to exercise, watch their diet and lose weight -- and their chest will get even better!

It is important to understand that weight loss, in general, results in only a shrinkage of fat cells -- the cells themselves remain.  Liposuction physically removes the fat cells from the body.  Therefore, if lipo is done on someone who still has some weight, we will be removing "plump" fat cells.  If lipo is done on a thinner person, then we are removing "thinner" fat cells.  But fat cells are removed in either case -- and they do not grow back!

Extremely overweight individuals are never good candidates for the standard lipo and excision -- they tend to be disappointed with the results because they didn't end up with what they envisioned:  a taut bodybuilder's chest, albeit on top of a large, fat body.

Bottom line:  each case is individual and the patient should discuss all possibilities with the surgeon in order to gauge potential results.  And just as each patient is different, each surgeon, too, will have his own unique and individual approach to the surgical treatment of gynecomastia.  What counts is the end result -- not the road by which the result was achieved.

Dr Jacobs

[Needsomeadvice]

I have a different take on weight loss prior to surgery.  First, surgery is better and safer if you are at a comfortable weight for yourself.  If a patient plans to lose lots of weight, then certainly it is better to take it off prior to surgery.

On the other hand, there are many men who have problems losing weight because their gyne is an embarrassment for them at the gym, pool, etc.  It then becomes a Catch-22 situation:  lose weight to get better surgery results but you need the surgery to feel comfortable to go to the gym to lose weight.  What to do?

I take a graduated approach with my patients.  If they are in reasonable shape, albeit a few pounds overweight, then I will perform the surgery, which always involves liposuction and frequently involves gland excision.  The goal of surgery is to provide a trim and contoured chest which is consistent with the general frame of the patient.  I will generally look at the pinch of skin/fat just under the collarbone and attempt to provide that same pinch all the way down the chest -- down to the lower ribs.  In a very thin patient, the pinch will be thin.  In a patient who is overweight (ie BMI up to around 30 or so), I will leave a slightly thicker pinch.  Then, once the gyne is removed (I call it an "excuse-ectomy"), the patient becomes more motivated to exercise, watch their diet and lose weight -- and their chest will get even better!

It is important to understand that weight loss, in general, results in only a shrinkage of fat cells -- the cells themselves remain.  Liposuction physically removes the fat cells from the body.  Therefore, if lipo is done on someone who still has some weight, we will be removing "plump" fat cells.  If lipo is done on a thinner person, then we are removing "thinner" fat cells.  But fat cells are removed in either case -- and they do not grow back!

Extremely overweight individuals are never good candidates for the standard lipo and excision -- they tend to be disappointed with the results because they didn't end up with what they envisioned:  a taut bodybuilder's chest, albeit on top of a large, fat body.

Bottom line:  each case is individual and the patient should discuss all possibilities with the surgeon in order to gauge potential results.  And just as each patient is different, each surgeon, too, will have his own unique and individual approach to the surgical treatment of gynecomastia.  What counts is the end result -- not the road by which the result was achieved.

Dr Jacobs

Thank you for your excellent explanation.

The exact same number of fat cells are being removed from the body if you weight is 200 Lbs or 150 lbs. Simple the fat cells are slightly larger in one case. 

It seem to me that your normal weight is about 200 Lbs, then you should have the surgery done at 200 lbs because your results would be consistent.

but if you lost a ton of weight just for the surgery and the surgeon left some fat behind and so your chest would look good at your current the 150 weight, but then since you could not sustain the 150 weight and went back to 200. Your may have the gyno back?

Do all surgeons leave a layer of fat behind( I think Dr. Bermant said he does) or do some surgeons try to get it all removed?

Thanks

[Dr. Elliot Jacobs]

It is imperative for a surgeon to leave a layer of fat -- it provides a glide-plane for the skin to move over the underlying muscle.  If too much fat is removed, then the under-layer of the skin can adhere to the muscle beneath and create a dimple or, at worse, skin distortion, upon movement of the arms or chest.

It is also important that a surgeon leave a layer of fat which is consistent with the surrounding frame of the patient.  Take too much and the entire chest will look sunken and take not enough and there appears to be residual gyne.  That is the "art" of doing this operation -- and that is why going to an experienced surgeon is so very important.  Trying to correct  or revise a prior operation is always more difficult and less predictable (and more costly in the long run) -- and sometimes the results of the second procedure may be less than optimal.

Best advice:  choose your surgeon wisely.  This is an elective operation -- not life or death.  So take your time and don't rush, visit several surgeons if possible, and make your choice of surgeon as carefully as possible.  And while price is important, it should not be the only deciding factor.  Remember, the results of your surgery will be with you for the rest of your life -- long after the fee is forgotten.

Dr Jacobs

[DrBermant]

There is a recent post by a man who had surgery (excision only) last year. This was followed by weight loss and he now is looking into the possibility of Lipo to refine the contour of the breast area.

If he had lost the weight first, there would be no need for a second procedure.

To get the best result from your surgery, you need to present yourself for surgery in good condition.

Hi.

Thank you for the reply and Dr Bermant as well.

In both your examples the assumption was made that it would be a gland removal only and the fat portion of the gyno was to be taken care of with weight loss afterward( which may not come off that area as we would like correct) ?

I am referring to an operating that you get both LIPO and gland removal with being slightly overweight.

If all the fat were removed and gland removed while being slightly overweight, is there something negative that would happen if weight loss happened after the surgery? 

What would be the max weight you would suggest for someone 5'11 and 29 years old.

Thanks

Plastic Surgery is not an alternative to losing weight.  I do offer compromise surgery for the overweight individual who does not plan to lose the weight or prefers to gamble.  The chest is contoured to about the same pinch test as the general body fat.  This thicker layer of global fat still hides muscle definition.  For such patients, the breast look smaller after surgery, but the remaining fat tends to obscure the muscle contours.

Men tend to put fat on first the abdomen and chest.  The abdomen and chest are the last areas to lose the fat.  Therefore, doing the surgery to "jump start" the process is a gamble.  If with further weight loss, chest fat does not go down as much as other areas, it may look like the gynecomastia has "returned."  However, this is just the normal way men lose weight.  If it is massive weight loss and the nipples need to be elevated, further weight loss can result in loose skin again and drooping nipples that ruins the look.

I have seen so many disasters from other doctors' early jump into the operating room.  I have also seen patients who have gambled and got away with it.  Even if a doctor was willing to offer free revisions, free anesthesia, free operating room costs, free travel, lodging, and paid time off of work, a second operation is still a second operation.

For those eager for an "instant" chest contour improvement, a Body Contouring Garment is one compromise that requires no surgery and no gamble.  Many patients have told me that they used the garments for emotional support while they were finishing their weight loss program or stabilizing their gynecomastia growth problem.

The exact same number of fat cells are being removed from the body if you weight is 200 Lbs or 150 lbs. Simple the fat cells are slightly larger in one case. 

It seem to me that your normal weight is about 200 Lbs, then you should have the surgery done at 200 lbs because your results would be consistent.

but if you lost a ton of weight just for the surgery and the surgeon left some fat behind and so your check would look good at your current the 150 weight, but then since you could not sustain the 150 weight and went back to 200. Your may have the gyno back?

Do all surgeons leave a layer of fat behind( I think Dr. Bermant said he does) or do some surgeons try to get it all removed?

Thanks

A layer of fat is critical to the chest in motion.  Removing all of the fat between the skin and underlying fascia looks just terrible, especially when moving like playing basketball, volley ball, or swimming.

Yes, I have seen patients from other doctors who put on weight after surgery and had breasts as big as their before surgery images.

Getting to a weight that a someone is comfortable with before surgery is what I suggest to my patients.  Losing weight to something they do not plan to maintain makes no sense.  Since fat cells remain behind, each individual cell can still put back on more fat.  That extra fat will make the belly and breasts and other global areas big again.

Hope this helps,

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

[Grandpa Bambu]

Remember, the results of your surgery will be with you for the rest of your life -- long after the fee is forgotten.

Very true doc! 

GB