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

[Needsomeadvice]

  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. or such patients, the breast look smaller after surgery, but the remaining fat tends to obscure the muscle contours.

So are you saying that your chest will look like a smaller version of what was there before? Like a reduction of your previous gynecomastia rather than a flat chest ? So if the procedure was done at 170 Lbs instead of 200 Lbs, the chest would look flatter with muscle defination after surgery?
However,at a weight of 200 lbs after surgery will have " obscure muscle contours" and smaller breast ( slight remaining gynecomastia)
but 170 lbs after surgery will have muscle definition which is the look that men are trying to accomplish with this procedure? 

Please let me know if I am understanding this correctly?

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."

When you refer to a surgery to " jump start", are you talking about intentionally leaving more fat in the chest area in anticipation of the person losing this fat after more weight loss?  Is this correct? ( In other words, do you remove more fat cells for a 170 lbs person than you would for a 200 lbs person? )

However if weight loss results in losing fat in all surrounding area except the breast area, then they would appear that you have gyno simple because of the surrounding area decreasing in size while the fat left behind in the breast would stay the same.

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.

Is this in reference to an extreme case of gynecomastia or extreme weight loss( 350 lbs to 200 lbs)  which requires the nipple elevated? This would not apply in a minor case of gynecomastia right and slightly overweight(200 lbs)? 

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.

I understand that if you remove 80% of the fat, that the remaining 20% of the fat cells can swell up like a balloon causing more gynecomastia. Would this not be all the more reason to remove as much fat as possible at any weight( while maintenance the absolute minimum layer of fat required ?) 



What I am really confused about is that if you have eliminated gynecomastia in a 200 lbs individual, then it should not return if that individual loses weight from there unless too much fat was left behind on purpose?


Why would you have fat that obscure the muscle contours and small breast( reduced gynecomastia) if you have the surgery done at 200 Lbs however if it is done at 170 then you will appear to have the muscle contours unless more fat was purposely left on a 200 LBS individual than a 170 individual in anticipation of possible weight loss?

If this is indeed the case, why not simple remove as much fat as possible to ensure the gyecomastia is gone at any weight or regardless of the person fluctuating in weight?  What would be the downside? (All while maintaining the absolutely  minimum layer of fat of course.)

1. This way if moderate weight gain occurred, enough fat was removed so the gynecomastia would not return.
2. If massive weight loss occurred, the weight loss in the surrounding areas would not cause the appearance of the " gyno returning" because of the proportion of surrounding weight loss.

The chest is contoured to about the same pinch test as the general body fat.

You are only removing fat in a ratio determined by a " pinch test" rather than removing the mass which is causing the gynecomastia?
So the more a person weights, the more fat that you would leave in the chest?

Please let me know if I understand what you are saying correctly or the logic behind leaving more fat behind on a person weighing 200 vs someone weighing 170 lbs and not striving to remove as much fat from the chest as can reasonable be done?

I want to make sure I completely understand this and that I can avoid having remaining gynecomastia or requiring a second operation.

Thanks for your help.   

[Banobo]

Alright man, I'm no pro but i think it's normal to keep an amount of fat in the chest area which is in keeping with the rest of the body. I'm sure the procedure would still involve removing gland if there was any presant but it would look strange being over weight but with a flat pan chest or have a very thin skinned and contoured pectoral area while the rest of the body didn't suit. Might make it look obvious surgery had been done!

30lbs Can be shed in a relatively short time scale with a strict diet and some moderate exercise. It would be so worth it!

[Needsomeadvice]

Several years ago, I weighted 200 before and my chest was flat. I have lost weight and weighed 170 and had my chest was still flat. 

 I have been both weights and had a normally looking chest for my entire life up until a few maybe 3 years ago.

So that is why I am having trouble understand why a doctor would say that losing weight after gynecomastia surgery would cause it to return( because he is unable or unwilling to remove the offending gynecomastia fat tissue)

Is it because lipo takes time and they are trying to finish up each operation as quick as possible and does not care if the person has to come back for a follow up procedure?

I read that most people are unhappy with the results and have to do follow up procedures.

Why are so many men left with substandard results from gynecomastia surgery?

Is there a twisted logic where a doctor feels that breast look good on Men?

My chest has always been flat regardless if I was 170 or 200 lbs, why would this be something so difficult to obtain again?

If you have developed a mass in your chest creating gynecomastia, why can't that mass simple be removed.

Lets call the gynecomastia = gland + 50,000 fat cells.

If you weight 150 Ibs, you still have gland + 50,000 fat cells

If you weight 170 Lbs, you still have gland + 50,000 fat cells

If you weight 200 lbs, you still have gland + 50,000 fat cells

If you weight 220, you still have gland + 50,000 fat cells.


Why can't a doctor just remove the gland + 50,000 fat cells so whatever weight you happen to be at(within reason), you will not have gynecomastia. 

The chest is contoured to about the same pinch test as the general body fat.

So  this is saying that depending on how much an individual is overweight, the more female like breast you are going to leave you patience with?

Can someone request that they actually have a male looking chest regardless of if your weight is 170 or 200 ?

 This is not one of your transgenders cases. People suffering from gynecomastia do not think that having breast in relation to general body fat(like a women) is something which looks natural. We want to have a flat chest like a man( not look like a transgenders case)

I don't want to have female-type breast size in ratio to my BMI index, I want to have a male looking flat chest if I have a surgery done at 200 lbs, and I want to have a male looking chest if I get down to 170.
( which is how it has worked for me for almost my entire life until recently)  

Does this make sense to anyone here here?

 Is anyone else confused as to why a doctor would leave behind breast tissue in relation to body fat. I thought the idea was to remove the gynecomastia and return to a male chest ( not have breast in proportion to your body weight like a women)

Please help me to understand how this works or if I misunderstand what you are saying( sorry my English is not the best).

[DrBermant]

Several years ago, I weighted 200 before and my chest was flat. I have lost weight and weighed 170 and had my chest was still flat. 

 I have been both weights and had a normally looking chest for my entire life up until a few maybe 3 years ago.

So that is why I am having trouble understand why a doctor would say that losing weight after gynecomastia surgery would cause it to return( because he is unable or unwilling to remove the offending gynecomastia fat tissue)

Is it because lipo takes time and they are trying to finish up each operation as quick as possible and does not care if the person has to come back for a follow up procedure?

I read that most people are unhappy with the results and have to do follow up procedures.

Why are so many men left with substandard results from gynecomastia surgery?

Is there a twisted logic where a doctor feels that breast look good on Men?

My chest has always been flat regardless if I was 170 or 200 lbs, why would this be something so difficult to obtain again?

If you have developed a mass in your chest creating gynecomastia, why can't that mass simple be removed.

Lets call the gynecomastia = gland + 50,000 fat cells.

If you weight 150 Ibs, you still have gland + 50,000 fat cells

If you weight 170 Lbs, you still have gland + 50,000 fat cells

If you weight 200 lbs, you still have gland + 50,000 fat cells

If you weight 220, you still have gland + 50,000 fat cells.


Why can't a doctor just remove the gland + 50,000 fat cells so whatever weight you happen to be at(within reason), you will not have gynecomastia. 

The chest is contoured to about the same pinch test as the general body fat.

So  this is saying that depending on how much an individual is overweight, the more female like breast you are going to leave you patience with?

Can someone request that they actually have a male looking chest regardless of if your weight is 170 or 200 ?

 This is not one of your transgenders cases. People suffering from gynecomastia do not think that having breast in relation to general body fat(like a women) is something which looks natural. We want to have a flat chest like a man( not look like a transgenders case)

I don't want to have female-type breast size in ratio to my BMI index, I want to have a male looking flat chest if I have a surgery done at 200 lbs, and I want to have a male looking chest if I get down to 170.
( which is how it has worked for me for almost my entire life until recently)  

Does this make sense to anyone here here?

 Is anyone else confused as to why a doctor would leave behind breast tissue in relation to body fat. I thought the idea was to remove the gynecomastia and return to a male chest ( not have breast in proportion to your body weight like a women)

Please help me to understand how this works or if I misunderstand what you are saying( sorry my English is not the best).

No, in my opinion breasts do not look good on men.  Obese men have enlarged breasts and bands of fat extending around the belly and chest.  However, 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. 

We are glad to help patients explore such issues in greater detail during consultations where, after learning more information and specifics, issues can be discussed.  Without the doctor having a complete picture, the wrong advice may be given.

If interested, Jane is my office manager.  She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.

Hope this helps,

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

[Needsomeadvice]

  Obese men have enlarged breasts and bands of fat extending around the belly and chest.

I do not have bands of fat extending around my chest. My skin is touching my rip cage and my gynecomastia sticks out from my chest like a sour thumb.

   Reducing the chest fat beyond the global fat also looks terribly distorted.

1. Is this because you are assuming that there are bands of fat around my chest? So you think that removing too much fat will cause mountains of global fat surrounding the breast area causing a gully on the breast area? ( I do not have these bands of fat you speak of, just gynecomastia really sticking out from my chest. All around my chest, my skin is touching my rip cage except for the gynecomastia)

2. You are also saying that someone who is 200 lbs is expected to have breast? ( I have been over 200 lbs in the past and my chest was flat which looked great and natural. Nothing was distorted, people usually think that I weigh a lot less than I actually do from my appearance.)

  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.

So the " compromise" is that you will do the surgery at the current weight however you will only make the breast smaller( instead of removing it)

Is that right?

The fact remains that you will leave more fat cells in a person who weights more than you would with a person who weights less correct? What situation would you remove the most number of fat cells from a person?

Let me ask you another question.

In a case of gynecomastia where a person

1. Has a minor case of gynecomastia
2. Is slightly overweight however
3. Does not have these rolls of fat around the chest( as you seem to be expecting)

Would you be able to remove the necessary gland and fat tissue instead of doing a " compromise surgery" which only reduces the breast?